How do you monitor patients who have symptoms of the coronavirus (COVID-19), but are not ill enough to need emergency care? How do you help those patients feel cared for and less frightened while convalescing at home?
That was the dilemma facing Dr Jeffrey Linder, Chief of General Internal Medicine and Geriatrics at Northwestern University, in dealing with a virus that is still not properly understood.
He found that the solution was to mount a massive home-monitoring programme for suspected patients of coronavirus. Through the programme, patients receive daily assistance from a range of healthcare professionals, including nurses, medical students, physicians’ assistants, and daily questionnaires. And with the digitisation of so much of life at the moment, the programme is delivered through an Electronic Health Record portal.
The programme’s development, feasibility, and early results were published on Tuesday in the New England Journal of Medicine Catalyst.
A total of 7,604 patients were monitored, of whom about 500 were sent to the emergency department.
“We were able to catch these patients before their condition dangerously deteriorated, which improved our ability to treat them,” said Linder, who also is a Professor of Medicine at Northwestern University Feinberg School of Medicine.
He added, “We started the programme to address the needs of the 80% of patients who would spend their entire course of COVID-19 at home.”
Linder noted that, based on early experience of the virus, patients could deteriorate quickly, particularly if their conditions were not monitored to give them the care they need. The programme also took into account that patients frequently have many questions about quarantine, the virus’ development, as well as many social needs.
Gayle Kricke, an Assistant Professor of Medicine at Feinberg, who implemented the monitoring programme, said, “We had no models for addressing a large-scale pandemic for outpatients, so we had to create one based on our best understanding of COVID-19, public health approaches, and care in the home.”
Linder and Kricke believe the programme improved the physical and emotional care given to patients.
One team member reported, “I just spoke with a patient who is very grateful for our calls. She has been sick for six weeks, and she said that there were some nights when she didn’t feel like she could take another breath. But knowing we would be calling to check on her helped her to get through those nights. She is finally starting to feel better, but she told me over and over again how very grateful she is for all of the people who have been calling to check on her.”
The idea behind the programme was to proactively reach out to patients, rather than waiting for them to identify a worsening in their condition.
Patients are asked to regularly fill out a questionnaire on an online portal, with a team member monitoring patient responses. The team member also calls on patients for follow-up if any symptoms of concern are reported, such as shortness of breath, chest pain, or confusion
Team members also call any individuals who do not report symptoms via the patient portal or who simply do not use it.
During the call, health care providers assess and triage individuals for urgent medical care if they report severe symptoms, such as trouble breathing or a bluish tint to the lips or face. The team members also refer patients to social work for non-medical challenges, such as difficulty with finances or accessing food.
“This model could be used for other acute conditions where quick deterioration is likely, as it has been especially helpful for giving our physicians something to offer a patient when there is really no treatment available,” Linder said. “For example, it allowed us to see changes in antibiotic prescribing habits for other respiratory infections if physicians had the option to enrol a patient in a monitoring programme rather than send a patient home with nothing.”