Cost Evaluation of COVID-19 Remote Home Monitoring Services' Patients in England during Wave 2 from October 2020-April 2021

Objectives: During the COVID-19 pandemic, the NHS delivered a community-based remote home monitoring service for COVID-19 patients. The service came in two models characterised based on the referral method: home-based care to ensure the right people were admitted at hospital at the right time (named COVID Oximetry @ home (CO@h)) and facilitation of patients' transition when discharged home (named Covid-19 Virtual Ward (CVW)). Patients were provided with pulse oximeters and asked to regularly record and submit oxygen levels and other symptoms to a team of administrators and clinicians via digital means (tech-enable and analogue mode) and/or over the phone (analogue). Our aim was to evaluate the costs of implementing these services in England during wave 2 of the pandemic (October 2020-April 2021). Method(s): We used a top-down approach to describe the costs of setting-up and running the service. 26 sites reported the number of patients and staff members involved in the service, and other used resources. Descriptive statistics and multivariate regression analysis were used appropriately. Result(s): The mean cost per patient monitored was lower in the CO@h service compared to the CVW (527.5 vs. 599.1). The corresponding cost was lower for sites using tech-enabled and analogue data submission mode compared to sites using analogue-only mode for both CO@h (515 vs. 561) and CVW (584 vs. 612) services. The number of patients enrolled in the service and the service type significantly affected the mean cost per patient (b=0.62, p= 0.001;b=-457.99, p=0.05 correspondingly). Conclusion(s): Our analysis offers a model for future research since it covers sites of various sizes and raises questions about different practices within the overall remote monitoring services.Copyright © 2023

Covid-19 Vaccination Impact on Atrial Arrhythmias - Real-World Evidence from the Certitude Registry

Background: The COVID-19 vaccines were developed unprecedentedly and have proven safe and efficacious in reducing transmissibility and severe infection. The impact of mRNA-based COVID-19 vaccines on atrial arrhythmias (AA) incidence is unknown. Objective(s): To analyze the incidence of AA after COVID-19 vaccination in patients with a cardiac implantable electronic device (CIED). Method(s): BIOTRONIK Home Monitoring data and Medicare claims data from CERTITUDE patients implanted with a CIED between 2010-20 were utilized to identify recipients of one or more doses of the COVID-19 vaccine in 2021. Those who had influenza vaccination in 2020 were also identified in the same cohort as a control. From remote monitoring data, the number of atrial high rate events (AHR) and % burden of AA in the three months post-vaccination was compared to the preceding three months using Wilcoxon signed rank test. Kruskal-Wallis test was used for group difference comparisons. New AF diagnosis was determined from ICD-10 diagnosis codes in Medicare claims. Result(s): First and 2nd doses of COVID vaccine (50% Pfizer, 47% Moderna, and 3% J&J) were administered to 7757 and 6579 individuals with a CIED (age 76.2 (+/-9.0) y, 49% males), respectively. In the same cohort, 4723 (61%) individuals received the influenza vaccine. A statistically significant increase in the number of AHR episodes and % burden of AA was noted in the three months post-vaccination compared to the preceding three months after the 1st and 2nd doses of the COVID-19 vaccine (Figure). No such association was noted following influenza vaccination. In subgroup analysis, AHR episodes increased significantly in age groups >70 and men. Post-vaccination increase in AHR episodes was more significant in those without a pre-vaccination history of AHR episodes (mean increase of AHR 6.9+/-88.4, p<0.001) and was non-significant in those with a preceding history of AHR (p=0.8). Among the 764 patients with no AF diagnosis in claims preceding the first COVID-19 vaccine, 87 (11.4%) developed a new AF diagnosis or AHR event in the first three months post-vaccination. Conclusion(s): We report a small but significant increase in the number of CIED-detected atrial arrhythmias following vaccination for COVID-19 but not influenza, specifically in men and age >70 years. Acknowledging the immense public health benefit of COVID-19 vaccines, our results should prompt increased awareness of evaluating for AF in this high-risk group following vaccination. [Formula presented]Copyright © 2023

