Primary Care Population Management for COVID-19 Patients
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Division of Internal Medicine and Adult Primary Care, Tufts Medical Center, Boston, MA, USA; 2Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center and Tufts University School of Medicine, Boston, MA, USA.
BACKGROUND: Most patients infected with SARS-CoV-2 have mild to moderate symptoms manageable at home; however, up to 20% develop severe illness requiring additional support. Primary care practices performing population management can use these tools to remotely assess and manage COVID-19 patients and identify those needing additional medical support before becoming critically ill. AIM: We developed an innovative population management approach for managing COVID-19 patients remotely. SETTING: Development, implementation, and evaluation took place in April 2020 within a large urban academic medical center primary care practice. PARTICIPANTS: Our panel consists of 40,000 patients. By April 27, 2020, 305 had tested positive for SARS-CoV-2 by RT-qPCR. Outreach was performed by teams of doctors, nurse practitioners, physician assistants, and nurses. PROGRAM DESCRIPTION: Our innovation includes an algorithm, an EMR component, and a twice daily population report for managing COVID-19 patients remotely. PROGRAM EVALUATION: Of the 305 patients with COVID-19 in our practice at time of submission, 196 had returned to baseline; 54 were admitted to hospitals, six of these died, and 40 were discharged. DISCUSSION: Our population management strategy helped us optimize at-home care for our COVID-19 patients and enabled us to identify those who require inpatient medical care in a timely fashion. J Gen Intern Med DOI: 10.1007/s11606-020-05981-1 © Society of General Internal Medicine 2020
reports of patients dying at home for failure to recognize the severity of their symptoms. It is critical for COVID-19 patients to receive remote support and monitoring so that they can recover successfully at home when possible and be advised when in-person evaluation is needed. This monitoring ensures that patients remain at home when they are safe to do so and avoids exposing health care workers and using valuable PPE unnecessarily. In addition, there are suggestions in the literature that earlier admission to the hospital results in better outcomes.5 Due to responsibility for a large number of patients, access to the results of SARS-CoV-2 testing, and expertise in population management, our primary care practice was able to quickly design, implement, and evaluate an algorithm, an electronic medical record (EMR) component, and a population report for managing COVID-19 patients remotely. We sought to standardize outreach to COVID-19 patients, manage patients effectively at home when appropriate, and identify and quickly facilitate care for those who require inpatient medical support.
SETTING AND PARTICIPANTS
We designed, implemented, and evaluated our innovative approach within a large primary care practice at an urban academic medical center. The study was deemed exempt by the Tufts Health Sciences Institutional Revie
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