Remote Monitoring Reduces Mortality and Hospitalizations Among COVID-19 Patients. Data from the Polish Nationwide Program

Background: Early diagnosis of progressive respiratory failure and immediate hospitalization are essential components of providing care for SARS-CoV-2 patients. This is a huge challenge due to the insidious nature of COVID-19, hence it is necessary to implement system solutions to facilitate this process. Already in Autumn 2020, in light of the growing second wave of the COVID-19 pandemic and the associated increase in mortality in Poland, the Ministry of Health launched a national remote monitoring program (Home Medical Care – HMC) for COVID-19 outpatients.Methods: The analysis of data obtained from the first six and half months of the national HMC program was conducted to evaluate its effectiveness in terms of its effects on COVID-19-related mortality and hospitalizations. HMC covered patients with confirmed SARS-CoV-2 infection, who were older than 18 years. Only unvaccinated patients were included in the analysis for this publication to eliminate the effect of being vaccinated on the parameters studied. The effectiveness of the HMC program against COVID-19 was calculated based on COVID-19-related mortality and hospitalization rates in population included in the program compared with the rates in the population outside the program, considering individual age groups (18–44, 45–54, 55–64, 65–74, 75–84 and +85 years).A total of 551 463 unvaccinated patients were involved in the HMC program and they were divided into two groups: active patients (group A) who sent at least one result of pulse oximetry measurement to the system (n = 86 036; 15·6%) and passive patients (group B) who did not send any results (n = 465 427; 84·4%). Group C consists of unvaccinated patients outside the HMC program, who were diagnosed with SARS-CoV-2 since December 2020 (n = 1 104 367). The median age of active population included in the HMC program was 60 years (IQR 55-65), 65 years (IQR 60-72) for passive population and 40 years (IQR 32-49) for the population outside the HMC program.Findings: A total of 1 655 830 SARS-CoV-2 infections, 132 396 hospitalizations and 43 081 deaths due to COVID-19 were analyzed from 5 November 2020 to 19 May 2021 among the unvaccinated population in Poland. Mortality was lower in active population compared to passive and outside the HMC program populations (1·12% vs. 2·97% and 3·66%, respectively), where a relative risk of COVID-19-related death was 2·69 (95% CI: 2·48-2·92) for passive population and 3·32 (95% CI: 3·07-3·60) for the population outside the HMC program. Importantly, the hospitalization rate was also lower in active population compared to passive and outside the HMC program populations (5·16% vs. 10·23% and 12·24%, respectively), where the relative risk of COVID-19-related hospitalization was 2·06 (95% CI: 1·98-2·14) for passive population and 2·57 (95% CI: 2·47-2·67) for the population outside the HMC program.Interpretation: The remote home monitoring of patients with confirmed SARS-CoV-2 infection has a high efficacy in reduction of mortality and hospitalizations, and it should be in common use as a valuable tool that counteracts the effects of the COVID-19 pandemic.Funding: Ministry of Health in PolandDeclaration of Interest: The authors declare no conflict of interest.Ethical Approval: Ethical approval was not sought for the present study because it did not directly involve human participants. This study was completed in accordance with the Helsinki Declarationas revised in 2013