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Mayo Clinic Proceedings ; 2022.
Article in English | ScienceDirect | ID: covidwho-2007936

ABSTRACT

Objective To evaluate care utilization, cost, and mortality among high-risk patients enrolled in a COVID-19 Remote Patient Monitoring (RPM) program. Methods This retrospective analysis included patients diagnosed with COVID-19 at risk for severe disease who enrolled in the RPM program between March 2020 - October 2021. The program included in-home technology for symptom and physiologic data monitoring with centralized care management. Propensity score matching established matched cohorts of RPM-engaged (defined as ≥1 RPM technology interactions) and non-engaged patients using a logistic regression model of 59 baseline characteristics. Billing codes and the electronic death certificate system were utilized for data ion from the EHR and reporting of care utilization and mortality endpoints. Results Among 5,796 RPM-enrolled patients, 80.0% engaged with the technology. Following matching, 1,128 pairs of RPM engaged and non-engaged patients comprised the analysis cohorts. Mean patient age was 63.3 years, 50.9% of patients were female sex, and 81.9% were non-Hispanic, white. RPM-engaged patients experienced significantly lower rates of 30-day, all-cause hospitalization (13.7% vs 18.0%, P=.01), prolonged hospitalization (3.5% vs 6.7%, P=.001), ICU admission (2.3% vs. 4.2%, P=.01), and mortality [0.5% vs. 1.7%, OR 0.31 (0.12, 0.78), P=.01], as well as cost of care ($2,306.33 USD vs $3,565.97 USD, P=0.04), than those enrolled in RPM but non-engaged. Conclusions High-risk, COVID-19 patients enrolled and engaged in an RPM program experienced lower rates of hospitalization, ICU admission, mortality, and cost than those enrolled and non-engaged. These findings translate to improved hospital bed access and patient outcomes.

2.
JMIR Formative Research ; 6(5), 2022.
Article in English | ProQuest Central | ID: covidwho-1871737

ABSTRACT

Background: During the COVID-19 pandemic, to prevent the spread of the virus, federal regulatory barriers around telemedicine were lifted, and health care institutions encouraged patients to use telemedicine, including video appointments. Many patients, however, still chose face-2-face (f2f) appointments for nonemergent clinical care. Objective: We explored patients’ personal and environmental barriers to the use of video appointments from April 2020 to December 2020. Methods: We conducted qualitative telephone interviews of Mayo Clinic patients who attended f2f appointments at the Mayo Clinic from April 2020 to December 2020 but did not utilize Mayo Clinic video appointment services during that time frame. Results: We found that, although most patients were concerned about preventing COVID-19 transmission, they trusted Mayo Clinic to keep them safe when attending f2f appointments. Many expressed that a video appointment made it difficult to establish rapport with their providers. Other common barriers to video appointments were perceived therapeutic benefits of f2f appointments, low digital literacy, and concerns about privacy and security. Conclusions: Our study provides an in-depth investigation into barriers to engaging in video appointments for nonemergent clinical care in the context of the COVID-19 pandemic. Our findings corroborate many barriers prevalent in the prepandemic literature and suggest that rapport barriers need to be analyzed and problem-solved at a granular level.

3.
NPJ Digit Med ; 4(1): 123, 2021 Aug 13.
Article in English | MEDLINE | ID: covidwho-1356587

ABSTRACT

Established technology, operational infrastructure, and nursing resources were leveraged to develop a remote patient monitoring (RPM) program for ambulatory management of patients with COVID-19. The program included two care-delivery models with different monitoring capabilities supporting variable levels of patient risk for severe illness. The primary objective of this study was to determine the feasibility and safety of a multisite RPM program for management of acute COVID-19 illness. We report an evaluation of 7074 patients served by the program across 41 US states. Among all patients, the RPM technology engagement rate was 78.9%. Rates of emergency department visit and hospitalization within 30 days of enrollment were 11.4% and 9.4%, respectively, and the 30-day mortality rate was 0.4%. A multisite RPM program for management of acute COVID-19 illness is feasible, safe, and associated with a low mortality rate. Further research and expansion of RPM programs for ambulatory management of other acute illnesses are warranted.

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