IMPROVING ACCESS TO OUTPATIENT MONOCLONAL ANTIBODY TREATMENT OF COVID-19 INFECTION FOR HIGH RISK PATIENTS

ABSTRACT

STATEMENT OF PROBLEM/QUESTION Early clinical trials demonstrated a decrease in hospital admissions and emergency department (ED) visits in high risk patients who received monoclonal antibody (MAB) treatment for COVID-19 within 3 days of a positive SARS-COV-2 test or within 5 days of symptom onset;thus rapid referral for treatment upon receipt of test results is imperative. DESCRIPTION OF PROGRAM/INTERVENTION An electronic health record report was generated to identify all patients of an outpatient network of general internal medicine clinics who tested positive for SARS-COV-2 in the previous 3 days. Pharmacists reviewed new patients on the report 1-2 times per day to determine eligibility for MAB treatment and quickly referred those eligible by electronic consultation to a pulmonologist for order placement. If approved, the infusion team contacted the patient to review the treatment option and associated Emergency Use Authorization. Patients who consented to receive MAB treatment were scheduled for and received the MAB infusion. MEASURES OF SUCCESS Measures of success include (1) number of high risk patients who qualified for and received MAB treatment, (2) time from symptom onset and positive SARS-COV-2 test to referral for MAB treatment and MAB treatment infusion, and (3) number of ED visits and hospital admissions in the patients who received MAB treatment compared to those who did not receive MAB treatment. Other important findings characterized include (1) COVID-19 risk factors for severe disease and/or hospitalization identified in patients who received MAB treatment compared to those who did not receive MAB treatment, (2) reasons eligible patients did not receive MAB treatment, and (3) COVID-19 symptoms reported in patients who received MAB treatment compared to those who did not receive MAB treatment. FINDINGS TO DATE During the 36-week study period, 277 patients were eligible for MAB treatment. Of those, 188 patients (67.9%) received MAB treatment, 55 patients (19.9%) declined MAB treatment, and 34 patients (12.3%) were lost to follow-up. Average time from symptom onset to MAB treatment was 4.6 ± 2.2 days. A total of 22 (11.7%) patients who received MAB treatment had an ED visit or hospital admission compared to 17 (19.1%) patients who did not receive MAB treatment. Data analysis for other measures listed above and inteferential statistics are pending and will be available within the next week. KEY LESSONS FOR DISSEMINATION Team-based care can improve the efficiency and quality of care provided to high risk patients while minimizing disruption in daily patient care activities. Keys to workflow success include comprehensive reporting, clear communication pathways, and team integration. Modifications in workflow for patients who report outside test results will also be described.