Virtual Health Care for Community Management of Patients With COVID-19 in Australia: Observational Cohort Study

  1. Owen Rhys Hutchings
  2. Cassandra Dearing
  3. Dianna Jagers
  4. Miranda Jane Shaw
  5. Freya Raffan
  6. Aaron Jones
  7. Richard Taggart
  8. Tim Sinclair
  9. Teresa Anderson
  10. Angus Graham Ritchie

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Abstract

Australia has successfully controlled the COVID-19 pandemic. Similar to other high-income countries, Australia has extensively used telehealth services. Virtual health care, including telemedicine in combination with remote patient monitoring, has been implemented in certain settings as part of new models of care that are aimed at managing patients with COVID-19 outside the hospital setting.

Objective

This study aimed to describe the implementation of and early experience with virtual health care for community management of patients with COVID-19.

Methods

This observational cohort study was conducted with patients with COVID-19 who availed of a large Australian metropolitan health service with an established virtual health care program capable of monitoring patients remotely. We included patients with COVID-19 who received the health service, could self-isolate safely, did not require immediate admission to an in-patient setting, had no major active comorbid illness, and could be managed at home or at other suitable sites. Skin temperature, pulse rate, and blood oxygen saturation were remotely monitored. The primary outcome measures were care escalation rates, including emergency department presentation, and hospital admission.

Results

During March 11-29, 2020, a total of 162 of 173 (93.6%) patients with COVID-19 (median age 38 years, range 11-79 years), who were diagnosed locally, were enrolled in the virtual health care program. For 62 of 162 (38.3%) patients discharged during this period, the median length of stay was 8 (range 1-17) days. The peak of 100 prevalent patients equated to approximately 25 patients per registered nurse per shift. Patients were contacted a median of 16 (range 1-30) times during this period. Video consultations (n=1902, 66.3%) comprised most of the patient contacts, and 132 (81.5%) patients were monitored remotely. Care escalation rates were low, with an ambulance attendance rate of 3% (n=5), emergency department attendance rate of 2.5% (n=4), and hospital admission rate of 1.9% (n=3). No deaths were recorded.

Conclusions

Community-based virtual health care is safe for managing most patients with COVID-19 and can be rapidly implemented in an urban Australian setting for pandemic management. Health services implementing virtual health care should anticipate challenges associated with rapid technology deployments and provide adequate support to resolve them, including strategies to support the use of health information technologies among consumers.

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  1. Version published to 10.2196/21064
  2. ScreenIT

    SciScore for 10.1101/2020.05.11.20082396: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board StatementIRB: The Sydney Local Health District Ethics Review Committee reviewed this manuscript and no ethical concerns were raised regarding the study or publication of the results.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    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:
    Supply chain delays may also impact rapid procurement of adequate quantities of the necessary technology to remote monitoring, which may be further compounded by limitations on the ability of the Flying Squad to deploy devices to patients. Risk stratification at admission with enhanced monitoring of those more likely to deteriorate is being considered, although there is little empirical evidence to guide that strategy(17). Criteria Led Discharge, a process in which discharge is determined from pre-defined clinical parameters, is also being explored with the aim of expediting discharge from the service(18). Mental health and well-being are issues requiring further consideration in the provision of VHC to patients with COVID-19. Quarantine and self-isolation for the purpose of controlling infectious diseases is associated with negative psychological effects including post-traumatic stress symptoms, confusion, and anger, with potential to be long-lasting(19). Two psychological assessment screening questions were included in the model to assist with recognising mental health concerns. The psychological impact of self-isolation in one’s own home may be different to that of individuals placed in mandatory quarantine in hotels following arrival from overseas. This is an issue requiring further exploration and consideration is being made to provide access to Social Workers, Psychologists and Psychiatrists through VHC. Rapid changes to the EMR were required to support VHC for patients...

    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.

    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.

  3. Version published to 10.2196/preprints.21064
  4. Version published to 10.1101/2020.05.11.20082396v1 on medRxiv