Intensive Home Care for COVID-19 to Reduce Admissions.

Rachel Aviv,Marcia Epstein,Madeline Abrams,Gita Lisker,Fiore Mastroianni

doi:10.1177/10848223211035718

Abstract

Hospitalization for COVID-19 has placed a significant financial and logistical burden on hospitals and health care systems. Limitations on visitation and isolation precautions have made hospitalization more isolating for patients in the time of COVID-19. Increasing the provision of healthcare delivered at home has the potential to decrease healthcare costs by providing care at home which may be preferred for many patients. We describe a series of 39 patients who were treated with intravenous remdesivir at home in addition to oxygen, dexamethasone, and anticoagulants. These patients were at high risk for decompensation due to COVID-19 and met accepted criteria for admission—need for supplemental oxygen and intravenous remdesivir. All patients had home lab monitoring and frequent telehealth visits. Over the study period 13 (33%) of patients were admitted for worsening COVID-19 and 5 (13%) died. Twenty-six patients avoided admission, and none experienced a severe adverse effect from in-home treatment. The expanded use of telehealth services due to the COVID-19 pandemic has the potential to increase the frequency of patient monitoring by physicians and the provision of care and monitoring usually restricted to hospitalized patients.

Highlights

Hospitalization for respiratory failure due to COVID-19 is frequent, several treatments for COVID-19 can be delivered in the home obviating the need for hospitalization
While remdesivir is currently approved for patients hospitalized with COVID-19, any benefit from remdesivir use is likely to be early in the disease course.[1]
All study patients could have been admitted for COVID-19 pneumonia with hypoxemia and treatment with intravenous remdesivir

Summary

Introduction

Hospitalization for respiratory failure due to COVID-19 is frequent, several treatments for COVID-19 can be delivered in the home obviating the need for hospitalization. In-hospital treatments for COVID-19 include dexamethasone, remdesivir, oxygen, and prophylactic anticoagulation. The need for IV access, oxygen, regular monitoring by physicians and nursing staff drives many admissions for COVID-19. While remdesivir is currently approved for patients hospitalized with COVID-19, any benefit from remdesivir use is likely to be early in the disease course.[1] We conducted a retrospective analysis of outpatient use of intravenous remdesivir to examine the effect of providing intensive home care on the need for admission in ill outpatients who otherwise met criteria for admission. All patients had been enrolled in our health system’s outpatient COVID-19 treatment program which consists of telehealth visits with physicians and nurse practitioners, in-home laboratory testing, imaging, and in-home infusions of intravenous fluids and other medications.[2]

Methods

Results

Conclusion