Background
Methods
COVID Watch Overview
Study Participants and Setting
Patient Recruitment and Sampling Strategy
Clinician and Administrator Recruitment and Sampling Strategy
Interview Guide Development
Examples: Patient Questions | Examples: Clinician Questions | |
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Sentiments
| Tell me how you felt when you got the text messages each time from the program.
Prompt: What made you feel that way? What role did COVID Watch play in helping you manage your symptoms, if any? | What led you or your clinical team to use or not use COVID Watch? What was it like to have a patient in COVID Watch? |
Feedback
| What kinds of changes do you think the program needs to make to be more useful for patients in the future? | What recommendations do you have for improving COVID Watch?
Prompt: What would have made it more useful to you?
Prompt: Tell me about any frustrations or difficulties with any aspect of it.
Prompt: What other thoughts do you have about the process, for example about things like the amount of time it took, or the ease of enrolling? |
Lessons for Future Remote Patient Monitoring Programs
|
This line of questioning was not asked of patient participants
| Can you share any “lessons learned” you have had from your experience with COVID Watch that might be relevant for future remote patient monitoring programs? How do you think remote patient monitoring programs could influence your clinical practice in the future? Are there particular areas or conditions that you think remote patient monitoring is most useful for? What parts of COVID Watch’s remote patient monitoring program do you think was the most useful for patients? For you? What aspects of COVID Watch do you think will be important for future remote patient monitoring programs? |
Data Collection and Analysis
Results
Participant Characteristics
Characteristics | N = 47 |
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Age, mean (SD) | 50 (15) |
Gender, no. (%) | |
Female | 32 (68) |
Male | 15 (32) |
Race, no. (%) | |
White | 19 (40) |
Black | 16 (34) |
Other | 12 (26) |
Ethnicity, no. (%) | |
Hispanic or Latino | 6 (13) |
Non-Hispanic or Latino | 41 (87) |
Preferred language, no. (%)
| |
English | 40 (85) |
Spanish | 7 (15) |
Enrollment location, no. (%)
| |
Emergency Department | 21 (45) |
Outpatient Setting | 26 (55) |
Access to a Pulse Oximeter, no. (%)
| |
Yes | 34 (72) |
No | 13 (28) |
Characteristics | Total | ED Clinicians | Primary Care Clinicians | ED Administrators | Primary Care Administrators |
---|---|---|---|---|---|
No. of participants | 38 | 9 | 16 | 9 | 4 |
Gender, no (%) | |||||
Female | 22 (58) | 2 (22) | 13 (81) | 4 (44) | 3 (75) |
Male | 16 (42) | 7 (78) | 3 (19) | 5 (56) | 1 (25) |
Race, no (%) | |||||
White | 33 (87) | 8 (89) | 14 (88) | 9 (100) | 2 (50) |
Asian | 4 (11) | 1 (11) | 1 (6) | 0 (0) | 2 (50) |
Other | 1 (3) | 0 (0) | 1 (6) | 0 (0) | 0 (0) |
Ethnicity, no (%) | |||||
Hispanic Latino/a | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) |
Non-Hispanic Latino/a | 38 (100) | 9 (100) | 16 (100) | 9 (100) | 4 (100) |
Clinician Type, no (%) | |||||
Physician | 22 (58) | 8 (89) | 7 (44) | 4 (44) | 3 (75) |
Physician Assistant | 3 (8) | 1 (11) | 2 (13) | 0 (0) | 0 (0) |
Nurse Practitioner | 5 (13) | 0 (0) | 7 (44) | 0 (0) | 1 (25) |
Years in Clinical Practice, no (%) | |||||
< 5 years | 4 (11) | 1 (11) | 3 (19) | 0 (0) | 0 (0) |
5–10 years | 13 (34) | 1 (11) | 7 (44) | 4 (44) | 0 (0) |
11–20 years | 8 (21) | 4 (44) | 1 (6) | 2 (22) | 2 (50) |
> 20 years | 13 (34) | 3 (33) | 5 (31) | 3 (33) | 2 (50) |
Illustrative Patient Excerpts | |
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Sentiments about COVID Watch | |
Comforting | “[I stayed enrolled because] it was nice knowing that there was a medical professional out there who was aware of my situation and I still, I knew if anything went wrong that, I would be able to be quickly assessed and figure out what next steps would be.” (English speaking, White/Non-Hispanic patient) |
Irritating | “Sometimes they’d text me when I was really tired, but I think I text the wrong response saying I couldn’t breathe or something like that. I don’t know. I was half asleep when I responded, so I think the text is okay. I think it’s cool, but I think they should make phone calls instead of texting … I just thought they was annoying, but I still responded.” (English speaking, Black/Non-Hispanic patient) |
Insufficient | “I just think the phone call could’ve been better because they also would [hear] how you sound as well, because sometimes people can’t really – they hear how they sound. I think that helps as well.” (English speaking, Black/Non-Hispanic patient) |
Feedback for Improving COVID Watch
| |
Improve the Enrollment Process | “I wish everybody was able to get it. I don’t understand why [Family Member Name] was the only one who received it and we’re all [Hospital System patients] … I think they should or at least have an option for [a patient] to say no … I just say for the future, if this continues the way it does, it’s a great feature for folks who are homebound and can’t see a doctor.” (English speaking, White/Non-Hispanic patient) |
