COVID-19 Oximetry @home: evaluation of patient outcomes

  1. Michael Boniface
  2. Daniel Burns
  3. Christopher Duckworth
  4. Mazen Ahmed
  5. Franklin Duruiheoma
  6. Htwe Armitage
  7. Naomi Ratcliffe
  8. John Duffy
  9. Caroline O’Keeffe
  10. Matt Inada-Kim

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Abstract

COVID-19 has placed unprecedented demands on hospitals. A clinical service, COVID-19 Oximetry @home (CO@h) was launched in November 2020 to support remote monitoring of COVID-19 patients in the community. Remote monitoring through CO@h aims to identify early patient deterioration and provide timely escalation for cases of silent hypoxia, while reducing the burden on secondary care.

Methods

We conducted a retrospective service evaluation of COVID-19 patients onboarded to CO@h from November 2020 to March 2021 in the North Hampshire (UK) community led service (a collaboration of 15 General Practitioner (GP) practices covering 230 000 people). We have compared outcomes for patients admitted to Basingstoke and North Hampshire Hospital who were CO@h patients (COVID-19 patients with home monitoring of oxygen saturation (SpO 2 ; n=115), with non-CO@h patients (those directly admitted without being monitored by CO@h (n=633)). Crude and adjusted OR analysis was performed to evaluate the effects of CO@h on patient outcomes of 30-day mortality, Intensive care unit (ICU) admission and hospital length of stay greater than 3, 7, 14 and 28 days.

Results

Adjusted ORs for CO@h show an association with a reduction for several adverse patient outcome: 30-day hospital mortality (p<0.001, OR 0.21, 95% CI 0.08 to 0.47), hospital length of stay larger than 3 days (p<0.05, OR 0.62, 95% CI 0.39 to 1.00), 7 days (p<0.001, OR 0.35, 95% CI 0.22 to 0.54), 14 days (p<0.001, OR 0.22 95% CI, 0.11 to 0.41), and 28 days (p<0.05, OR 0.21, 95% CI 0.05 to 0.59). No significant reduction ICU admission was observed (p>0.05, OR 0.43, 95% CI 0.15 to 1.04). Within 30 days of hospital admission, there were no hospital readmissions for those on the CO@h service as opposed to 8.7% readmissions for those not on the service.

Conclusions

We have demonstrated a significant association between CO@h and better patient outcomes; most notably a reduction in the odds of hospital lengths of stays longer than 7, 14 and 28 days and 30-day hospital mortality.

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  1. Version published to 10.1136/bmjoq-2021-001584
  2. Version published to 10.1101/2021.05.29.21257899v2 on medRxiv
  3. ScreenIT

    SciScore for 10.1101/2021.05.29.21257899: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    EthicsIRB: The study was however evaluated by the University of Southampton Ethics Committee (REF ERGO/61242) and approved as a service evaluation following Data Protection Impact Assessment and establishment of Data Sharing Agreements.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Analysis was performed in Python v3.9.4 (using pandas, seaborn, statsmodels).
    Python
    suggested: (IPython, RRID:SCR_001658)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    These findings must be understood in light of their limitations. CO@h was rapidly developed in response to the pandemic, and as a result, the improvement cycles were conducted at pace. PDSA quality improvement was conducted using evidence-based practice, where insights were provided by data professionals to clinicians. A multi-disciplinary team of healthcare professionals, QI personnel, and data scientists met frequently to discuss patient care, and CO@h efficacy. Operational improvements were implemented through these discussions to deliver continual improvement especially procedures relating to integrated services between conveyance, CO@h and hospitals. Formally, the distinct improvement cycles were as follows: (1) CO@h service pilots (1st wave of the pandemic: March 2020 to July 2020) including community COVID-19 assessment centres implemented without remote monitoring beyond paper diaries and phone, treating n=1600 suspected-COVID patients and escalating n=105 to hospital; and support by hospital Same Day Emergency Care and care homes telemedicine services (2) NHS Trust-wide implementation of CO@h (2nd wave of the pandemic: November 2020 to March 2021) with efficacy evaluation presented here. Finally, this service evaluation is for an integrated community care pathway and a single hospital trust, therefore generalisation is limited by population size and clinical setting.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  4. Version published to 10.1101/2021.05.29.21257899v1 on medRxiv