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?:abstract
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Study Objectives: COVID-19, the disease caused by the SARS-CoV-2 virus, has plagued patients and communities across the world The pandemic has exposed and augmented gaps in access to care, particularly for vulnerable populations Mobile integrated health (MIH) is the use of traditional out-of-hospital providers in untraditional ways to bridge gaps in health care Early in the COVID pandemic, our health care system identified an opportunity to leverage our community’s existing EMS workforce to respond to patients in their homes with confirmed or suspected COVID-19 who were otherwise unable to obtain needed health care services Barriers to care included patient comorbidities in addition to homebound status, lack of transportation, or limited or absent technology to facilitate telehealth evaluation Methods: The primary objective of this novel program is to prevent ED visits by providing an alternative means of evaluating vulnerable populations with limited access to care Patients with confirmed or suspected COVID-19 infection are referred for MIH evaluations through three pathways A) Referred by the Respiratory Illness Clinic (RIC) for evaluation of disease progression in lieu of a referral to the ED;B) Referred by the ED as an alternative to hospital admission;C) Referred by a primary care physician (PCP) in lieu of a referral to the RIC or ED MIH paramedics delivered home-based evaluations within 24 hours of referral Patients not yet tested for COVID receive testing as part of the evaluation Using an algorithm of vital sign thresholds and clinical features, paramedics treat patients in collaboration with a physician or advanced practice provider using telemedicine, and determine whether patients can continue in-home isolation or require ED referral for further treatment and potential hospitalization Results: Over 46 days from April 15 through May 31 our program received 170 patient referrals resulting in 116 (68 2%) dispatches and 102 (60 0%) evaluations Of the declined referrals, failure to meet program criteria was most common (32 patients, 18 8%) followed by direct referral to the ED (16 patients, 9 4%) Most referrals came from our RIC (34 7%) followed by ED (22 4%) and PCP (20 0%) The majority of patients (90 6%) were COVID-19 positive or had results pending at the time of enrollment Of 23 (22 6%) patients experiencing high-risk symptoms at the time of evaluation, ambulatory oxygen saturation < 91% was the most common (17 4%) Overall 92 2% of patients evaluated by our MIH program were able to continue in-home isolation with the remainder referred to the ED There were no emergent transports to the ED Conclusion: During the COVID-19 surge in Massachusetts, our program successfully prevented 93 ED visits among 102 patient evaluations By reducing ED use, we were able to preserve limited hospital resources including personal protective equipment and ED beds, reduce infectious exposure to both staff and patients, and reduce associated health care costs Further, we mitigated health disparities by providing care to those with limited health care access, both physical and technological While our program was safe and effective, with no patients requiring emergent ED transport, future evaluation of a more robust set of outcome data is warranted MIH programs for COVID-19 response can prevent ED visits by safely evaluating and managing vulnerable patients with low-cost, high quality home-based care
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