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      Implementation of a multisite, interdisciplinary remote patient monitoring program for ambulatory management of patients with COVID-19

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          Abstract

          Established technology, operational infrastructure, and nursing resources were leveraged to develop a remote patient monitoring (RPM) program for ambulatory management of patients with COVID-19. The program included two care-delivery models with different monitoring capabilities supporting variable levels of patient risk for severe illness. The primary objective of this study was to determine the feasibility and safety of a multisite RPM program for management of acute COVID-19 illness. We report an evaluation of 7074 patients served by the program across 41 US states. Among all patients, the RPM technology engagement rate was 78.9%. Rates of emergency department visit and hospitalization within 30 days of enrollment were 11.4% and 9.4%, respectively, and the 30-day mortality rate was 0.4%. A multisite RPM program for management of acute COVID-19 illness is feasible, safe, and associated with a low mortality rate. Further research and expansion of RPM programs for ambulatory management of other acute illnesses are warranted.

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          Telehealth Transformation: COVID-19 and the rise of Virtual Care

          Abstract The novel coronavirus disease-19 (COVID-19) pandemic has altered our economy, society and healthcare system. While this crisis has presented the US healthcare delivery system with unprecedented challenges, the pandemic has catalyzed rapid adoption of telehealth or the entire spectrum of activities used to deliver care at a distance. Using examples reported by US healthcare organizations including ours, we describe the role telehealth has played in transforming healthcare delivery during the three phases of the US COVID-19 pandemic: 1) Stay-at-Home Outpatient Care; 2) Initial COVID-19 Hospital Surge, and 3) Post-Pandemic Recovery. Within each of these three phases, we examine how people, process and technology work together to support a successful telehealth transformation. Whether healthcare enterprises are ready or not, the new reality is that virtual care has arrived.
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            COVID-19 transforms health care through telemedicine: evidence from the field

            Abstract This study provides data on the feasibility and impact of video-enabled telemedicine use among patients and providers and its impact on urgent and non-urgent health care delivery from one large health system (NYU Langone Health) at the epicenter of the COVID-19 outbreak in the United States. Between March 2nd and April 14th 2020, telemedicine visits increased from 369.1 daily to 866.8 daily (135% increase) in urgent care after the system-wide expansion of virtual health visits in response to COVID-19, and from 94.7 daily to 4209.3 (4345% increase) in non-urgent care post expansion. Of all virtual visits post expansion, 56.2% and 17.6% urgent and non-urgent visits, respectively, were COVID-19-related. Telemedicine usage was highest by patients aged 20-44, particularly for urgent care. The COVID-19 pandemic has driven rapid expansion of telemedicine use for urgent care and non-urgent care visits beyond baseline periods. This reflects an important change in telemedicine that other institutions facing the COVID-19 pandemic should anticipate.
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              Assessing the age specificity of infection fatality rates for COVID-19: systematic review, meta-analysis, and public policy implications

              Determine age-specific infection fatality rates for COVID-19 to inform public health policies and communications that help protect vulnerable age groups. Studies of COVID-19 prevalence were collected by conducting an online search of published articles, preprints, and government reports that were publicly disseminated prior to 18 September 2020. The systematic review encompassed 113 studies, of which 27 studies (covering 34 geographical locations) satisfied the inclusion criteria and were included in the meta-analysis. Age-specific IFRs were computed using the prevalence data in conjunction with reported fatalities 4 weeks after the midpoint date of the study, reflecting typical lags in fatalities and reporting. Meta-regression procedures in Stata were used to analyze the infection fatality rate (IFR) by age. Our analysis finds a exponential relationship between age and IFR for COVID-19. The estimated age-specific IFR is very low for children and younger adults (e.g., 0.002% at age 10 and 0.01% at age 25) but increases progressively to 0.4% at age 55, 1.4% at age 65, 4.6% at age 75, and 15% at age 85. Moreover, our results indicate that about 90% of the variation in population IFR across geographical locations reflects differences in the age composition of the population and the extent to which relatively vulnerable age groups were exposed to the virus. These results indicate that COVID-19 is hazardous not only for the elderly but also for middle-aged adults, for whom the infection fatality rate is two orders of magnitude greater than the annualized risk of a fatal automobile accident and far more dangerous than seasonal influenza. Moreover, the overall IFR for COVID-19 should not be viewed as a fixed parameter but as intrinsically linked to the age-specific pattern of infections. Consequently, public health measures to mitigate infections in older adults could substantially decrease total deaths. Electronic supplementary material The online version of this article (10.1007/s10654-020-00698-1) contains supplementary material, which is available to authorized users.
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                Author and article information

                Contributors
                haddad.tufia@mayo.edu
                Journal
                NPJ Digit Med
                NPJ Digit Med
                NPJ Digital Medicine
                Nature Publishing Group UK (London )
                2398-6352
                13 August 2021
                13 August 2021
                2021
                : 4
                : 123
                Affiliations
                [1 ]GRID grid.66875.3a, ISNI 0000 0004 0459 167X, Center for Digital Health, , Mayo Clinic, ; Rochester, MN USA
                [2 ]GRID grid.66875.3a, ISNI 0000 0004 0459 167X, Kern Center for the Science of Health Care Delivery, , Mayo Clinic, ; Rochester, MN USA
                [3 ]GRID grid.66875.3a, ISNI 0000 0004 0459 167X, Department of Nursing, , Mayo Clinic, ; Rochester, MN USA
                [4 ]GRID grid.66875.3a, ISNI 0000 0004 0459 167X, Department of Management Engineering and Consulting, , Mayo Clinic, ; Rochester, MN USA
                [5 ]GRID grid.66875.3a, ISNI 0000 0004 0459 167X, Division of Pulmonary and Critical Care Medicine, , Mayo Clinic, ; Rochester, MN USA
                [6 ]GRID grid.66875.3a, ISNI 0000 0004 0459 167X, Division of Infectious Diseases, , Mayo Clinic, ; Rochester, MN USA
                [7 ]GRID grid.470142.4, ISNI 0000 0004 0443 9766, Division of Infectious Diseases, , Mayo Clinic, ; Phoenix, AZ USA
                [8 ]GRID grid.417467.7, ISNI 0000 0004 0443 9942, Division of General Internal Medicine, , Mayo Clinic, ; Jacksonville, FL USA
                [9 ]GRID grid.66875.3a, ISNI 0000 0004 0459 167X, Division of General Internal Medicine, , Mayo Clinic, ; Rochester, MN USA
                [10 ]GRID grid.66875.3a, ISNI 0000 0004 0459 167X, Department of Oncology, , Mayo Clinic, ; Rochester, MN USA
                Author information
                http://orcid.org/0000-0002-5256-0654
                http://orcid.org/0000-0001-8226-3581
                Article
                490
                10.1038/s41746-021-00490-9
                8363637
                34389787
                9dd5b245-0b57-4ea0-bc0d-05d7f8862c79
                © The Author(s) 2021

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 10 March 2021
                : 21 July 2021
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                © The Author(s) 2021

                outcomes research,rehabilitation
                outcomes research, rehabilitation

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