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Managing COVID-19 With In-Home Monitoring

by Michael Ruggeri

The novel coronavirus (COVID-19) pandemic has presented many challenges for managing patient care. To meet one of those challenges, BJC Medical Group and Washington University School of Medicine collaborated to create an in-home monitoring program for those sick with COVID-19. The program is helping patients to recover at home, while keeping health care providers as safe as possible.

The program involves a daily check-in for each patient via the MyChart smartphone app or a phone call. This process allows medical professionals to identify signs of worsening illness early. That way, they can intervene and provide patients with the care they need before their illness worsens to the point of hospitalization.

During the check-in, patients answer a series of questions, such as: What is your temperature? How is your cough? Do you have shortness of breath?

If any worrisome responses are flagged, a nurse or medical assistant will follow up with the patient via phone call. If necessary, they will also schedule a virtual visit with a doctor or nurse practitioner or advise the patient to come to the hospital for further care.

Ongoing home monitoring enables medical professionals to better manage symptoms, track a patient’s progress, and help the patient recover as quickly and thoroughly as possible.

Launched April 6, about 850 patients have participated in the program, including 230-250 patients who are currently enrolled.

“Any patient who has COVID-19 — or who is suspected of having COVID-19 but has not been tested — qualifies for potential enrollment in the program,” says Megan Guinn, director of clinical improvement at BJC Medical Group.

Guinn is one of five BJC Medical Group leaders who helped organize the program in collaboration with WUSM. Other BJC Medical Group team members include John Paul Shoup, MD, medical director of performance and clinical process improvement; Nathan Moore, MD, medical director of the BJC Accountable Care Organization; Michele Thomas, MD, chief medical information officer; and Nancy Kadlec-Patterson, vice president and chief nursing officer.

In addition to BJC Medical Group team members, both Jennifer Schmidt, MD, assistant professor of medicine at WUSM, and Dick Taylor, MD, chief clinical informatics officer for BJC, helped organize the program.

The team of BJC Medical Group and WUSM physicians, led by Dr. Schmidt, researched how physicians at other institutions have cared for COVID-19 patients. They combined those reports with their own expertise in infectious diseases, pulmonary and critical care medicine, and general medicine to develop a set of criteria that suggests a COVID-19 patient could be taking a turn for the worse.

BJC Home Care has also played a critical role in the program, providing any necessary supplies for home monitoring, including thermometers and pulse oximeters to measure oxygen levels in the blood.

Duration in the program depends on the patient’s condition. Daily monitoring typically continues for 14 days from the reported onset of symptoms before a patient is evaluated for graduation from the program. Patients who exhibit stable or improved symptoms for three consecutive days may also be evaluated for graduation from the program.

“We have learned that COVID-19 has a highly variable disease course,” says Guinn. “Some patients have relatively mild symptoms that gradually improve. Others have symptoms that start mild and then worsen.”

Instead of waiting for something to go wrong, the in-home monitoring program allows patients to stay engaged with their health care team to quickly and safely receive the care they need before critical illness develops.

“One of the tricky things about COVID is that it is so new that we are still learning about the ways the illness can progress,” says Dr. Schmidt. “Sometimes people look like they’re getting better, and then all of a sudden they get worse. Having the patients regularly check in really helps us catch those who are starting to get sicker so we can get them the care that they need.”

“We want to avoid scenarios where a patient’s condition deteriorates and the health-care provider doesn’t realize it until the patient comes to the emergency room,” adds Dr. Taylor. “This is something that we think will improve the quality of care so people can stay at home safely.”

Going forward, the COVID-19 in-home monitoring program holds high promise for monitoring and managing a broad group of patients with chronic conditions, such as congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD) and diabetes, to help prevent disease exacerbations and gain tighter control over symptoms.

The benefits of in-home monitoring to the patients are many. Perhaps the most significant during the COVID-19 pandemic is the ability to recover at home. "We know how important it is for patients to be in the comfort and safety of their own home during this pandemic, limiting their exposure to others, and to have the support of their loved ones when battling this disease," says Guinn.

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