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Transition of care interventions to manage severe COVID-19 in the ambulatory setting: a systematic review

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Abstract

Background

Severe COVID-19, with the need in supplemental oxygen and hospitalization, leads to major burden on patients and healthcare systems. As a result, safe and effective ambulatory treatment strategies for severe COVID-19 are of urgent need. In this systematic review, we aimed to evaluate interventions to transition care to the ambulatory setting for patients with active severe COVID-19 that required supplemental oxygen.

Methods

We searched Medline, Scopus, Web of Science, and DOAJ databases to identify articles with original data published until the 1st of April 2023. Characteristics and outcomes of interventions to transition care to home management were reviewed. Given the heterogeneous settings and outcomes studied, a meta-analysis was not performed.

Results

Of the 235 studies identified, 11 observational studies, with 2645 patients, were included. The interventions were initiated from the emergency department, observation units or inpatient units, and included continuous home telemonitoring (n = 8), mobile applications (n = 2), and patient-initiated medical contact (n = 3). Included patients had an overall short length of hospital stay, high readmission rates, and positive patients’ feedback. There was a lack of prospective controlled data and cost-effectiveness analyses.

Conclusion

Our findings highlight the potential in treating severe COVID-19 at the ambulatory setting and the lack of high-quality data in this field. Dedicated medical teams, adjusted monitoring methods, improving clinical trajectory, and correct inclusion settings are needed for safe and effective transition of care.

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Data availability

The authors confirm that the data supporting the findings of this study are available within the article [and/or] its supplementary materials.

References

  1. Boserup B, McKenney M, Elkbuli A (2021) The financial strain placed on America’s hospitals in the wake of the COVID-19 pandemic. Am J Emerg Med 45:530–531. https://doi.org/10.1016/j.ajem.2020.07.007

    Article  PubMed  Google Scholar 

  2. Omer SB, Malani P, del Rio C (2020) The COVID-19 pandemic in the US: a clinical update. JAMA 323(18):1767–1768. https://doi.org/10.1001/jama.2020.5788

    Article  CAS  PubMed  Google Scholar 

  3. Mild or Moderate Covid-19 | NEJM. https://www.nejm.org/doi/10.1056/NEJMcp2009249?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed. Accessed 3 Nov 2023

  4. Covid-19 and Health Care’s Digital Revolution | NEJM. https://www.nejm.org/doi/full/10.1056/NEJMp2005835. Accessed 3 June 2023

  5. COVID-19 Treatment Guidelines Panel. Coronavirus Disease 2019 (COVID-19) treatment guidelines. National Institutes of Health. https://www.covid19treatmentguidelines.nih.gov/. Accessed 3 June 2023

  6. Lewnard JA, Liu VX, Jackson ML et al (2020) Incidence, clinical outcomes, and transmission dynamics of severe coronavirus disease 2019 in California and Washington: prospective cohort study. BMJ 369:m1923. https://doi.org/10.1136/bmj.m1923

    Article  PubMed  PubMed Central  Google Scholar 

  7. Ram FSF, Wedzicha JA, Wright J, Greenstone M (2004) Hospital at home for patients with acute exacerbations of chronic obstructive pulmonary disease: systematic review of evidence. BMJ 329(7461):315. https://doi.org/10.1136/bmj.38159.650347.55

    Article  PubMed  PubMed Central  Google Scholar 

  8. Hauck K, Zhao X (2011) How dangerous is a day in hospital? A model of adverse events and length of stay for medical inpatients. Med Care 49(12):1068–1075. https://doi.org/10.1097/MLR.0b013e31822efb09

    Article  PubMed  Google Scholar 

  9. Greenhalgh T, Knight M, Inada-Kim M, Fulop NJ, Leach J, Vindrola-Padros C (2021) Remote management of covid-19 using home pulse oximetry and virtual ward support. BMJ 372:n677. https://doi.org/10.1136/bmj.n677

    Article  PubMed  Google Scholar 

  10. Annunziata A, Coppola A, Carannante N et al (2021) Home management of patients with moderate or severe respiratory failure secondary to COVID-19, using remote monitoring and oxygen with or without HFNC. Pathogens 10(4):413. https://doi.org/10.3390/pathogens10040413

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Carmichael HL, Peltan ID, Palakanis K et al (2023) Remote biometric monitoring of patients with COVID-19 with exertional hypoxia treated with supplemental oxygen. Chest 163(3):498–501. https://doi.org/10.1016/j.chest.2022.09.026

    Article  CAS  PubMed  Google Scholar 

  12. Elbagalaty M, Shawkat S, Mohamed M (2022) Combating coronavirus disease 2019 at home: evaluation of home treatment approach for patients diagnosed with coronavirus disease 2019 with moderate and severe symptoms in Egypt. Egypt J Chest Dis Tuberc 71(4):452–456

