Text messaging service for monitoring COVID-19 at home reduces mortality

Most patients with SARS-CoV-2 infection can be safely managed at home. However, the need for hospitalization can arise suddenly, since patients can decline rapidly and unpredictably. Remote monitoring of patients at home has the potential to facilitate emergency department and hospital-level care for patients who require it, while supporting patients who can safely remain at home. A new U.S. study aimed to determine whether enrollment in an automated remote monitoring service—called COVID Watch—for community-dwelling adults at home with COVID-19 was associated with improved mortality. The automated text message-based, remote monitoring program was developed by the University of Pennsylvania Health System. The retrospective cohort analysis included outpatient adults in the Penn Medicine academic health system who tested positive for SARS-CoV-2 between March 23 and Nov. 30, 2020. The COVID Watch service intervention consisted of twice-daily, automated text message check-ins, with an option to report worsening symptoms at any time. Read: Higher rates of mortality in myocardial infarction patients with COVID-19 The automated text message check-ins asked patients how they were feeling compared to 12 hours ago (better, same or worse). Patients replying “worse” received a follow-up question asking whether it was harder than usual for them to breathe (yes or no). For patients responding “yes,” an alert was generated for a telemedicine clinician to contact the patient by telephone within one hour. Anytime outside of the twice-daily check-ins, patients were instructed to text “worse” to prompt a clinician call back. After an escalation, clinicians could provide reassurance, advise how best to manage symptoms at home, prescribe medications, or redirect patients to the emergency department. Read: Traditional Chinese medicine widely believed to prevent COVID-19 The study compared 3,488 patients enrolled in COVID Watch and 4,377 usual care control participants. At 30 days, COVID Watch patients had an odds ratio for death of 0.32 (95% CI, 0.12–0.72), with 1.8 fewer deaths per 1,000 patients (CI, 0.5–3.1) (p = 0.005). At 60 days, the difference was 2.5 fewer deaths per 1,000 patients (CI, 0.9–4.0) (p = 0.002). Patients in COVID Watch had more telemedicine encounters, emergency department visits and hospitalizations, and presented to the emergency department sooner (mean, 1.9 days sooner [CI, 0.9–2.9 days]; p < 0.001). The investigators highlighted the four main findings of their study: The mortality rate for community-dwelling adults with COVID-19 was significantly lower among those in COVID Watch compared with usual care, even after adjustment for differences in patients' clinical and sociodemographic characteristics. More than one-third of the deaths in the usual care group occurred outside the hospital versus none among those in COVID Watch. Patients in COVID Watch were more likely to present to the hospital, and they presented earlier. All major racial and ethnic subgroups had reduced mortality rates when enrolled in COVID Watch. The researchers also pointed out that since COVID Watch was automated, only two to four staff members were required to oversee more than 1,000 patients at a time. In addition, because it relied on symptom self-report, COVID Watch did not require dedicated temperature sensors or pulse oximetry. Overall, COVID Watch was associated with a 64% relative reduction in the risk for death, and one life was saved for every 400 patients enrolled. The authors concluded that enrollment of outpatients with COVID-19 in the automated text messaging remote monitoring service was associated with reduced mortality. This was possibly due to more frequent telemedicine encounters and more frequent and earlier presentation to the emergency department. Read: FAQ sheet for parents on COVID-19 vaccinations for kids from UWaterloo School of Pharmacy The authors suggest that future research is needed to determine whether this type of monitoring service could be adapted to other acute conditions (e.g., pneumonia, cellulitis) and chronic conditions (e.g., asthma, diabetes) in which automated text check-ins and low barrier access to rapid clinical assessment and emergency department triage could improve outcomes. Reference 1. Delgado MK, Morgan AU, Asch DA, et al. Comparative effectiveness of an automated text messaging service for monitoring COVID-19 at home. Ann Intern Med 2021; published online, November 16, 2021. https://www.acpjournals.org/doi/10.7326/M21-2019 (accessed November 18, 2021)

Text messaging service for monitoring COVID-19 at home reduces mortality

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