Implementation and Evaluation of COVIDCare@Home, a Family Medicine Led Remote Monitoring Program for COVID-19 Patients: a multi-method cross-sectional study

• Published in: JMIR human factors
• Main Authors: Laur, Celia, Agarwal, Payal, Thai, Kelly, Kishimoto, Vanessa, Kelly, Shawna, Liang, Kyle, Bhatia, R Sacha, Bhattacharyya, Onil, Martin, Danielle, Mukerji, Geetha
• Format: Journal Article
• Language: English
• Published: Canada 01.05.2022
• ISSN: 2292-9495

COVIDCare@Home (CC@H) is a multi-faceted, interprofessional team-based remote monitoring program led by family medicine for diagnosed COVID-19 patients, based at Women's College Hospital, an ambulatory academic centre in Toronto, Canada. CC@H offers virtual visits (phone and video) to address the clinical needs and broader social determinants of health of patients during the acute phase of COVID-19 infection, including finding a primary care provider and support for food insecurity. The objective of this evaluation is to understand the implementation and quality outcomes of CC@H within the Quadruple Aim framework of patient experience, provider experience, cost, and population health. This multi-method cross-sectional evaluation follows the Quadruple Aim to focus on implementation and service quality outcomes including feasibility, adoption, safety, effectiveness, equity, and patient-centeredness. These measures were explored using clinical and service utilization data, patient-experience data (an online survey and a post-discharge questionnaire), provider-experience data (surveys, interviews and focus groups) and stakeholder interviews. Descriptive analysis was conducted for surveys and utilization data. Deductive analysis was conducted for interviews and focus groups, mapping to implementation and quality domains. The Ontario Marginalization Index (ON-Marg) measured the proportion of underserved patients accessing CC@H. 3412 visits were conducted in the first 8 months (Apr 8-Dec 8, 2020) for 616 discrete patients, including 2114 visits with family physician staff/residents, and 149 visits with social worker/mental health professionals. There was a median of 5 (IQR=4) visits per patient, with a median follow-up of 7 days (IQR=27). The Net Promoter Score was 77. 23.3% of patients were in the most marginalized populations based on residential postal code (as per the ON-Marg index). Interviews with providers and stakeholder indicated that the program continues to adapt to meet the needs of patients and the healthcare system. Future remote monitoring should integrate support for addressing the social determinants of health and ensure patient-centred care through comprehensive care teams.