Project Summary
This research project is in progress. PCORI will post the research findings on this page within 90 days after the results are final. In the meantime, results have been published in peer-reviewed journals, as listed below.
PCORI has identified COVID-19 as an important research topic. Patients, clinicians, and others want to learn: What are effective ways to prevent or reduce the impact of COVID-19, especially on vulnerable populations and the healthcare workforce? To help answer this question, PCORI launched an initiative in 2020 to Strengthen Understanding of COVID-19 Impact and Inform Healthcare Responses. The initiative funded this research project and others.
What is the research about?
COVID-19 is a viral disease that can be mild or severe. About 90 percent of adults with COVID-19 don’t need hospital care. Most people can stay home and monitor their symptoms. But it can be hard for patients to know when to seek hospital care if their symptoms get worse.
One way to support patients with COVID-19 at home is through remote home monitoring using phone calls, video visits, or text messaging. Patients can also use a pulse oximeter. This device clips onto the patient’s fingertip and can detect if their oxygen levels are too low. It can help patients know if they should go to the hospital.
In this study, the research team is comparing how well patients with COVID-19 recover at home with or without remote home monitoring. The team is also testing remote home monitoring with and without a pulse oximeter. In addition, the team is looking at how well these home monitoring approaches help Black and Latino patients. Black and Latino patients have higher rates of serious health problems and death from COVID-19 than White patients.
Who can this research help?
Results may help doctors when considering ways to monitor patients with COVID-19 at home.
What is the research team doing?
The study has three parts. The first part is using data from electronic health records, or EHRs, for 11,903 people diagnosed with COVID-19 who do and don’t receive remote home monitoring. More than half of the people included are Black or Latino. In remote home monitoring, patients receive a text message twice a day asking if they have shortness of breath. If a patient’s responses suggest the need for follow-up care, a nurse contacts the patient by phone or video within one hour. Doctors then conduct phone or video visits with the patient if needed.
In the second part, the research team is enrolling 1,233 people with COVID-19 who are receiving care at a health system in Philadelphia. All patients are receiving usual care and remote home monitoring. Usual care includes phone or video calls or emergency room visits as needed. The team is assigning patients by chance to receive or not receive a pulse oximeter.
In both part 1 and part 2, the research team is looking at EHRs to see if patients go to the hospital or die in the 30 days after testing positive for COVID-19. The team is exploring whether these outcomes differ for Black and Latino patients.
In the third part, the research team is interviewing doctors and patients. The team wants to learn how they use remote home monitoring.
Community members, people who have had COVID-19, and experts in racial equity are helping to design the study.
Research methods at a glance
| Design Elements | Description |
|---|---|
| Design | Part 1. Observational (retrospective) cohort study Part 2. Randomized controlled trial Part 3. Mixed-methods analysis |
| Population | Part 1. 11,903 adults over age 17 who have tested positive for COVID-19 Part 2. 1,233 adults over age 17 who have tested positive for COVID-19 Part 3. About 30 doctors and 35 patients |
| Interventions/ Comparators |
Part 1. Remote home monitoring versus no remote home monitoring Part 2. Usual care with remote home monitoring versus usual care with remote home monitoring plus fingertip pulse oximeter |
| Outcomes | Days alive, days out of hospital |
| Timeframe | 30-day follow-up |
More to Explore...
2021 PCORI Virtual Annual Meeting: Poster Presentation
Outcomes of Automated Home Monitoring for COVID-19
During the meeting, Principal Investigator Mucio "Kit" Delgado, MD, MS, presented a poster outlining the results of the first part of the study, which were also published in the Annals of Internal Medicine.
Journal Citations
Article Highlights:
- Patients with COVID-19 who were remotely monitored at home using a text-message-based program — known as COVID Watch — did not experience better outcomes if they used a pulse oximeter, according to research findings published in the New England Journal of Medicine. Supported in part by PCORI funding, this study compared patients who received standard care as part of the COVID Watch program to patients in the same program who were also given a pulse oximeter to monitor their oxygen levels. Researchers found that adding the pulse oximeter did not save more lives or keep more people out of the hospital.
- A system designed to monitor COVID-19 patients at home using automated text messages saved a life about twice a week during the early days of the pandemic, and overall, patients who enrolled in the system — called COVID Watch — were 68 percent less likely to die, according to results published in the Annals of Internal Medicine. Supported in part by PCORI funding, this study analyzed data from every adult who received outpatient care from Penn Medicine over eight months in 2020. Regardless of income, race, or health risks, patients enrolled in COVID Watch benefited, likely due to increased access to and use of telemedicine as well as more frequent and earlier trips to the hospital when symptoms worsened—an average of two days earlier for COVID Watch patients. This paper received AcademyHealth's 2022 Publication of the Year Award. It was also included on the Annals of Internal Medicine's "Best of 2021" list.