Remote monitoring of patients with COVID-19

280 p.ill.,SCIENTIFIC REPORT 14 -- CHAPTER 1 – INTRODUCTORY CHAPTER 14 -- 1 WHY TELEMONITORING IN COVID-19? 14 -- 1.1 FROM A WORLDWIDE PERSPECTIVE 14 -- 1.2 FROM A BELGIAN PERSPECTIVE 15 -- 2 SCOPE AND RESEARCH OBJECTIVES 17 -- 2.1 RESEARCH QUESTIONS RAISED IN THE CONVENTION 17 -- 2.2 RESEARCH QUESTIONS RAISED BY KCE AND SUBJECT OF THIS REPORT 17 -- CHAPTER 2 – DESCRIPTION OF THE PROJECT AND PATIENT CHARACTERISTICS 19 -- 1 KEY POINTS 19 -- 2 BACKGROUND: COVID-19 RPM AS DESCRIBED IN THE CONVENTION 23 -- 2.1 AIMS OF THE CONVENTION 23 -- 2.2 TARGET POPULATION 23 -- 2.3 FINANCING AND INVOICING 24 -- 2.4 COLLABORATION FRAMEWORK 25 -- The group of healthcare providers 27 -- The technical platform/helpdesk/dashboard 27 -- The telemonitoring team 28 -- The general practitioner(s) 29 -- The ambulatory care nurse(s) 29 -- The patient 29 -- 3 METHOD 30 -- 3.1 SELECTION OF STUDY PERIOD AND ELIGIBLE PROJECTS 30 -- 3.2 METHODS TO GATHER INFORMATION ON PROJECT CHARACTERISTICS 31 -- 4 RESULTS 32 -- 4.1 OVERVIEW OF THE INCLUDED TELEMONITORING PROJECTS 32 -- 4.2 GEOGRAPHICAL LOCATION OF THE STUDIED PROJECTS 34 -- 4.3 INFORMATION GATHERED TO DESCRIBE THE CHARACTERISTICS OF THE INCLUDED PROJECTS 34 -- Focus on actors involved and collaborations set up 36 -- Focus on onboarding, patient inclusion and characteristics 51 -- Focus on the process of remote monitoring 60 -- Focus on patient satisfaction and usefulness of telemonitoring for healthcare professionals 70 -- Claims made should be interpreted with care 72 -- 5 DISCUSSION 73 -- 6 CONCLUSIONS 79 -- CHAPTER 3 – PERCEPTIONS OF THE ACTORS INVOLVED IN COVID-19 RPM 80 -- 1 KEY POINTS 80 -- 2 AIM AND RESEARCH QUESTIONS 83 -- 3 METHOD 84 -- 3.1 DESIGN OF THE QUALITATIVE EVALUATION 84 -- 3.2 SAMPLING OF PARTICIPANTS 84 -- Interviews with patients 84 -- Interviews with Telemonitoring teams 85 -- Interviews with GPs 86 -- Interviews with ambulatory care nurses 86 -- 3.3 INTERVIEW PLAN 87 -- 3.4 DATA ANALYSIS 88 -- 3.5 METHODOLOGICAL QUALITY 89 -- 4 FINDINGS 90 -- 4.1 FINDINGS FROM INTERVIEWS WITH PATIENTS 90 -- Description of patients 90 -- Experiences related to quality of care, patient needs and patient and health system outcomes 91 -- Experiences related to implementation: barriers and facilitators for success 93 -- 4.2 FINDINGS FROM INTERVIEWS WITH TELEMONITORING TEAMS 95 -- Description of sample 95 -- Experiences related to quality of care, patient needs and patient and healthcare system outcomes 95 -- Experiences related to implementation: barriers and facilitators for success 99 -- Experiences related to adaptations 105 -- Experiences related to opportunities 106 -- 4.3 FINDINGS FROM INTERVIEWS WITH GPS 108 -- Description of sample 108 -- Description of GPs’ role 108 -- Experiences related to quality of care, patient needs and patient and health system outcomes 109 -- Experiences related to implementation: barriers and facilitators for successful RPM 110 -- Experiences related to adaptations 114 -- Experiences related to opportunities 114 -- 4.4 FINDINGS FROM INTERVIEWS WITH AMBULATORY CARE NURSES 115 -- Description of sample 115 -- Description of the role of ambulatory care nurses 115 -- Experiences related to quality of