JMIR Publications

ABSTRACT

Background:

Survivors of COVID-19 acute respiratory distress syndrome (ARDS) with long-lasting impairments are at high-risk for unanticipated healthcare utilization post discharge.

Objective:

We explored the feasibility of instituting a COVID-19 ARDS intensive care unit (ICU) survivor telemedicine (TM) clinic and examined its effect on healthcare utilization post discharge.

Methods:

This randomized, unblinded, single-center, parallel-group exploratory study was conducted at a rural, academic, tertiary-care medical center. Study group (SG) participants underwent a TM visit within 14 days of discharge, during which a six-minute walk test (6MWT), a EuroQoL 5-Dimension (EQ-5D) questionnaire, and vital signs logs (VSL) were reviewed by an intensivist. The control group (CG) received a TM visit within six weeks of discharge and completed the EQ-5D questionnaire.

Results:

Both SG (n=20) and CG (n=20) participants had similar baseline characteristics and dropout rate (10%). Among SG participants, 72.2% agreed to follow up in the pulmonary clinic compared to 50.0% of CG participants (p=0.31). Unanticipated visits to the emergency department were lower in the SG compared to the CG (11.1% vs. 5.6%). There was a lower rate of pain/discomfort (66.7% vs. 61.1%, p=0.72) and anxiety/depression (72.2% vs. 61.1%, p=0.59) in the SG compared to the CG. Participants’ self-assessed health rating scores were higher in the SG (M=73.9, SD 16.1) compared to the CG (M=70.6, SD 20.9) (p=0.59). Primary care physicians (PCP) and participants perceived the TM clinic as a favorable model for post-discharge critical illness follow-up.

Conclusions:

This exploratory study found no statistically significant results in reducing healthcare utilization post-discharge and HRQoL. However, PCP and patients perceived TM as a feasible and favorable model for post-discharge care among COVID-19 ICU survivors to facilitate expedited subspecialty assessment, decrease unanticipated post-discharge healthcare utilization, and reduce post-intensive care syndrome. Further investigation is warranted to determine the feasibility of incorporating TM-based post-hospitalization follow-up for all medical ICU survivors. Clinical Trial: The Institutional Review Board (IRB) at West Virginia University (WVU) approved the study (#2104284924) on July 7, 2021.