Monitoring outpatients by text appeared to reduce mortality from COVID-19

A remote monitoring service for outpatients with COVID-19 was associated with reduced mortality, a recent study found.

The retrospective analysis included 3,488 patients of one U.S. health care system who tested positive for SARS-CoV-2 between March 23 and Nov. 30, 2020, and were not initially admitted to a hospital. They received twice-daily, automated text message check-ins with an option to report worsening symptoms at any time. Escalations were managed 24 hours a day by dedicated telemedicine clinicians. The outcomes of patients enrolled in this program, called COVID Watch, were compared with those of 4,377 patients who were eligible to enroll but received usual care. Results were published by Annals of Internal Medicine on Nov. 16.

At 30 days, three (0.09%) patients in the monitoring program had died versus 12 (0.27%) receiving usual care, which after propensity score weighting and modeling worked out to a mortality odds ratio of 0.32 (95% CI, 0.12 to 0.72), with 1.8 fewer deaths per 1,000 patients (95% CI, 0.5 to 3.1) (P=0.005). At 60 days, there were 2.5 fewer deaths per 1,000 patients (95% CI, 0.9 to 4.0) in the monitoring group (P=0.002). None of the deaths in this group occurred outside the hospital.

Participants had more telemedicine encounters, ED visits, and hospitalizations and presented to the ED a mean of 1.9 days sooner (95% CI, 0.9 to 2.9 days) (P<0.001 for all). These findings likely explained the program's effect of “increasing vigilance over those at home and efficiently sorting them into those who will benefit from the ED and those who will not,” said the study authors. They concluded that the program is “a model for outpatient health system management of patients with COVID-19 and possibly other conditions where the early detection of clinical declines is critical.” They noted that racial and ethnic information on the participating patients showed that Black and Hispanic patients were as likely to benefit from the monitoring service as White patients.

The study was limited by its observational design and could not capture patients' social needs, nature and timing of symptoms before the testing date, and other unobserved confounders, the study authors said. However, they noted that the monitored group actually had more characteristics associated with worse outcomes from COVID-19 than the usual care group.