• M Kit Delgado, Anna U Morgan, David A Asch, Ruiying Xiong, Austin S Kilaru, Kathleen C Lee, David Do, Ari B Friedman, Zachary F Meisel, Christopher K Snider, Doreen Lam, Andrew Parambath, Christian Wood, Chidinma M Wilson, Michael Perez, Deena L Chisholm, Sheila Kelly, Christina J O'Malley, Nancy Mannion, Ann Marie Huffenberger, Susan McGinley, Mohan Balachandran, Neda Khan, Nandita Mitra, and Krisda H Chaiyachati.
• Center for Emergency Care Policy and Research, Department of Emergency Medicine, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, and Leonard Davis Institute of Health Economics, University of Pennsylvania, and Center for Health Care Innovation, University of Pennsylvania Health System, Philadelphia, Pennsylvania (M.K.D.).
• Ann. Intern. Med. 2022 Feb 1; 175 (2): 179190179-190.

BackgroundAlthough most patients with SARS-CoV-2 infection can be safely managed at home, the need for hospitalization can arise suddenly.ObjectiveTo determine whether enrollment in an automated remote monitoring service for community-dwelling adults with COVID-19 at home ("COVID Watch") was associated with improved mortality.DesignRetrospective cohort analysis.SettingMid-Atlantic academic health system in the United States.ParticipantsOutpatients who tested positive for SARS-CoV-2 between 23 March and 30 November 2020.InterventionThe COVID Watch service consists of twice-daily, automated text message check-ins with an option to report worsening symptoms at any time. All escalations were managed 24 hours a day, 7 days a week by dedicated telemedicine clinicians.MeasurementsThirty- and 60-day outcomes of patients enrolled in COVID Watch were compared with those of patients who were eligible to enroll but received usual care. The primary outcome was death at 30 days. Secondary outcomes included emergency department (ED) visits and hospitalizations. Treatment effects were estimated with propensity score-weighted risk adjustment models.ResultsA total of 3488 patients enrolled in COVID Watch and 4377 usual care control participants were compared with propensity score weighted models. At 30 days, COVID Watch patients had an odds ratio for death of 0.32 (95% CI, 0.12 to 0.72), with 1.8 fewer deaths per 1000 patients (CI, 0.5 to 3.1) (P = 0.005); at 60 days, the difference was 2.5 fewer deaths per 1000 patients (CI, 0.9 to 4.0) (P = 0.002). Patients in COVID Watch had more telemedicine encounters, ED visits, and hospitalizations and presented to the ED sooner (mean, 1.9 days sooner [CI, 0.9 to 2.9 days]; all P < 0.001).LimitationObservational study with the potential for unobserved confounding.ConclusionEnrollment of outpatients with COVID-19 in an automated remote monitoring service was associated with reduced mortality, potentially explained by more frequent telemedicine encounters and more frequent and earlier presentation to the ED.Primary Funding SourcePatient-Centered Outcomes Research Institute.

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