Civic Telehealth focuses on enabling those with a variety of chronic conditions, as well as healthy people wishing to focus more carefully on their well-being generally to get access to remote patient monitoring (“RPM,” also sometimes called remote physiologic monitoring), to improve the chances that any deterioration or worsening can be detected earlier. But RPM can have value in acute care as well, even in the battle against COVID-19.
Kaiser Permanente (“KP”) recently provided an example of this capability. KP is an integrated managed care consortium, and one of the largest nonprofit healthcare plans in the United States, with over 12 million members. KP offers an insurance plan, a network of owned and contracted hospitals, and eight independent and physician-led Permanente Medical Groups.
According to a recent paper,1 KP’s Southern California region developed a COVID-19 Home Monitoring program as an alternative to hospital admission, to decrease hospital bed days, and to mitigate the adverse effects of a surge. In this way, KP sought to provide patients infected with the virus an alternative to admission, or early discharge, reducing COVID-19 exposure to the patient, family members, and healthcare workers. The program was designed to provide safe, high-quality care to patients at home, and to allow medical professionals to identify signs of worsening illness early so they could intervene. KP pointed to national guidelines suggesting that most mildly ill COVID-19 patients can be managed in an ambulatory setting or at home through telemedicine, and patients with moderate disease should be monitored closely.2
KP provided patients and caregivers instructions via handouts and videos, and where necessary additional assistance, so they understood how to use the technology. The program required patients to enter daily symptoms through an mHealth app, which care providers could monitor at the hospital.
The investigators studied all patients enrolled in the COVID-19 Home Monitoring program between April 13, 2020 through February 12, 2021. As of the paper’s July, 2021 publication date, more than 15,000 patients had been enrolled, and only about 10% of enrolled patients had required admission to hospital care.
More specifically, a total of 12,461 of 13,055 patients diagnosed with COVID-19 (95.5%) recovered and completed the program, 1387 patients (10.6%) were admitted to the hospital, and only 20 patients (0.2%) died while they were being monitored at home. These patients were usually 60 or older and more likely to have had existing comorbidities, such as obesity or hypertension. The mortality rate at 30 days from enrollment was 1.6%. Hospital length of stay for ambulatory patients receiving oxygen only was 5.4 days compared to 3.1 days for those ambulatory patients receiving oxygen, dexamethasone, and remdesivir. Of the more than half of the participants answering a patient satisfaction survey after completing the program, 94 percent said they were satisfied with the quality of care they received and would recommend the program to others.
From these results, the authors concluded that COVID-19 home monitoring appeared to be both safe and effective. These initial data suggested to the investigators that RPM can serve as an alternative to hospitalization for infected patients, decreasing hospital length of stay when patients receive therapies in the ambulatory setting otherwise reserved for the hospital.
The likelihood is good that, over time, more and more uses for RPM will be discovered. The hope is that, as KP has shown in managing patients infected with SARS-CoV-2, earlier detection can improve outcomes. It makes sense to follow developments in this field, so that as knowledge expands, we can evaluate whether and when to apply this technology in new and beneficial ways.
1 Dan Ngoc Huynh, Alyssa Millan, Earl Quijada, et al., “Description and Early Results of the Kaiser Permanente Southern California COVID-19 Home Monitoring Program,” Perm J 2021;25:20.281, https://www.thepermanentejournal.org/issues/2021/summer/7664-description-and-early-results-of-the-kaiser-permanente-southern-california-covid-19-home-monitoring-program.html#ref.