Background: Patients hospitalized with COVID-19 are at risk for clinical deterioration after discharge. Because of this concern, hospitals established home monitoring programs during the pandemic. This study sought to describe these programs among a sample of US academic medical centers.
Methods: We conducted a voluntary survey of hospital medicine leaders who participate in the Hospital Medicine Re-engineering Network (HOMERuN), a national network of US academic medical centers. We defined post-discharge monitoring as gathering of information from patients regarding physiologic parameters and/or patient-reported outcomes after discharge. A committee of experts in transitional care designed and pretested the survey, which contained general questions regarding each hospital’s programs, the kinds of data collected, criteria for and nature of care escalation, and details regarding sustainability. Surveys were administered to HOMERuN participants, one per hospital, using REDCap (Vanderbilt University, Nashville, TN). Respondents received an email link to the survey with several follow-up reminders to complete it. Survey results are presented descriptively.
Results: Surveys were sent to 83 HOMERuN participants in March 2021, and 35 (42%) responded, representing 35 different hospitals. Of these, 22 (63%) had a post-discharge monitoring program for patients discharged with COVID-19. Regarding program design and patient eligibility (Table 1), 16 of these programs (73%) were newly developed for COVID-19, while the rest were adapted from existing programs. The goals of the programs were several, including safer discharge using standard criteria, reduced readmissions, earlier discharge, and improved patient satisfaction. Programs were run by a variety of departments, including internal medicine, primary care, and emergency medicine. Fourteen of these programs (67%) were opt in (providers had to select which patients received it), while the rest were opt out (eligible patients were enrolled unless providers excluded them). Eligibility criteria varied widely, including presence of symptoms, positive diagnosis, specific high-risk features, and language and insurance requirements. Regarding data collection and escalation (Table 2), 16 programs (80% of respondents to this question) collected physiologic data (e.g., pulse oximetry, temperature, blood pressure), and 75% collected patient-reported data. Patients were often discharged with monitoring devices, but in most cases, patients had to report the results of physiologic monitoring manually. Patient interfaces with the care team included phone calls, a web portal, smartphone app, text messages, and virtual visits. When a portal or app was used, it was linked to the EHR 67% of the time. Criteria for escalation of care included hypoxia (95%), shortness of breath (95%), fever (45%), and other signs or symptoms (35%). Care was escalated in various ways, including virtual urgent care visits, instructions to go the emergency department, PCP contact, and a variety of other actions.
Conclusions: Approximately two-thirds of responding hospitals in this early 2021 survey had a COVID-19 post-discharge monitoring program, most often newly started specifically for COVID-19 patients, and with limited interoperability with hospital EHRs as a result. Whether these programs improve care and how they are being sustained or expanded to other conditions will require further research.