Feasibility of telehealth spirometry for people with cystic fibrosis

Background: Telemedicine has flourished during the COVID-19 pandemic. There is increasing interest in performing spirometry at home as part of a telehealth program, especially in cystic fibrosis (CF), to follow the course of the disease, but it is unclear whether the quality and accuracy of home spirometry are comparable with those of in-clinic spirometry [1-3]. This study aimed to evaluate the feasibility and measurement quality of telehealth spirometry assessments for people with CF. Method(s): Patientswith acceptable hardware at homewere provided with a flow sensor portable spirometer (Spirobank Smart) compatible with ATS/ ERS 2019 standards for volume accuracy. They performed spirometry during "home admissions" or ongoing home monitoring for 1 year during the COVID-19 pandemic (January 2021 to January 2022). At the end of each session, the family forwarded the data to the CF center. Result(s): Twenty-nine people were evaluated (median age 17.4, range 6.7- 34;58% female;mean baseline percentage predicted forced expiratory volume in 1 second 79.8 +/- 21.4%). According to American Thoracic Society/ European Respiratory Society criteria, spirometry was performed successfully in 320 of 430 (74.5%) attempted sessions. The median distance between the subject's home and the hospital was 124 km (range 49- 418 km)-a median travel time saving of 1.5 hours per hospital visit. Conclusion(s): Home-based telehealth spirometry is feasible in people with CF and can support the CF team in ongoing outpatient monitoring.Copyright © 2022, European Cystic Fibrosis Society. All rights reserved

Effectiveness and Medicoeconomic Evaluation of Home Monitoring of Patients With Mild COVID-19: Covidom Cohort Study.

BACKGROUND: Covidom was a telemonitoring solution for home monitoring of patients with mild to moderate COVID-19, deployed in March 2020 in the Greater Paris area in France to alleviate the burden on the health care system. The Covidom solution included a free mobile application with daily monitoring questionnaires and a regional control center to quickly handle patient alerts, including dispatching emergency medical services when necessary. OBJECTIVE: This study aimed to provide an overall evaluation of the Covidom solution 18 months after its inception in terms of effectiveness, safety, and cost. METHODS: Our primary outcome was to measure effectiveness using the number of handled alerts, response escalation, and patient-reported medical contacts outside of Covidom. Then, we analyzed the safety of Covidom by assessing its ability to detect clinical worsening, defined as hospitalization or death, and the number of patients with clinical worsening without any preceding alert. We evaluated the cost of Covidom and compared the cost of hospitalization for Covidom and non-Covidom patients with mild COVID-19 cases seen in the emergency departments of the largest network of hospitals in the Greater Paris area (Assistance Publique-Hôpitaux de Paris). Finally, we reported on user satisfaction. RESULTS: Of the 60,073 patients monitored by Covidom, the regional control center handled 285,496 alerts and dispatched emergency medical services 518 times. Of the 13,204 respondents who responded to either of the follow-up questionnaires, 65.8% (n=8690) reported having sought medical care outside the Covidom solution during their monitoring period. Of the 947 patients who experienced clinical worsening while adhering to daily monitoring, only 35 (3.7%) did not previously trigger alerts (35 were hospitalized, including 1 who died). The average cost of Covidom was €54 (US $1=€0.8614) per patient, and the cost of hospitalization for COVID-19 worsening was significantly lower in Covidom than in non-Covidom patients with mild COVID-19 cases seen in the emergency departments of Assistance Publique-Hôpitaux de Paris. The patients who responded to the satisfaction questionnaire had a median rating of 9 (out of 10) for the likelihood of recommending Covidom. CONCLUSIONS: Covidom may have contributed to alleviating the pressure on the health care system in the initial months of the pandemic, although its impact was lower than anticipated, with a substantial number of patients having consulted outside of Covidom. Covidom seems to be safe for home monitoring of patients with mild to moderate COVID-19.

