COVID Oximetry @home: evaluation of patient outcomes
Abstract
Background
COVID-19 has placed unprecedented demands on hospitals. A clinical service, COVID 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 GP practices covering 230,000 people). We have compared outcomes for patients admitted to Basingstoke & North Hampshire Hospital who were CO@h patients (COVID-19 patients with home monitoring of SpO2 (n=115)), with non-CO@h patients (those directly admitted without being monitored by CO@h (n=633)). Crude and adjusted odds ratio analysis was performed to evaluate the effects of CO@h on patient outcomes of 30-day mortality, ICU admission and hospital length of stay greater than 3, 7, 14, and 28 days.
Results
Adjusted odds ratios 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 0.08-0.47), hospital length of stay larger than 3 days (p<0.05, OR 0.62 95% CI 0.39-1.00), 7 days (p<0.001 OR 0.35 95% CI 0.22-0.54), 14 days (p<0.001 OR 0.22 95% CI 0.11-0.41), and 28 days (p<0.05 OR 0.21 95% CI 0.05-0.59). No significant reduction ICU admission was observed (p>0.05 OR 0.43 95% CI 0.15-1.04). 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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