    Article  Google Scholar 

  13. Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 339:b2535. https://doi.org/10.1136/bmj.b2535

  14. Page MJ, McKenzie JE, Bossuyt PM et al (2021) The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. Published online March 29, 2021:n71. https://doi.org/10.1136/bmj.n71

  15. Sterne JA, Hernán MA, Reeves BC et al (2016) ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ 355:i4919. https://doi.org/10.1136/bmj.i4919

    Article  PubMed  PubMed Central  Google Scholar 

  16. Banerjee J, Canamar CP, Voyageur C et al (2021) Mortality and readmission rates among patients with COVID-19 after discharge from acute care setting with supplemental oxygen. JAMA Netw Open 4(4).https://doi.org/10.1001/jamanetworkopen.2021.3990

  17. Martinez JA, Ehsan A, Mellady M, Goldberg L, Martinez RA (2023) Hospital days reduced for moderate and severe COVID-19 patients through a home monitoring program with oxygen. Clin Nurs Res 32(3):601–607

    Article  PubMed  Google Scholar 

  18. Ward TJC, Mavilakandy A, Danns J, Tsaknis G, Reddy RV (2022) Outcomes from a virtual ward delivering oxygen at home for patients recovering from COVID-19: a real world observational study. Clin Med 22(3):197–202

    Article  Google Scholar 

  19. Schoenling A, Frisch A, Callaway CW, Yealy DM, Weissman A (2023) Home oxygen therapy from the emergency department for COVID-19 an observational study. Am J Emerg Med 68:47–51. https://doi.org/10.1016/j.ajem.2023.03.012

    Article  PubMed  PubMed Central  Google Scholar 

  20. van den Berg R, Meccanici C, de Graaf N, van Thiel E, Schol-Gelok S (2022) Starting home telemonitoring and oxygen therapy directly after emergency department assessment appears to be safe in COVID-19 patients. J Clin Med 11(23). https://doi.org/10.3390/jcm11237236

  21. Schiff R, Oyston M, Quinn M, Walters S, McEnhill P, Collins M (2022) Hospital at home: another piece of the armoury against COVID-19. Future Healthc J 9(1):90–95. https://doi.org/10.7861/fhj.2021-0137

    Article  PubMed  PubMed Central  Google Scholar 

  22. Freund O, Weiss TE, Tau L et al (2023) Safety and outcomes of an early discharge strategy with oxygen home therapy in stable severe COVID-19 patients. Infect Dis 55(4):292–298. https://doi.org/10.1080/23744235.2023.2168047

    Article  CAS  Google Scholar 

  23. Kuo S, Aledia A, O’Connell R, Rudkin S, Dangodara AA, Amin AN (2022) Implementation and impact on length of stay of a post-discharge remote patient monitoring program for acutely hospitalized COVID-19 pneumonia patients. JAMIA Open 5(3):ooac060. https://doi.org/10.1093/jamiaopen/ooac060

  24. Hussein NR, Saleem ZSM, Rashad BH et al (2021) Home management scheme for patients with severe covid-19 in Duhok city, Kurdistan region of Iraq: a possible role for family physicians. J Family Med Prim Care 10(11):4260–4263

    Article  PubMed  PubMed Central  Google Scholar 

  25. Viel S, Markowicz S, Ait-Medjber L et al (2022) Dedicated team to ambulatory care for patients with COVID-19 requiring oxygen: low rate of hospital readmission. Int J Infect Dis 123:92–96. https://doi.org/10.1016/j.ijid.2022.07.057

    Article  PubMed  PubMed Central  Google Scholar 

  26. Terp S, Reichert Z, Burner E et al (2023) Characteristics and outcomes of 360 consecutive COVID-19 patients discharged from the emergency department with supplemental oxygen. Ann Emerg Med 81(1):14–19. https://doi.org/10.1016/j.annemergmed.2022.08.449

    Article  PubMed  Google Scholar 

  27. Di Fusco M, Shea KM, Lin J et al (2021) Health outcomes and economic burden of hospitalized COVID-19 patients in the United States. J Med Econ 24(1):308–317. https://doi.org/10.1080/13696998.2021.1886109

    Article  PubMed  Google Scholar 

  28. Gupta A, Madhavan MV, Sehgal K et al (2020) Extrapulmonary manifestations of COVID-19. Nat Med 26(7):1017–1032. https://doi.org/10.1038/s41591-020-0968-3

    Article  CAS  PubMed  Google Scholar 

  29. Freund O, Azolai L, Sror N et al (2023) Diagnostic delays among COVID-19 patients with a second concurrent diagnosis. J Hosp Med 18(4):321–328. https://doi.org/10.1002/jhm.13063