The effectiveness of a telemedical program for COVID-19 positive high-risk patients in domestic isolation

Background: For almost two years, the Covid-19 pandemic has posed an enormous challenge to healthcare systems. Recurrent waves of disease brought the health systems to the limit of their resilience. Purpose(s): The Tele-Covid telemedicine care program was installed in December 2020 to monitor high-risk patients in home isolation. Close monitoring allows early detection of disease deterioration and timely intensification of therapy, ideally avoiding intensive care. Conversely, if the course of the disease is stable, unnecessary hospitalisation can be avoided, thus reducing the burden on the healthcare system. Method(s): Patient acquisition was performed in collaboration with the local public health service and primary care physicians. Covid-19 positive highrisk patients (age >65 years and/or severe comorbidities) from the greater Innsbruck area were fitted with an ear sensor-based home monitoring system. The ear sensor measures SpO2, respiratory rate, body temperature and heart rate. The monitoring team (25 medical students supervised by 6 physicians) provided continuous monitoring of vital signs (24/7). After validation of the measurements, the collected parameters were evaluated using a specially developed risk score. If a defined risk score was exceeded, the patient was contacted by telephone. The combination of the clinical condition and the risk score determined the further course of action: (a) wait and see, (b) notify the primary care physician, or (c) refer for inpatient admission. The program was active from December 2020 to March 2022. In Summer 2021, the program was temporarily paused due to the epidemiological situation. Result(s): A total of 132 patients (59.8% women) were monitored. The median age was 74 years (IQR: [67.3-80.8]). 91 patients (68.9%) had at least one relevant comorbidity. During the monitoring period, hospitalisation was required in 20 patients (15.2%), 3 of whom were transferred to the intensive care unit. Of the hospitalised patients, 3 (15%) patients died. During the same monitoring period, the Austrian Ministry of Health reported a mortality rate of 20.5% of all hospitalised patients in Austria aged 70-79 years. Subjectively, the patients felt safe due to close monitoring. Conclusion(s): The Tele-Covid program is the successful implementation of a remote monitoring system in a pandemic situation. In the future, a broad application of the program is feasible.

Getting to knowledge-enhanced health and healthcare

In this chapter, we describe advances in technology capabilities and in the healthcare ecosystem that are driving breakthrough innovations in clinical decision support (CDS). New and enhanced capabilities include the rise of precision medicine, patient/user engagement, aggregation of data for population health, onset of an "app culture,” artificial intelligence, and interoperability and standards development and adoption. Advances in healthcare delivery include new demands, stimuli, and incentives for CDS brought about by the factors such as broad adoption of electronic health record (EHR) systems, national programs such as the US Meaningful Use EHR certification, value-driven healthcare delivery and financing models, quality monitoring and reporting, as well as remarkable sociotechnical shifts during the COVID-19 pandemic. This chapter discusses the impact of these changes on the CDS landscape along with unique possibilities for CDS moving forward. © 2023 Elsevier Inc. All rights reserved.

Using digital technology for home monitoring in children and adolescents with cystic fibrosis

Introduction: Cystic Fibrosis (CF) centers globally increased the number of telehealth clinics during the Covid-19 pandemic and developed processes utilizing telemedicine to replace a standard clinic visit. Whether these new approaches provide an opportunity to improve patients' clinical condition need further investigations. Aims and objectives: To assess the short-term clinical impact of using the NuvoAir Home platform to monitor children and adolescents with CF at home for six months as part of a virtual model of care. Method(s): The NuvoAir Home platform consists of a smartphone application, Bluetooth spirometer and clinician portal. Patients and/or parents were trained to use the platform and asked to do home spirometry monthly. Cystic Fibrosis Questionnaire-Revised (CFQ-R) was collected at the time of study entry and after six months. We calculated the percentage of change between "pre" and "post" conditions of the variables. Result(s): Sixteen children and adolescent CF patients from Federico II Hospital, Naples, Italy (9 females;mean age 16.3+/-0.9;5 homozygous for delta F508;FEV1 79.5+/-26.2 % predicted;FVC 91.6+/-23.6 % predicted;BMI 21.5+/-3.8) were recruited from June 2021. All patients had completed six months follow-up. CFQ-R revealed higher scores indicating a higher patient-reported quality of life with regard to "health perception" + 3%, "social limitations" + 11%, "digestive symptoms" + 6%. We observed a 2 % improvement from baseline in FEV1 % predicted. There was no difference in pulmonary exacerbation versus the previous year. No changes of medical treatment were reported during that time. Conclusion(s): Digital technology for home monitoring in children and adolescents with cystic fibrosis led to improved quality of life and lung function.

