Evaluation of an outreach programme for patients with COVID-19 in an integrated healthcare delivery system: a retrospective cohort study

• Published in: BMJ open Vol. 14; no. 1; p. e073622
• Main Authors: Myers, Laura C, Lawson, Brian L, Escobar, Gabriel J, Daly, Kathleen A, Chen, Yi-fen Irene, Dlott, Richard, Lee, Catherine, Liu, Vincent
• Format: Journal Article
• Language: English
• Published: England British Medical Journal Publishing Group 08.01.2024; BMJ Publishing Group LTD; BMJ Publishing Group
• Series: Original research
• Subjects: Adult; Automation; Cancer; Cohort analysis; Comorbidity; COVID-19; COVID-19 - therapy; COVID-19 Vaccines; Delivery of Health Care, Integrated; Departments; Diabetes; Emergency medical care; Health care delivery; Hospices; Hospitalization; Humans; Infectious Diseases; Inpatients; Intervention; Medical records; Medical referrals; Medical screening; Mortality; Overcrowding; Pandemics; Physicians; Physiology; Population; Primary care; PUBLIC HEALTH; Retrospective Studies; SARS-CoV-2; Severe acute respiratory syndrome coronavirus 2; Northern California; United States > US; COVID-19; PUBLIC HEALTH
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2023-073622

ObjectivesIn the first year of the COVID-19 pandemic, health systems implemented programmes to manage outpatients with COVID-19. The goal was to expedite patients’ referral to acute care and prevent overcrowding of medical centres. We sought to evaluate the impact of such a programme, the COVID-19 Home Care Team (CHCT) programme.DesignRetrospective cohort.SettingKaiser Permanente Northern California.ParticipantsAdult members before COVID-19 vaccine availability (1 February 2020–31 January 2021) with positive SARS-CoV-2 tests.InterventionVirtual programme to track and treat patients with ‘CHCT programme’.OutcomesThe outcomes were (1) COVID-19-related emergency department visit, (2) COVID-19-related hospitalisation and (3) inpatient mortality or 30-day hospice referral.MeasuresWe estimated the average effect comparing patients who were and were not treated by CHCT. We estimated propensity scores using an ensemble super learner (random forest, XGBoost, generalised additive model and multivariate adaptive regression splines) and augmented inverse probability weighting.ResultsThere were 98 585 patients with COVID-19. The majority were followed by CHCT (n=80 067, 81.2%). Patients followed by CHCT were older (mean age 43.9 vs 41.6 years, p<0.001) and more comorbid with COmorbidity Point Score, V.2, score ≥65 (1.7% vs 1.1%, p<0.001). Unadjusted analyses showed more COVID-19-related emergency department visits (9.5% vs 8.5%, p<0.001) and hospitalisations (3.9% vs 3.2%, p<0.001) in patients followed by CHCT but lower inpatient death or 30-day hospice referral (0.3% vs 0.5%, p<0.001). After weighting, there were higher rates of COVID-19-related emergency department visits (estimated intervention effect −0.8%, 95% CI −1.4% to −0.3%) and hospitalisation (−0.5%, 95% CI −0.9% to −0.1%) but lower inpatient mortality or 30-day hospice referral (−0.5%, 95% CI −0.7% to −0.3%) in patients followed by CHCT.ConclusionsDespite CHCT following older patients with higher comorbidity burden, there appeared to be a protective effect. Patients followed by CHCT were more likely to present to acute care and less likely to die inpatient.