Results Summary

What was the research about?

Most people with COVID-19 can safely recover at home. But it can be hard for patients to know when to seek care if their symptoms get worse.

In this project, the research team wanted to learn if a home monitoring program helped patients with COVID-19 get needed follow-up care when symptoms worsened. Patients in the program received text messages twice daily asking how they felt. If patients reported trouble breathing, a doctor called to advise them on treatment or to go to the hospital.

The research team did two studies. First, the team compared people who did and didn’t use the program. Second, the team compared use of the program with and without patients’ reports of their oxygen levels checked with a device at home.

What were the results?

Study 1. Compared with patients who didn’t use the program, patients who used it:

  • Had fewer deaths
  • Had more hospital, telehealth, and emergency room, or ER, visits
  • Went to the ER sooner

The two groups didn’t differ in the number of patients receiving critical care, like using a machine to help them breathe.

Study 2. Patients who used the oxygen monitoring device had more phone contacts with the health system than patients who used the program without the device. The two groups didn’t differ in the number of days patients weren’t in the hospital, deaths, healthcare visits, receipt of critical care, time before going to an ER, or patient-reported anxiety or confidence about their health.

What did the research team do?

Study 1. The research team reviewed health records to identify patients with COVID-19 who did and didn’t use the text message program between March 2020 and November 2020. The study included 7,865 adults with COVID-19. Of patients, 39 percent were non-Hispanic Black, 38 percent were non-Hispanic White, 9 percent were Hispanic, and 14 percent were another or unknown race. The average age was 43, and 60 percent were women. All received care at one health system in Pennsylvania.

Study 2. The research team assigned patients by chance to use the program with and without the oxygen monitoring device between November 2020 and February 2021. The team asked patients to report their oxygen level twice a day through text messages. If oxygen levels went down, a doctor called to advise them. The study included 2,097 adults with COVID-19. Patients had traits like those of patients in study 1.

Patients and caregivers of patients who have had COVID-19, and doctors helped design both studies.

What were the limits of the study?

In study 1, the research team didn’t assign patients by chance to the program. So, the team can’t say for sure that the results were due to the program or something else.

Future research could further test the text message program with patients who may benefit from home symptom monitoring.

How can people use the results?

Health systems can use these results when considering ways to monitor patients with COVID-19 at home.

Final Research Report

This project's final research report is expected to be available by September 2024.

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.

Peer-Review Summary

The Peer-Review Summary for this project will be posted here soon.

Conflict of Interest Disclosures

Project Information

Mucio Kit Delgado, MD, MS
University of Pennsylvania Perelman School of Medicine
Evaluating the Effectiveness and Implementation of an Automated Remote Monitoring Program for COVID-19 Patients

Key Dates

December 2023


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Last updated: January 2, 2024