Evaluation of home monitoring for patients withinterstitial lung disease during the COVID-19 pandemic

Introduction: During the COVID-19 pandemic we used an online home monitoring app to ensure continuity of carefor patients with interstitial lung disease (ILD). Here we report on patient experiences with home monitoring in dailycare. Method(s): Patients with ILD across the Netherlands were given the option to use the home monitoring app ILD-onlinein daily care. ILD-online includes home spirometry, patient-reported outcomes, eContacts and videocontacts. Wedistributed a 15-item online survey to evaluate patient experiences. Outcomes were scored on visual analoguescales from 0-10. Result(s): 257 patients used ILD-online;116 completed the survey (78% male, mean age 72). The majority of patientsthought home monitoring was useful to get insights in their disease course (90%). More than half of patients (55%)felt safer during the pandemic and 45% visited the hospital less often due to home monitoring. Home spirometry wasconsidered easy to perform (mean score 7.2, SD 2.2) and not burdensome (mean 2.6, SD 3.0). Patients stated that itwas pleasant to see their own spirometry results (mean 8.6, SD 1.4). Overall satisfaction with the home monitoring app was high (mean 8.1, SD 1.3) and patients considered the app easy to use (mean 8.1, SD 1.5). 76% of patients would recommend home monitoring to others and 98% would want to continue using the app. Conclusion(s): The use of home monitoring with spirometry for ILD care is highly appreciated by patients and is not considered burdensome. In about half of patients, hospital visits were replaced by home monitoring. Home monitoring could enable frequent monitoring at a distance and replace face-to-face visits during and beyond the COVID-19 pandemic.

Feasibility of telehealth spirometry for patients with cystic fibrosis in a regional setting

Introduction: Telemedicine has flourished during the covid-19 pandemic. There is an increasing interest in performing spirometry at home, as part of a telehealth program, especially in cystic fibrosis (CF), to follow the course of the disease. However, it is unclear whether the results of home spirometry are comparable with the in-clinic performed spirometry in terms of quality and accuracy. Aim(s): To evaluate the feasibility and measurement quality of telehealth spirometry assessments for patients with CF living in a regional setting. Method(s): Patients with acceptable hardware at home were provided with a flow sensor portable spirometer (Spirobank Smart) compatible with ATS/ERS 2019 standards for volume accuracy. They performed spirometry during 'home admissions' or ongoing home monitoring for one year over the COVID-19 pandemic (January 2021 to January 2022). At the end of each session, the family forwarded the data to the CF Centre. Result(s): Twenty-nine patients with median age 17.4 years (6.7 to 34 years), 58% females were evaluated (mean baseline FEV1pp 79.8 (21.4). According to the American Thoracic Society/European Respiratory Society criteria, they performed successful spirometry in 320 of 430 (74.5%) attempted sessions. The median distance between the subject's home and the hospital was 124 km (range 49-418 km), equating to a median travel time saving of 1.5 hours per hospital visit. Conclusion(s): Home-based telehealth spirometry is feasible among patients with CF and can support the CF team for ongoing outpatient monitoring.

Retour d'expérience sur Covidom : une solution de télésurveillance pour les patients porteurs ou suspectés Covid-19

Covidom est une plateforme de télésurveillance destinée aux patients suspects ou atteints de Covid-19, ne nécessitant pas une hospitalisation au décours de leur prise en charge initiale. Cet outil a été coconstruit avec tous les acteurs du soin (ville, hôpital, institutions). Il se compose d'une application Web et d'un centre de télésurveillance permettant de surveiller à distance les patients atteints de Covid-19. Cette surveillance est faite à l'aide de brefs questionnaires quotidiens, autoadministrés et standardisés. Actuellement, plus de 60 000 patients ont achevé leur suivi dans Covidom. Covidom est une solution innovante permettant la surveillance à domicile des patients atteints d'une forme légère de Covid-19.Alternate : COVIDOM is a telemonitoring platform that has been designed for patients suspected or affected by COVID-19 and who do not require hospitalization. This tool has been co-constructed with all healthcare stakeholders (regional agencies, hospitals, and family physicians). It brings together a web application and a remote monitoring center for home monitoring of patients suffering from Covid-19. Monitoring is done via brief and standardized daily questionnaires. Currently, more than 60,000 patients have completed their follow-up in COVIDOM. COVIDOM is an innovative solution for home monitoring of patients with mild forms of COVID-19.

