The impact of remote home monitoring of people with COVID-19 using pulse oximetry: A national population and observational study

Chris Sherlaw-Johnson; Theo Georghiou; Steve Morris; Nadia E Crellin; Ian Litchfield; Efthalia Massou; Manbinder S Sidhu; Sonila M Tomini; Cecilia Vindrola-Padros; Holly Walton; Naomi J Fulop

doi:10.1016/j.eclinm.2022.101318

The impact of remote home monitoring of people with COVID-19 using pulse oximetry: A national population and observational study

EClinicalMedicine. 2022 Mar:45:101318. doi: 10.1016/j.eclinm.2022.101318. Epub 2022 Mar 1.

Affiliations

¹ Nuffield Trust, 59 New Cavendish Street, London, Northern Ireland W1G 7LP, United Kingdom.
² Department of Public Health and Primary Care, University of Cambridge, Northern Ireland, United Kingdom.
³ College of Medical and Dental Sciences, University of Birmingham, Institute of Applied Health Research, 40 Edgbaston Park Rd, Birmingham, Northern Ireland B15 2RT, United Kingdom.
⁴ Health Services Management Centre, School of Social Policy, University of Birmingham, 40 Edgbaston Park Rd, Birmingham, Northern Ireland B15 2RT, United Kingdom.
⁵ Department of Applied Health Research, University College London, Gower Street London, Northern Ireland WC1E 6BT, United Kingdom.
⁶ Department of Targeted Intervention, Charles Bell House, University College London, 43-45 Foley Street, London, Northern Ireland W1W 7TY, United Kingdom.

Abstract

Background: Remote home monitoring of people testing positive for COVID-19 using pulse oximetry was implemented across England during the Winter of 2020/21 to identify falling blood oxygen saturation levels at an early stage. This was hypothesised to enable earlier hospital admission, reduce the need for intensive care and improve survival. This study is an evaluation of the clinical effectiveness of the pre-hospital monitoring programme, COVID oximetry @home (CO@h).

Methods: The setting was all Clinical Commissioning Group (CCG) areas in England where there were complete data on the number of people enrolled onto the programme between 2nd November 2020 and 21st February 2021. We analysed relationships at a geographical area level between the extent to which people aged 65 or over were enrolled onto the programme and outcomes over the period between November 2020 to February 2021.

Findings: For every 10% increase in coverage of the programme, mortality was reduced by 2% (95% confidence interval:4% reduction to 1% increase), admissions increased by 3% (-1% to 7%), in-hospital mortality fell by 3% (-8% to 3%) and lengths of stay increased by 1·8% (-1·2% to 4·9%). None of these results are statistically significant, although the confidence interval indicates that any adverse effect on mortality would be small, but a mortality reduction of up to 4% may have resulted from the programme.

Interpretation: There are several possible explanations for our findings. One is that CO@h did not have the hypothesised impact. Another is that the low rates of enrolment and incomplete data in many areas reduced the chances of detecting any impact that may have existed. Also, CO@h has been implemented in many different ways across the country and these may have had varying levels of effect.

Funding: This is independent research funded by the National Institute for Health Research, Health Services & Delivery Research programme (RSET Project no. 16/138/17; BRACE Project no. 16/138/31) and NHSEI. NJF is an NIHR Senior Investigator.

Keywords: COVID-19; Clinical effectiveness; Remote home monitoring; SARS-CoV-2; Silent hypoxia; Virtual wards.