The implementation of remote home monitoring models during the COVID-19 pandemic in England

Abstract

ObjectiveThere is a paucity of evidence for the implementation of remote home monitoring for COVID-19 infection. The aims of this study were to: identify the key characteristics of remote home monitoring models for COVID-19 infection, explore the experiences of staff implementing these models, understand the use of data for monitoring progress against outcomes, and document variability in staffing and resource allocation.MethodsThis was a multi-site mixed methods study that combined qualitative and quantitative approaches to analyse the implementation and impact of remote home monitoring models during the first wave of the COVID-19 pandemic (March to August 2020). The study combined interviews (n=22) with staff delivering these models across eight sites in England with the collection and analysis of data on staffing models and resource allocation.ResultsThe models varied in relation to the healthcare settings and mechanisms used for patient triage, monitoring and escalation. Implementation was embedded in existing staff workloads and budgets. Good communication within clinical teams, culturally-appropriate information for patients/carers and the combination of multiple approaches for patient monitoring (app and paper-based) were considered facilitators in implementation. The mean cost per monitored patient varied from £400 to £553, depending on the model.ConclusionsIt is necessary to provide the means for evaluating the effectiveness of these models, for example, by establishing comparator data. Future research should also focus on the sustainability of the models and patient experience (considering the extent to which some of the models exacerbate existing inequalities in access to care).STRENGTHS AND LIMITATIONS OF THE STUDYThe study makes a contribution to existing evidence on remote home monitoring models by exploring the design and implementation of these models for confirmed or suspected COVID-19 cases.The study was carried out across eight remote home monitoring models implemented in England, capturing variability in the mechanisms used for triage, monitoring and escalation.Limited evidence was available to assess the effectiveness of the remote home monitoring models.No comparator data were available for the absence of remote home monitoring.The study was designed as a rapid evaluation and only captured experiences and processes of implementation in a convenience sample of eight models implemented during the first wave of the pandemic in England.

Remote management of covid-19 using home pulse oximetry and virtual ward support

“…Various kinds of remote monitoring services in England were established rapidly and pragmatically in early 2020. 43 They were run from primary or secondary care: patients were referred to them from primary care, emergency departments, or post-discharge from hospital. The services supported patients in their own homes and also in care homes.…”

“…We based the advice on extensive clinical experience, especially MK's role overseeing a large virtual ward for covid-19 patients, which has been formally evaluated. 44 We summarised and updated some rapid systematic reviews undertaken by TG, MIK, and MK and their teams early in the pandemic, 23 47 48 and also drew on a new systematic review 42 and empirical evaluation of virtual wards 43 undertaken by NJF and CV's team more recently. In addition, we refer to national guidance 19 and an educational video developed for patients (box 4) which MIK had been involved in writing for NHS England.…”

“…Low technology approaches to monitoring (phone and paper) tended to achieve lower data capture than electronic ones (apps, web portals, or wearable sensors) but also appeared to be more inclusive. Reassuringly, of 1737 patients referred for virtual ward care across six UK centres, only 20 deaths occurred (1.1%) 4344…”

“…The goal of supported home monitoring seems achievable based on a range of different models, and a number of critical success factors have been identified (box 2). 4243…”

“…Home oximetry and virtual ward support could potentially save many lives by enabling patients requiring hospitalisation to be identified earlier, while also conserving hospital beds and reducing the risk of nosocomial infection. As the evidence base for the efficacy, safety, and acceptability of such models is now accumulating,3334424344 some unanswered questions remain, for which further research is needed, including the impact of home monitoring on patient outcomes (box 3).…”