TY - JOUR
T1 - Association of Race and Neighborhood Disadvantage with Patient Engagement in a Home-Based COVID-19 Remote Monitoring Program
AU - Fritz, Bradley A.
AU - Ramsey, Brett
AU - Taylor, Dick
AU - Shoup, John Paul
AU - Schmidt, Jennifer M.
AU - Guinn, Megan
AU - Maddox, Thomas M.
N1 - Funding Information:
Contributors: The authors would like to acknowledge Maria Gerritzen, Stacy Olinger, Nathan Moore, Michele Thomas, Janice Ernest, and Beth LeCorgne for their leadership and support of the COVID Home Monitoring Program and Andrew Guyton for the hours of technical build to make the program work, as well as Julie Fox and the group of medical assistants, care managers, and nurses caring for COVID patients every day. We never tire of hearing the patients praise the tremendous job they do every day.
Funding Information:
This work was supported by BJC Healthcare and Washington University School of Medicine. Dr. Fritz received support from the National Institutes of Health (T32 GM108539) and the Foundation for Anesthesia Education and Research (MRTG08152020FRITZ) during the conduct of this study. Dr. Maddox discloses current grant funding from the NIH NCATS (1U24TR002306-01: A National Center for Digital Health Informatics Innovation) and honoraria and/or expense reimbursement in the past 3 years from the Henry Ford health system (March 2019), the University of California San Diego (January 2020), the University of Chicago (Jan 2021) and George Washington University (Jan 2021). He has also received travel expense reimbursement for meetings connected to the American College of Cardiology. He is currently employed as a cardiologist and the executive director of the Healthcare Innovation Lab at BJC HealthCare/Washington University School of Medicine. In this capacity, he is advising Myia Labs, for which his employer is receiving equity compensation in the company. He is receiving no individual compensation from the company. He is also a compensated director for a New Mexico-based foundation, the J.F Maddox Foundation.
Publisher Copyright:
© 2021, Society of General Internal Medicine.
PY - 2022/3
Y1 - 2022/3
N2 - Background: COVID-positive outpatients may benefit from remote monitoring, but such a program often relies on smartphone apps. This may introduce racial and socio-economic barriers to participation. Offering multiple methods for participation may address these barriers. Objectives: (1) To examine associations of race and neighborhood disadvantage with patient retention in a monitoring program offering two participation methods. (2) To measure the association of the program with emergency department visits and hospital admissions. Design: Retrospective propensity-matched cohort study. Participants: COVID-positive outpatients at a single university-affiliated healthcare system and propensity-matched controls. Interventions: A home monitoring program providing daily symptom tracking via patient portal app or telephone calls. Main Measures: Among program enrollees, retention (until 14 days, symptom resolution, or hospital admission) by race and neighborhood disadvantage, with stratification by program arm. In enrollees versus matched controls, emergency department utilization and hospital admission within 30 days. Key Results: There were 7592 enrolled patients and 9710 matched controls. Black enrollees chose the telephone arm more frequently than White enrollees (68% versus 44%, p = 0.009), as did those from more versus less disadvantaged neighborhoods (59% versus 43%, p = 0.02). Retention was similar in Black enrollees and White enrollees (63% versus 62%, p = 0.76) and in more versus less disadvantaged neighborhoods (63% versus 62%, p = 0.44). When stratified by program arm, Black enrollees had lower retention than White enrollees in the app arm (49% versus 55%, p = 0.01), but not in the telephone arm (69% versus 71%, p = 0.12). Compared to controls, enrollees more frequently visited the emergency department (HR 1.71 [95% CI 1.56–1.87]) and were admitted to the hospital (HR 1.16 [95% CI 1.02–1.31]). Conclusions: In a COVID-19 remote patient monitoring program, Black enrollees preferentially selected, and had higher retention in, telephone- over app-based monitoring. As a result, overall retention was similar between races. Remote monitoring programs with multiple modes may reduce barriers to participation.
AB - Background: COVID-positive outpatients may benefit from remote monitoring, but such a program often relies on smartphone apps. This may introduce racial and socio-economic barriers to participation. Offering multiple methods for participation may address these barriers. Objectives: (1) To examine associations of race and neighborhood disadvantage with patient retention in a monitoring program offering two participation methods. (2) To measure the association of the program with emergency department visits and hospital admissions. Design: Retrospective propensity-matched cohort study. Participants: COVID-positive outpatients at a single university-affiliated healthcare system and propensity-matched controls. Interventions: A home monitoring program providing daily symptom tracking via patient portal app or telephone calls. Main Measures: Among program enrollees, retention (until 14 days, symptom resolution, or hospital admission) by race and neighborhood disadvantage, with stratification by program arm. In enrollees versus matched controls, emergency department utilization and hospital admission within 30 days. Key Results: There were 7592 enrolled patients and 9710 matched controls. Black enrollees chose the telephone arm more frequently than White enrollees (68% versus 44%, p = 0.009), as did those from more versus less disadvantaged neighborhoods (59% versus 43%, p = 0.02). Retention was similar in Black enrollees and White enrollees (63% versus 62%, p = 0.76) and in more versus less disadvantaged neighborhoods (63% versus 62%, p = 0.44). When stratified by program arm, Black enrollees had lower retention than White enrollees in the app arm (49% versus 55%, p = 0.01), but not in the telephone arm (69% versus 71%, p = 0.12). Compared to controls, enrollees more frequently visited the emergency department (HR 1.71 [95% CI 1.56–1.87]) and were admitted to the hospital (HR 1.16 [95% CI 1.02–1.31]). Conclusions: In a COVID-19 remote patient monitoring program, Black enrollees preferentially selected, and had higher retention in, telephone- over app-based monitoring. As a result, overall retention was similar between races. Remote monitoring programs with multiple modes may reduce barriers to participation.
KW - COVID-19
KW - ambulatory monitoring
KW - facilities and services utilization
KW - race factors
UR - http://www.scopus.com/inward/record.url?scp=85122454332&partnerID=8YFLogxK
U2 - 10.1007/s11606-021-07207-4
DO - 10.1007/s11606-021-07207-4
M3 - Article
C2 - 34993862
AN - SCOPUS:85122454332
VL - 37
SP - 838
EP - 846
JO - Journal of General Internal Medicine
JF - Journal of General Internal Medicine
SN - 0884-8734
IS - 4
ER -