    Article  PubMed  Google Scholar 

  30. Pimentel MAF, Redfern OC, Hatch R, Young JD, Tarassenko L, Watkinson PJ (2020) Trajectories of vital signs in patients with COVID-19. Resuscitation 156:99–106. https://doi.org/10.1016/j.resuscitation.2020.09.002

    Article  PubMed  PubMed Central  Google Scholar 

  31. Docherty AB, Harrison EM, Green CA et al (2020) Features of 20 133 UK patients in hospital with covid-19 using the ISARIC WHO clinical characterisation protocol: prospective observational cohort study. BMJ 369:m1985. https://doi.org/10.1136/bmj.m1985

    Article  PubMed  PubMed Central  Google Scholar 

  32. Vekaria B, Overton C, Wiśniowski A et al (2021) Hospital length of stay for COVID-19 patients: data-driven methods for forward planning. BMC Infect Dis 21(1):700. https://doi.org/10.1186/s12879-021-06371-6

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Baker MA, Sands KE, Huang SS et al (2022) The impact of coronavirus disease 2019 (COVID-19) on healthcare-associated infections. Clin Infect Dis 74(10):1748–1754. https://doi.org/10.1093/cid/ciab688

    Article  CAS  PubMed  Google Scholar 

  34. Megido I, Sela Y, Grinberg K (2023) Cost effectiveness of home care versus hospital care: a retrospective analysis. Cost Eff Resour Alloc 21:13. https://doi.org/10.1186/s12962-023-00424-0

    Article  PubMed  PubMed Central  Google Scholar 

  35. Vindrola-Padros C, Sidhu MS, Georghiou T et al (2021) The implementation of remote home monitoring models during the COVID-19 pandemic in England. EClinicalMedicine 34:100799. https://doi.org/10.1016/j.eclinm.2021.100799

    Article  PubMed  PubMed Central  Google Scholar 

  36. Richardson S, Hirsch JS, Narasimhan M et al (2020) Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area. JAMA 323(20):2052–2059. https://doi.org/10.1001/jama.2020.6775

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Auerbach AD, Astik GJ, O’Leary KJ et al (2023) Prevalence and causes of diagnostic errors in hospitalized patients under investigation for COVID-19. J Gen Intern Med 38(8):1902–1910. https://doi.org/10.1007/s11606-023-08176-6

    Article  PubMed  PubMed Central  Google Scholar 

  38. Haleem A, Javaid M, Singh RP, Suman R (2021) Telemedicine for healthcare: capabilities, features, barriers, and applications. Sens Int 2:100117. https://doi.org/10.1016/j.sintl.2021.100117

    Article  PubMed  PubMed Central  Google Scholar 

  39. Eron L (2010) Telemedicine: the future of outpatient therapy? Clin Infect Dis 51(Supplement_2):S224–S230. https://doi.org/10.1086/653524

  40. Pronovost PJ, Cole MD, Hughes RM (2022) Remote patient monitoring during COVID-19: an unexpected patient safety benefit. JAMA 327(12):1125–1126. https://doi.org/10.1001/jama.2022.2040

    Article  CAS  PubMed  Google Scholar 

  41. Alboksmaty A, Beaney T, Elkin S et al (2022) Effectiveness and safety of pulse oximetry in remote patient monitoring of patients with COVID-19: a systematic review. Lancet Digit Health 4(4):e279–e289. https://doi.org/10.1016/S2589-7500(21)00276-4

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Lentz CM, De Lind Van Wijngaarden RAF, Willeboordse F, Hooft L, van der Laan MJ (2022) Dedicated teams to optimize quality and safety of surgery: a systematic review. Int J Qual Health Care 34(4): mzac078. https://doi.org/10.1093/intqhc/mzac078

  43. COVID-19: Treatment for older people in the community. British Geriatrics Society. https://www.bgs.org.uk/resources/covid-19-treatment-for-older-people-in-the-community. Accessed 10 June 2023

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. The Institute of Pulmonary Medicine, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine Tel Aviv University, Tel-Aviv, Israel

    Sabrina Fried, Amir Bar-Shai & Ophir Freund

  2. Internal Medicine B, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Weizmann 6, Tel-Aviv, Israel

    Shir Frydman & Ophir Freund

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  1. Sabrina Fried
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Contributions

O.F.—Data curation, Formal analysis, Writing—original draft. A.B.S.—Validation, Conceptualization, Project administration, Writing-review and editing. S. Fry.—Investigation, Validation, Writing-review and editing. S.F.—Data curation, Formal analysis, Writing—original draft.

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Correspondence to Ophir Freund.

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Fried, S., Bar-Shai, A., Frydman, S. et al. Transition of care interventions to manage severe COVID-19 in the ambulatory setting: a systematic review. Intern Emerg Med 19, 765–775 (2024). https://doi.org/10.1007/s11739-023-03493-4

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