Visual fields in glaucoma: Where are we now?

Visual fields are an integral part of glaucoma diagnosis and management. COVID has heightened the awareness of the potential for viral spread with the practice of visual fields modified. Mask artefacts can occur due to fogging of the inferior rim of the trail lens. Fortunately, the risk of airborne transmission when field testing is low. The 24-2c may be useful to detect early disease and the 10-2 more sensitive to detect advanced loss. The SITA faster test algorithm is able to reduce testing time thereby improving clinic efficiency, however, may show milder results for moderate or severe glaucoma. The technician has an important role of supervising the visual field performance to achieve reliable output. Home monitoring can provide earlier detection of progression and thus improve monitoring of glaucoma as well as reduce the burden of in-clinic assessments. Artificial Intelligence has been found to have high sensitivity and specificity compared to expert observers in detecting field abnormalities and progression as well as integrating structure with function. Although these advances will improve efficiency and guide accuracy, there will remain a need for clinicians to interpret the results and instigate management.

Early Hospital Discharge on Day Two Post Robotic Lobectomy with Telehealth Home Monitoring: A Pilot Study.

Despite the adoption of enhanced recovery programs, the reported postoperative length of stay after robotic surgery is 4 days even in highly specialized centers. We report preliminary results of a pilot study for a new protocol of early discharge (on day 2) with telehealth home monitoring after robotic lobectomy for lung cancer. All patients with a caregiver were discharged on postoperative day 2 with a telemonitoring device if they satisfied specific discharge criteria. Teleconsultations were scheduled once in the afternoon of post-operative day 2, twice on postoperative day 3, and then once a day until the chest tube removal. Post-discharge vital signs were recorded by patients at least four times daily through the device and were available for consultation by two surgeons through phone application. In case of sudden variation of vital signs or occurrence of adverse events, a direct telephone line was available for patients as well as a protected re-hospitalization path. Primary outcome was the safety evaluated by the occurrence of post-discharge complications and readmissions. Secondary outcome was the evaluation of resources optimization (hospitalization days) maintaining the standard of care. During the study period, twelve patients satisfied all preoperative clinical criteria to be enrolled in our protocol. Two of twelve enrolled patients were successively excluded because they did not satisfy discharge criteria on postoperative day 2. During telehealth home monitoring a total of 27/427 vital-sign measurements violated the threshold in seven patients. Among the threshold violations, only 1 out of 27 was a critical violation and was managed at home. No postoperative complication occurred neither readmission was needed. A mean number of three hospitalization days was avoided and an estimated economic benefit of about EUR 500 for a single patient was obtained if compared with patients submitted to VATS lobectomy in the same period. These preliminary results confirm that adoption of telemonitoring allows, in selected patients, a safe discharge on postoperative day 2 after robotic surgery for early-stage NSCLC. A potential economic benefit could derive from this protocol if this data will be confirmed in larger sample.

Multimodal Remote Home Monitoring of Lung Transplant Recipients during COVID-19 Vaccinations: Usability Pilot Study of the COVIDA Desk Incorporating Wearable Devices.

