Automated text messaging service helps reduce deaths in outpatients with COVID-19

Adults newly diagnosed with COVID-19 in outpatient settings and enrolled in an automated remote monitoring service are less likely to succumb to the disease potentially due to more frequent telemedicine encounters and earlier presentation to the emergency department (ED), a study has shown.

“These results reveal 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,” the researchers said.

This retrospective cohort analysis involving the Mid-Atlantic academic health system in the US included outpatients who tested positive for SARS-CoV-2 between 23 March and 30 November 2020. The researchers compared 3,488 patients enrolled in COVID Watch with 4,377 usual care controls using propensity score weighted models.

The COVID Watch service consists of twice-daily, automated text message check-ins with an option to report worsening symptoms at any time. Dedicated telemedicine clinicians managed all escalations 27 hours a day, 7 days a week.

COVID Watch patients had almost 70-percent reduced mortality risk at 30 days (odds ratio [OR], 0.32, 95 percent confidence interval [CI], 0.12–0.72), with 1.8 fewer deaths per 1,000 patients (95 percent CI, 0.5–3.1; p=0.005). The difference at 60 days was 2.5 fewer deaths per 1,000 patients (95 percent CI, 0.9–4.0; p=0.002). [Ann Intern Med 2021;doi:10.7326/M21-2019]

In addition, patients enrolled in COVID Watch had more telemedicine encounters, ED visits, and hospitalizations, and they also presented to the ED sooner (mean, 1.9 days sooner, 95 percent CI, 0.9–2.8; p<0.001 for all).

“These findings imply that COVID Watch is associated with a 64-percent relative reduction in the risk for death and that one life was saved for every 400 patients enrolled—or about 1 every 4 days during peak enrolment weeks,” the researchers said.

“Although remote patient monitoring programs used to manage patients with COVID-19 outside of hospital settings have been described, we believe ours to be the first risk-adjusted study to show improved survival,” they added. [J Am Med Dir Assoc 2019;20:1391-1396.e1; J Gen Intern Med 2006;21:1276-1281; BMC Med Res Methodol 2013;13:58]

The researchers also suggested that the use of technology-based, automated remote monitoring backed by clinician support was vital for the observed clinical effect. COVID Watch, being automated, only required two to four staff members to oversee >1,000 patients at a time, which was significantly fewer than personnel-intensive calling systems.

By relying on symptom self-report, COVID Watch did not need dedicated temperature sensors or pulse oximetry. However, the use of additional equipment in the home varied across remote patient monitoring programmes, with unknown incremental values. [J Hosp Med 2015;10:645-650]

“Future research is needed to determine whether this type of monitoring service could be adapted to other acute conditions (eg, pneumonia or cellulitis) and chronic conditions (eg, asthma or diabetes) in which automated text check-ins and low barrier access to rapid clinical assessment and ED triage could improve outcomes,” the researchers said.