COVID-19 Oximetry @home: evaluation of patient outcomes

Abstract

Background: 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 (SpO₂; 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.

Keywords: COVID-19; Evidence-Based Practice; Quality improvement.

Figure 1

Primary care assessment centre and COVID Oximetry @home service deployed supporting community patient monitoring as defined by North Hampshire Integrated Care System. GP, General Practitioner.

Figure 2

Patient cohort selection showing CO@h intervention group and non-CO@h control group (those patients not being treated by the CO@h service). BNHH, Basingstoke and North Hants Hospital; CO@h, COVID-19 Oximetry @home. ICP; Integrated Care Partnership.

Figure 3

Monthly COVID-19 referrals for monitoring by CO@h service (blue) and total hospital admissions (orange) from November 2020 to March 2021. Hospital admissions include CO@h referrals escalated and admitted to hospital. CO@h, COVID-19 Oximetry @home.

Figure 4

Hospital length of stay distributions for our intervention (CO@h; green) and control cohorts (non-CO@h; blue). (Left) cumulative distribution for length of stay with 80th percentile length of stay shown as vertical lines for each period. (Right) kernel density estimate for hospital length of stay. CO@h, COVID-19 Oximetry @home.