Background and Objectives: Remote patient monitoring (RPM) of vital signs and symptoms for lung transplant recipients (LTRs) has become increasingly relevant in many situations. Nevertheless, RPM research integrating multisensory home monitoring in LTRs is scarce. We developed a novel multisensory home monitoring device and tested it in the context of COVID-19 vaccinations. We hypothesize that multisensory RPM and smartphone-based questionnaire feedback on signs and symptoms will be well accepted among LTRs. To assess the usability and acceptability of a remote monitoring system consisting of wearable devices, including home spirometry and a smartphone-based questionnaire application for symptom and vital sign monitoring using wearable devices, during the first and second SARS-CoV-2 vaccination. Materials and Methods: Observational usability pilot study for six weeks of home monitoring with the COVIDA Desk for LTRs. During the first week after the vaccination, intensive monitoring was performed by recording data on physical activity, spirometry, temperature, pulse oximetry and self-reported symptoms, signs and additional measurements. During the subsequent days, the number of monitoring assessments was reduced. LTRs reported on their perceptions of the usability of the monitoring device through a purpose-designed questionnaire. Results: Ten LTRs planning to receive the first COVID-19 vaccinations were recruited. For the intensive monitoring study phase, LTRs recorded symptoms, signs and additional measurements. The most frequent adverse events reported were local pain, fatigue, sleep disturbance and headache. The duration of these symptoms was 5-8 days post-vaccination. Adherence to the main monitoring devices was high. LTRs rated usability as high. The majority were willing to continue monitoring. Conclusions: The COVIDA Desk showed favorable technical performance and was well accepted by the LTRs during the vaccination phase of the pandemic. The feasibility of the RPM system deployment was proven by the rapid recruitment uptake, technical performance (i.e., low number of errors), favorable user experience questionnaires and detailed individual user feedback.

Hospital Days Reduced for Moderate and Severe COVID-19 Patients Through a Home Monitoring Program With Oxygen.

While the COVID-19 pandemic continues to strain the healthcare system, it has also expanded telemedicine. There is a subset of hospitalized moderate to severe COVID-19 patients requiring oxygen but no other intervention. This is a retrospective study of patients ≥18 years with moderate to severe COVID-19 that participated in a home monitoring program with supplemental oxygen (HMP-O2) (N = 25). For study outcomes, HMP-O2 participants were compared to patients meeting the same inclusion criteria but did not participate in the program (N = 60). On average, the HMP-O2 patients spent 5.8 days (±5.5 days) in the hospital compared to 8.12 days (±5.5 days) for non-program patients. This resulted in 19% cost-savings for HMP-O2 patients. Lessons learned from this program can be applied to future HMPs for either COVID-19 or other conditions that would benefit from telecare.

Machine learning-aided detection of heart failure (LVEF ≤ 49%) by using ballistocardiography and respiratory effort signals.

Purpose: Under the influence of COVID-19 and the in-hospital cost, the in-home detection of cardiovascular disease with smart sensing devices is becoming more popular recently. In the presence of the qualified signals, ballistocardiography (BCG) can not only reflect the cardiac mechanical movements, but also detect the HF in a non-contact manner. However, for the potential HF patients, the additional quality assessment with ECG-aided requires more procedures and brings the inconvenience to their in-home HF diagnosis. To enable the HF detection in many real applications, we proposed a machine learning-aided scheme for the HF detection in this paper, where the BCG signals recorded from the force sensor were employed without the heartbeat location, and the respiratory effort signals separated from force sensors provided more HF features due to the connection between the heart and the lung systems. Finally, the effectiveness of the proposed HF detection scheme was verified in comparative experiments. Methods: First, a piezoelectric sensor was used to record a signal sequences of the two-dimensional vital sign, which includes the BCG and the respiratory effort. Then, the linear and the non-linear features w.r.t. BCG and respiratory effort signals were extracted to serve the HF detection. Finally, the improved HF detection performance was verified through the LOO and the LOSO cross-validation settings with different machine learning classifiers. Results: The proposed machine learning-aided scheme achieved the robust performance in the HF detection by using 4 different classifiers, and yielded an accuracy of 94.97% and 87.00% in the LOO and the LOSO experiments, respectively. In addition, experimental results demonstrated that the designed respiratory and cardiopulmonary features are beneficial to the HF detection (LVEF ≤ 49 % ). Conclusion: This study proposed a machine learning-aided HF diagnostic scheme. Experimental results demonstrated that the proposed scheme can fully exploit the relationship between the heart and the lung systems to potentially improve the in-home HF detection performance by using both the BCG, the respiratory and the cardiopulmonary-related features.

