Background: The SARS-CoV-2 pandemic has required healthcare systems around the world to rapidly innovate and adapt to unprecedented operational and clinical strain. Many healthcare systems have turned to virtual care capabilities as an innovative means to safely and efficiently monitor patients while reducing staff exposure and resource constraints.
Purpose: The overarching aim of this project was to implement the COVID-19 Remote Patient Monitoring Program across the Military Health System (MHS) and determine its safety, efficacy, and cost-effectiveness.
Description: The CRPM enrollment process starts in the hospital inpatient unit or emergency department. The core kit contains a tablet and an arm band containing a coin-sized monitor capable of measuring vital signs including temperature, heart rate, blood pressure, pulse oximetry. such as a blood pressure cuff, a temperature patch and digital spirometer.Over a 19-month interval, 209 patients were enrolled in the pilot across 8 MTFs. One hundred eighty-nine189 (90%) of the patients enrolled have been subsequently discharged, with nineteen 19 currently active patients. COVID-19 comprises 87% (182/209) of the total patients. A total of 397 inpatient, non-ICU bed days were saved via 129 enrollments. Inpatient bed days saved was determined based on estimates from the primary medical team at enrollment. The average number of days enrolled was 20.5 days. 45 (22%) of patients were referred at one time to the MTF for a higher level of care, with 21 (10%) requiring re-admission and 3 (1.4%) requiring an intensive care unit (ICU) level admission. The average number of days monitored prior to care escalation was 8.3 days. At the eight participating MTF sites, a variable cost savings per non-ICU bed day was estimated using data provided by officials from each site. Using the total estimated bed days saved, a potential total variable cost savings could be calculated. Over the 19-month period, a cumulative variable cost savings from bed days saved was $1,193,752.38. A simple return on investment (ROI) analysis, taking into account costs of the pilot, was performed and determined an estimated annual net savings of $503,608.77 at the current rate of enrollment. This translate into a gross ROI ratio of 1.36 and net ROI ratio of 0.36.
Conclusions: Remote health monitoring has been established in multiple clinical models as an effective adjunct in order to ensure treatment regimen adherence, make real-time treatment adjustments based on parameters, and identify patients at risk for decompensation early.The COVID-19 Remote Patient Monitoring Pilot’s initial aim was to demonstrate the safety and efficacy of the remote monitoring system in COVID-19. In over 200 encounters across 8 different MTFs, 90% of enrolled patients were eventually discharged successfully without negative outcomes. More importantly, this technology needs to exhibit a high sensitivity in order to capture those at-risk for decompensation for appropriate transfer. Of the 22% of patients requiring referrals back to the MTF, 10% required admission to the hospital while 1.4% required ICU admission.Cost effectiveness was a secondary aim, especially in the setting of an operationally-strained healthcare system. Our program showed efficacy in this realm by demonstrating a nearly $1.2 million-dollar savings over a 19 month time frame. With continued replication and increased usage of these monitoring kits for expanding indications, this number is expected to rise.