care, patient needs and patient and healthcare system outcomes 115 -- Experiences related to implementation: barriers and facilitator for success 118 -- Experiences related to adaptations 119 -- Experiences related to opportunities 120 -- 5 DISCUSSION 120 -- 6 CONCLUSION 123 -- CHAPTER 4 – REVIEW OF THE COVID-19 RPM LITERATURE 124 -- 1 KEY POINTS 124 -- 2 BACKGROUND 126 -- 3 METHOD 126 -- 3.1 DATA SOURCES 126 -- 3.2 SEARCH STRATEGIES 127 -- 3.3 IN- AND EXCLUSION CRITERIA 127 -- 3.4 INCLUSION PROCESS 128 -- 3.5 DATA-EXTRACTION & ANALYSIS 129 -- 4 RESULTS 130 -- 4.1 SEARCH RESULTS 130 -- 4.2 HOW DO THE TELEMONITORING INTERVENTIONS LOOK LIKE? 131 -- OUTCOMES 135 -- 4.4 ED-VISITS 136 -- Hospital (re)admissions 138 -- Mortality 140 -- Previous length of hospital stay (LOS) in posthosp 141 -- Economic outcomes of COVID-19 RPM 142 -- Patient experience 142 -- 4.5 RPM IN SPECIAL PATIENT POPULATIONS 142 -- 4.6 BARRIERS AND FACILITATORS IN IMPLEMENTING RPM FOR PATIENTS WITH COVID-19 143 -- 5 ONGOING STUDIES 147 -- 6 SEARCH UPDATE FOR RANDOMIZED CONTROLLED TRIALS 147 -- 7 DISCUSSION 149 -- 7.1 COMPARED TO PREVIOUS REVIEWS ON RPM IN PATIENTS WITH COVID-19 149 -- 7.2 COMPARED TO RPM OVERVIEW STUDIES FROM THE UK 150 -- 7.3 COVID-19 RPM VERSUS RPM IN OTHER DISEASES 151 -- 7.4 HOW TO INTERPRET THE CLINICAL OUTCOMES FROM RPM? 151 -- Are ED-visits and hospital admissions good or bad outcomes? 151 -- Is shortening of hospital length of stay really a shortening? 152 -- Does RPM reduces strain on hospital capacity and work force? 152 -- 7.5 WHICH PATIENTS COULD PROFIT THE MOST OF RPM? 152 -- 7.6 OTHER REMAINING QUESTIONS: 153 -- 8 CONCLUSIONS 154 -- CHAPTER 5 – INTEGRATION OF RESULTS AND DISCUSSION 155 -- 1 COVID-19 RPM WAS INITIATED DURING AN ACUTE HEALTHCARE CRISIS 155 -- COVID-19 RPM WAS ENDORSED BY EXPERIENCE, MOTIVATION, DEDICATED CLINICAL LEADERS AND RESOURCES 156 -- 3 COVID-19 RPM IS GENERALLY CHARACTERIZED BY A LARGE HETEROGENEITY AND LACK OF SCIENTIFIC EVIDENCE 156 -- 4 COVID-19 RPM DEMONSTRATED TO BE A FEASIBLE INTERVENTION THROUGHOUT THE PANDEMIC 157 -- 4.1 IN THE SHORT-TERM, IT WAS BELIEVED THE INVESTMENTS CONTRIBUTED TO THE AIMS FOR WHICH THE PROJECTS WERE INITIATED. 157 -- 4.2 IN THE LONG-TERM, INVESTMENTS DONE DURING A CRISIS ALLOW HEALTHCARE ORGANIZATIONS AND PROFESSIONALS TO LEARN FROM EXPERIENCE. 158 -- 5 LESSONS LEARNED FROM COVID-19 RPM FOR FURTHER DEVELOPMENT AND IMPLEMENTATION 159 -- 5.1 ENHANCING THE COLLABORATION BETWEEN THE ACTORS ACROSS CARE LINES… 160 -- Constructing partnerships based on solid communication 160 -- Access to the RPM system enhances collaboration across levels of care. 161 -- Roles and responsibilities of the actors should be clear 161 -- A legal framework on RPM and generalized patient informed consent is desirable 162 -- Good quality of data and reliable measurements are needed 162 -- 5.2 …TO COMPLY WITH PATIENTS NEEDS IN COVID-19 RPM 163 -- 5.3 PARTNERSHIPS AND COLLABORATIONS CAN BE ENDORSED BY SUPPORT AND RESOURCES 164 -- 5.4 PATIENT ADHERENCE TO COVID-19 RPM IS FACILITATED BY THE USER FRIENDLINESS OF THE TECHNOLOGY AND INFORMATION RECEIVED 165 -- 5.5 EQUITY IN CARE SHOULD BE INCREASED TO MAKE COVID-19 RPM SUSTAINABLE 166 -- 6 MAIN MESSAGE 167 -- REFERENCES 168 -- APPENDICES 19