Remote Monitoring Via Text Linked to Fewer COVID-19 Deaths

An automated texting program helped Philadelphia-based Penn Medicine lower the risk of death for COVID-19 patients who quarantined at home, according to a new study.

As the novel coronavirus surged in waves across the country last year, hospitals were overwhelmed with patients. As a result, many hospitals turned to remote patient monitoring to keep an eye on COVID-19 patients at home and free up inpatient beds for those who needed it the most.

The study, which was published in the Annals of Internal Medicine, examined data for patients who tested positive for COVID-19 between March 23 and Nov. 30, 2020.

Researchers compared outcomes of patients enrolled in COVID Watch — a Penn Medicine program designed to remotely monitor patients via twice-a-day, automated text message check-ins — with patients who received the usual outpatient care. Those in COVID Watch had the option to report worsening symptoms, which were managed 24/7 by a dedicated team of telemedicine clinicians.

At 30 days, three of the 3,488 patients enrolled in COVID Watch had died as compared with 12 of 4,377 who received usual care.

The COVID Watch group had 1.8 fewer deaths per 1,000 patients than the usual care group at 30 days. That figure jumped up to 2.5 fewer deaths per 1,000 patients at 60 days.

Further, COVID Watch was linked to equitable benefits, with white, Black, and Hispanic subgroups all experiencing reduced mortality within 60 days.

"It's crucial that we found all major racial and ethnic groups benefited because non-white and low-income communities have had disproportionately higher infection rates, lower access to care, and higher death rates," said M. Kit Delgado, MD, an assistant professor of emergency medicine and epidemiology at the University of Pennsylvania's medical school and lead author of the study, in a news release. "This implies that this model of care could have reduced disparities in COVID outcomes if it was scaled up more broadly to these communities."

Not only was the COVID Watch program linked with declines in mortality, but it also influenced other factors.  

For example, patients in COVID Watch had a similar number of office visits to those in the usual care group, but they had a greater mean number of telemedicine encounters per patient within 30 days of testing positive for COVID-19.

In addition, COVID Watch patients presented to the emergency department about three days sooner than their usual care counterparts in the first month.

"Automation isn't something that will replace human clinical care, but it is something that can extend it," said David Asch, MD, a study co-author and executive director of the Center for Health Care Innovation at Penn Medicine, in a news release. "Without an automated system to help us watch over the thousands of COVID patients in our community, our doctors and nurses would have been stretched even thinner than they were."

Nearly 20,000 patients have been enrolled in COVID Watch since it started in March 2020. Now, the COVID Watch team plans to see if the program can be used to help people with other chronic conditions manage their care at home.