Initial Experience with Telemedicine for Interstage Monitoring in Infants with Palliated Congenital Heart Disease.

Infants with staged surgical palliation for congenital heart disease are at high-risk for interstage morbidity and mortality; home monitoring programs have mitigated these risks. In 2019, we instituted telemedicine (TM) in our established Infant Single Ventricle Monitoring Program. All consecutive patients discharged following neonatal operation/intervention were monitored until subsequent stage 2 surgical palliation. We offered TM (synchronous video) visits as part of regularly scheduled follow-up, replacing at least one in-person primary care visit with a TM cardiologist visit. We tracked emergency department (ED) visits, hospitalizations, how TM identified clinical concerns, and whether use of TM prevented unnecessary ED visits or expedited in-person assessment. We assessed caregiver and clinician satisfaction. Between 8/2019 and 5/2020, we conducted 60 TM visits for 29 patients. Of 31 eligible patients, 2 families (6.9%) declined. Median monitoring time was 199 days (range 75-264) and median number of TM visits/patient was 2 (range 1-5). In 6 visits (10%), significant clinical findings were identified which avoided an ED visit. Five TM visits led to expedited outpatient assessments, of which 1 patient required hospitalization. There were no missed events or deaths. Median ED visits/patient/month were significantly lower compared to the same calendar period of the prior year (0.0 (0-2.5) vs. 0.4 (0-3.7), p = 0.0004). Caregivers and clinicians expressed high levels of satisfaction with TM. TM for this high-risk population is feasible and effective in identifying clinical concerns and preventing unnecessary ED visits. TM was particularly effective during the COVID-19 pandemic, allowing for easy adaptation of care to ensure patient safety in this fragile cohort.

Characteristics and outcomes of COVID-19 home monitoring in Saudi Arabia during the second and third waves.

Introduction: As severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) spread around the world, patient care was shifted to outpatient care and home monitoring. This paper describes the characteristics and outcomes of patients with coronavirus disease 2019 (COVID-19) treated at home during the second and third waves in Saudi Arabia. Materials and methods: Descriptive evaluation of the characteristics and outcome of COVID-19-positive cases enrolled in the home monitoring programme. Results: This study included 14,970 SARS-CoV-2-positive patients (52.6% male). The mean age was 30.8 [standard deviation (SD) 19.9] years. Among the confirmed cases, 14,234 had documented vaccination status; of these, 3943 (27.7%) had not received any doses of COVID-19 vaccine, 1452 (10.2%) had received one dose, 4882 (34.3%) had received two doses, and 3957 (27.8%) had received three doses. The mean number of days in the home monitoring programme was 8.3 (SD 3.5) days. The mean interval from the last vaccine dose until SARS-CoV-2 infection was 116.6 (SD 75.5) days in 7975 patients. The presence of comorbidities was as follows: chronic kidney disease, 340 (2.3%); hypertension, 2569 (17.2%); chronic pulmonary disease, 2539 (17%); smoking, 1711 (11.4%) of 9269 with documented smoking histroy; coronary artery disease, 854 (5.7%); and diabetes mellitus, 1531 (10.3%). The hospitalization rate was 1.8%, and the case fatality rate was 5% of admitted patients, accounting for 0.11% of all cases. The mean age of patients who died was 76.6 (SD 17.7) years, which was higher compared with the mean age of those who survived [30.8 (SD 19.9) years] (P<0.001). Conclusion: Utilization of a home monitoring programme was effective and safe for patients with COVID-19 who were either asymptomatic or had mild symptoms.

