Large-scale Implementation of a COVID-19 Remote Patient Monitoring Program.

Introduction: We implemented a large-scale remote patient monitoring (RPM) program for patients diagnosed with coronavirus 2019 (COVID-19) at a not-for-profit regional healthcare system. In this retrospective observational study, patients from nine emergency department (ED) sites were provided a pulse oximeter and enrolled onto a monitoring platform upon discharge. Methods: The RPM team captured oxygen saturation (SpO2), heart rate, temperature, and symptom progression data over a 16-day monitoring period, and the team engaged patients via video call, phone call, and chat within the platform. Abnormal vital signs were flagged by the RPM team, with escalation to in-person care and return to ED as appropriate. Our primary outcome was to describe study characteristics: patients enrolled in the COVID-19 RPM program; engagement metrics; and physiologic and symptomatic data trends. Our secondary outcomes were return-to-ED rate and subsequent readmission rate. Results: Between December 2020-August 2021, a total of 3,457 patients were referred, and 1,779 successfully transmitted at least one point of data. Patients on COVID-19 RPM were associated with a lower 30-day return-to-ED rate (6.2%) than those not on RPM (14.9%), with capture of higher acuity patients (47.7% of RPM 30-day returnees were subsequently hospitalized vs 34.8% of non-RPM returnees). Conclusion: Our program, one of the largest studies to date that captures both physiologic and symptomatic data, may inform others who look to implement a program of similar scope. We also share lessons learned regarding barriers and disparities in enrollment and discuss implications for RPM in other acute disease states.

Health system reconstitution syndrome: an often misunderstood phenomenon in global health practice.

The beginning of the 21st century was marked by the new definition and framework of health systems strengthening (HSS). The global movement to improve access to high-quality care garnered new resources to design and implement comprehensive HSS programs. In this effort, billions of dollars flowed from novel mechanisms such as The Global Fund to Fight AIDS, Tuberculosis and Malaria; Gavi, the Vaccine Alliance; and several bilateral funders. However, poor health outcomes, particularly in low-income countries, raise questions about the effectiveness of HSS program implementation. While several evaluation projects focus on the ultimate impact of HSS programs, little is known about the short- and mid-term reactions occurring throughout the active implementation of HSS interventions. Using the well-documented WHO framework of six HSS building blocks, we describe the evolution and phases of health system reconstitution syndrome (HSRS), including: (1) quiescent phase, (2) reactive phase, (3) restorative phase and (4) stability phase. We also discuss the implications of HSRS on global health funding, implementation, policy and research. Recognizing signs of HSRS could improve the rigour of HSS program design and minimize premature decisions regarding the progress of HSS interventions.