About this Blog Series

On March 10, 2020, the Department of Public Health confirmed the first case of COVID-19 in Philadelphia. Eleven days later, COVID Watch, a patient outreach program designed to monitor people with COVID for worsening symptoms, was launched by the University of Pennsylvania Health System.

M. Kit Delgado, MD, MS, Assistant Professor of Emergency Medicine at the University of Pennsylvania Perelman School of Medicine and a Penn Presbyterian emergency department physician, recalls that during those early days of the pandemic, there was a lot of uncertainty and “everyone was focused on in-hospital mortality being high.” As an emergency room doctor on the front line, however, he and his colleagues at the Penn Medicine Center for Health Care Innovation soon began asking, “how do we take care of the 90 percent of COVID patients who will be stable enough to initially isolate at home?” This question fueled the creation of COVID Watch.

Soon after COVID Watch was created, Delgado received PCORI funding to compare the use of COVID Watch to usual care for patients with milder COVID symptoms. At a time when there was “barely enough [personal protective equipment] to take care of patients safely in the ED, let alone in primary care settings,” Delgado and his team hoped that COVID Watch might help reduce risk among both patients and providers by facilitating remote care. Given all the unknowns associated with COVID infection, Delgado was optimistic that remote monitoring was “a better way to manage COVID at the health system level” rather than in individual emergency rooms, primary care offices, and clinics.

Automation and Innovation

Through COVID Watch, patients receive two automated text messages daily to check in with them about their symptoms. If a patient complains of progressive symptoms, particularly worsening shortness of breath, a COVID Watch nurse calls back to determine if the patient requires a telehealth visit or needs to come to the emergency room for further evaluation. Delgado notes that the program was able to launch so quickly in 2020 because it used a web-based patient engagement platform that was already integrated into the electronic medical record. As a result, he adds, “any patient who came into contact with our health system could be enrolled into COVID Watch.”

Since March of 2020, over 30,000 patients have been enrolled into this innovative program. The team’s use of automated services has allowed them “to engage such a large cohort of people,” Delgado says. Of note, about 80 percent of patients have been managed by the automated system without the need to escalate their care. Those in need of in-person care, however, have also been appropriately identified. Delgado explains that at the beginning of the pandemic, “compared to usual care, patients [enrolled in COVID Watch] were getting to the hospital two to three days faster.” This may explain why patients enrolled in COVID Watch experienced lower mortality rates than patients who received usual care.

Low Tech, High Impact

Delgado believes COVID Watch has been successful, in part, because it was rapidly optimized by real-time feedback from patients and clinicians. He notes that user input helped the team realize that “low tech interventions [like automated text messages] can be as effective and more scalable” than resource-intense initiatives involving wearable devices and other technology. “Engaging patients and clinicians in the design of interventions is critical for developing healthcare tools that people actually want to use and are sustainable,” he adds. Delgado and his team were recently awarded additional PCORI funding to determine if text-message check-ins can help patients with opioid use disorder. As challenges persist with healthcare access, Delgado is hopeful that text messaging-based telehealth interventions will be useful for engaging patients and delivering excellent care outside the walls of the hospital.

Hear more from Delgado during the Results and Lessons from PCORI's COVID-19 Portfolio breakout session. View the full annual meeting agenda and register now!