Comparative Surge Data on SARS CoV-2 Variants in a Rural Community - A Virtual Hospital Experience

Background. UNC Health Blue Ridge is a nonprofit community teaching hospital with 145 staffed beds. The COVID-19 pandemic has challenged rural hospitals like ours with high occupancy and periodic surges. UNC Health Blue Ridge COVID Virtual Hospital (CVH) created a home monitoring program for enrolled patients with severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) infection utilizing disease risk stratification and pulse oximeter readings to dictate nurse and clinician follow-up. We report raw data that compare surge levels in our community for the Alpha (B.1.1.7), Delta (B.1.617.2) and Omicron (B.1.1.529) surges. Methods. From April 2020 to present, the CVH enrolled patients diagnosed with COVID-19 based on FDA approved PCR tests. For this , we defined any surge as an outpatient CVH census of greater than 50 patients or an inpatient census of >10 patients. We defined the maximum intensity of the surge as >20% outpatient SARS CoV-2 positivity and a CVH census >100 patients or >20 inpatients with SARS CoV-2 infection. Results. For the outpatient setting, days of surge and maximum intensity were 144 / 98 days for Alpha, 92 / 71 days for Delta, 74 / 47 days for Omicron, respectively. Average daily CVH admissions during surges were 17.7 for Alpha, 26.15 for Delta, and 27.15 for Omicron. Total emergency department (ED) and urgent care visits were 12,765 and 23,696 for Delta, and 9701 and 16102 for Omicron. In the inpatient setting, days of surge and maximum intensity days were 102/76 days for Delta and 78/48 days for Omicron. Our peak inpatient COVID-19 daily census was 51 and 50 patients for Delta and Omicron. Conclusion. Our CVH has enrolled over 8700 patients, and our hospital has not been on diversion during the COVID-19 pandemic, unlike many surrounding hospital systems of similar size. More importantly, the CVH has helped create a sustainable model that gathers local data to aid predictive algorithms and facilitate proactive rather than reactive resource allocations. This virtual model can be adapted for multiple other health conditions in the outpatient setting to improve patient safety and quality care.

Impact of COVID-19 on management of diabetes mellitus in urban towns of Kenya: A case study of Mbagathi County Referral Hospital, Nairobi, Kenya

Introduction: Diabetes is a chronic Non-Communicable Disease (NCD) with a rising burden nationally and globally and a leading cause of morbidity. Since December 2019, the world has been battling corona virus pandemic, which was first reported in China, and consequently the first case reported in Kenya on 13 March 2020. Patients >60 years of age and those with underlying conditions such as diabetes have been reported to have an increased risk of the disease, severe diseases and death. Objective(s): The impact of the pandemic to diabetic care has been sparsely documented in developing countries and so this study sought to look into its effect on accessibility of care and the burden of reported complications in Nairobi, Kenya. Method(s): This is a retrospective cross-sectional survey of diabetic patients at Mbagathi county hospital in Kenya. A total of 232 participants were randomly recruited. Modified cox regression analysis was used to measure the correlation between access to health services and diabetes complications during the COVID-19 pandemic. Result(s): Difficulties in access to the health care services was experienced by 40% of the people living with diabetes (PWD) in Nairobi. The difficulties included access to consultations (62%), medication (18%), and lab testing (12%). About 61% (142) of the participants developed either acute or chronic diabetes complications between March 2020 and June 2021. Those who had service access difficulties were 1.4 times (PR 1.40, 95% CI: 1.09-1.83) more likely to develop diabetes complications than those who did not. Conclusion(s): The COVID-19 pandemic has an impact on access to health care services and diabetes related complications as seen in PWD in Nairobi, Kenya. We recommend effective communications to ensure patient engagement with diabetes care services and appropriate use of home monitoring, remote consultations, and other innovations in care.

Monitoring and processing of physiological and domotics parameters in an Internet of Things (IoT) assistive living environment

In relation to an ever changing epidemiological world context, a category of people that is more subject to be impacted consists of the elderly. Certain steps can be taken in order to improve their quality of life especially in case of illness. One way of achieving this is to have a smart assistive living environment, which includes home automation and medical monitoring. The proposed system expands on an IoT solution for assisted living and introduces a highly flexible rules engine for processing physiological and domotics data obtained from the home environment, and for interacting with the system actuators. As proof-of-concept, there are several use-cases that are discussed depending on the type of patient: diabetic, cardiac, hypertensive, obese, COVID or Alzheimer. These scenarios emphasize the efficiency of the proposed solution and offer an insight on the high degree of ion and extensibility of the system. © 2022 IEEE.