Effects of COVID-19 Acute Respiratory Distress Syndrome ICU Survivor Telemedicine Clinic on Patient Readmission, Pain Perception and Self-Assessed Health Scores: A Randomized, Prospective, Single-Center Exploratory Study.

Abstract

Post-intensive care syndrome (PICS) affects up to 50% of intensive care unit (ICU) survivors leading to long-term neurocognitive, psychosocial, and physical impairments. Approximately 80% of COVID-19 pneumonia patients who require ICU level care are at elevated risk for developing acute respiratory distress syndrome (ARDS). Survivors of COVID-19 ARDS are at high-risk for unanticipated healthcare utilization post discharge. Common to this group of patients are increased readmission rates, long term decreased mobility, and overall poorer outcomes. Multidisciplinary post-ICU clinics for ICU survivors are usually located in large urban academic medical centers providing in-person consultation. Data is lacking on the feasibility of providing telemedicine post-ICU care for COVID-19 ARDS survivors. We explored the feasibility of instituting a COVID-19 ARDS ICU survivor telemedicine clinic and examined its effect on healthcare utilization post hospital discharge. This randomized, unblinded, single-center, parallel-group exploratory study was conducted at a rural, academic, tertiary-care medical center. Study group (SG) participants underwent a telemedicine visit within 14 days of discharge, during which a six-minute walk test (6MWT), a EuroQoL 5-Dimension (EQ-5D) questionnaire, and vital signs logs (VSL) were reviewed by an intensivist. Additional appointments were arranged as needed based on the outcome of these review and tests. The control group (CG) received a telemedicine visit within six weeks of discharge and completed the EQ-5D questionnaire; additional care was provided as needed based on findings in this telemedicine visit. Both SG (n=20) and CG (n=20) participants had similar baseline characteristics and dropout rate (10%). Among SG participants, 72.2% agreed to follow up in the pulmonary clinic compared to 50.0% of CG participants (P=.31). Unanticipated visits to the emergency department were 11.1% in the SG compared to 5.6% CG (not sig.). The rate of pain/discomfort was noted to be 66.7% in the SG compared to 61.1% in the CG (P=.72). The anxiety/depression rate was 72.2% vs. 61.1% (P=.59) in the SG compared to the CG. Participants' self-assessed health rating scores was M=73.9, SD 16.1 in the SG compared to M=70.6, SD 20.9 in the CG (P=.59). Both primary care physicians (PCPs) and participants in the SG perceived the telemedicine clinic as a favorable model for post-discharge critical illness follow-up in an open-ended questionnaire regarding care. This exploratory study found no statistically significant results in reducing healthcare utilization post-discharge and health related quality of life. However, PCPs and patients perceived telemedicine as a feasible and favorable model for post-discharge care among COVID-19 ICU survivors to facilitate expedited subspecialty assessment, decrease unanticipated post-discharge healthcare utilization, and reduce PICS. Further investigation is warranted to determine the feasibility of incorporating telemedicine-based post-hospitalization follow-up for all medical ICU survivors which may show improvement in healthcare utilization in a larger population.