Clarify the Monitoring and Escalation Process | “When it says like, ‘if you’re feeling worse, go to the emergency room.’ Well, what does that mean? Like, what level is worse?” (English speaking, White/Non-Hispanic patient)
|
Illustrative Clinician Excerpts | |
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Sentiments about COVID Watch | |
Comforting | “Knowing that the patients are going to have guaranteed follow-up is a huge – it makes it much more comfortable discharging those borderline patients and knowing that that follow-up will be daily and continuous.” (Emergency department administrator) |
Increased Access to Care for Patients | “I used it a lot, because it gives me something for patients who I don’t have a relationship, it gives me some way to hand them off as a safety net for their care. A lot of my patients don’t have primary care, don’t have access to the system I don’t follow them longitudinally. So, it really was a nice mechanism for them to be at least tied in for care during their very nervous time when they had COVID.” (Emergency department clinician) |
Reduced Follow-up Burden | “[COVID Watch] really let me focus on other patients and not following up with the same [ones]. I know that sounds tough, but timing is always difficult. And we always have more patients call in, so it kind of allowed me to pass off the COVID-positive patient, knowing that someone was going to check on them no matter what.” (Primary care clinician) |
Feedback for Improving COVID Watch
| |
Improve the Enrollment Process | “I think [enrolling patients] was like a little bit of a struggle in the beginning. It can be hard to find the right part of the EMR where you enroll patient with the COVID Watch…[when] I started trying to use it on my own, little bit of a struggle, but then I got like another email from [Colleague] and it solidified how to use it. And then I started using it more regularly. Having said that, even now, I still sometimes can’t find how to enroll patients and so I have to like, look for it a little bit, but it only takes me a few clicks before I find it.” (Primary care clinician) |
Provide Solutions for Patients with Limited Device Access or Hesitancy | “Maybe make it if the patient doesn’t know how to text, you guys have someone call or don’t make them text… it might be beneficial to have like, it’s like an 85-year-old that still living by themselves can’t text, they switch it to a phone call.” (Primary care clinician) |
Address Low-Literacy and Language Preferences Among Patients | “Having access to other languages would have been really meaningful. And I think that there was definitely some wide loss in not having other languages available…” (Emergency department clinician) |
Create a Feedback Loop for Clinicians | “[I’d suggest] a report at the end. I don’t know if you’d want to do it every day, but maybe once a week, or once every two weeks, [send] a report of what patients were reached out to and if you have any issues or improving, just so that we’re aware that it is still being done.” (Primary care clinician) |
Clinician Perspectives on the Future of Remote Patient Monitoring
| |
Enhanced Data Collection | “I thought that the implementation of the home pulse oximeter was really helpful. Because I felt like people would say that they were short of breath, but then their number was reassuring. We expected people to get short of breath and we expected people to have some discomfort, but having a very clear number that they could use was helpful. I think that that’s actual data that’s being referred back to the nurse and/or chat system, you know… That enabled the other side of the message to get real information rather than ‘I feel’, and…[being able to] give objective data is obviously helpful.” (Emergency department clinician) |
A Guide for Patients | “Knowing when [a patient] needs to get escalated to a phone call is important. In other words, when [patient care] needs to move off the texting medium and move away from a text bot and towards just a conversation on the phone. Having the right threshold there is important. [With COVID Watch]…there were…even more robust contact with healthcare [clinicians].” (Emergency department administrator) |
Extend Remote Patient Monitoring to Non-COVID-19 Conditions | “From an Emergency Department aspect, I mean, the one I guess– from other types of infections, so not just COVID, but anyone we discharge on antibiotics, we could do kind of a sepsis initiative kind of thing to prevent progression of illness and to prevent antibiotic failure, so kind of check in…So I would say, off the top of my head, that’s probably the highest yield from an Emergency Department perspective and can probably prevent readmissions and even prevent death, potentially.” (Emergency department administrator) |