Abstract
Background: The COVID-19 pandemic has imposed immense stress on global health care systems, especially in low- and middle-income countries (LMICs). Armenia, a middle-income country in the Caucasus region, contended with the pandemic and a concurrent war, resulting in significant demand on its already strained health care infrastructure. The COVID@home program was a multi-institution, international collaboration to address critical hospital bed shortages by implementing a home-based oxygen therapy and remote monitoring program. Objective: The objective of this study was to describe the program protocol and clinical outcomes of implementing an early discharge program in Armenia through a collaboration of partner institutions, which can inform the future implementation of COVID-19 remote home monitoring programs, particularly in LMICs or low-resource settings. Methods: Seven hospitals in Yerevan participated in the COVID@home program. A web app based on OpenMRS was developed to facilitate data capture and care coordination. Patients meeting eligibility criteria were enrolled during hospitalization and monitored daily while on oxygen at home. Program evaluation relied on data extraction from (1) eligibility and enrollment forms, (2) daily monitoring forms, and (3) discharge forms. Results: Over 11 months, 439 patients were screened, and 221 patients were managed and discharged. Around 94% (n=208) of participants safely discontinued oxygen therapy at home, with a median home monitoring duration of 26 (IQR 15-45 days; mean 32.33, SD 25.29) days. Women (median 28.5, mean 35.25 days) had similar length of stay to men (median 26, mean 32.21 days; P=.75). Despite challenges in data collection and entry, the program demonstrated feasibility and safety, with a mortality rate below 1% and low re-admission rate. Opportunities for operational and data quality improvements were identified. Conclusions: This study contributes practical evidence on the implementation and outcomes of a remote monitoring program in Armenia, offering insights into managing patients with COVID-19 in resource-constrained settings. The COVID@home program’s success provides a model for remote patient care, potentially alleviating strain on health care resources in LMICs. Policymakers can draw from these findings to inform the development of adaptable health care solutions during public health crises, emphasizing the need for innovative approaches in resource-limited environments.
| Original language | English (US) |
|---|---|
| Article number | e57703 |
| Journal | JMIR Public Health and Surveillance |
| Volume | 10 |
| DOIs | |
| State | Published - 2024 |
Funding
The authors would like to express their gratitude to all of their team members who made the COVID@home program possible, the clinicians and staff members who tirelessly cared for patients under difficult circumstances, and the patients and families who agreed to participate and made this research possible. We would also like to thank Payal Shah and Lynn Kysh for their indispensable support with citation management and submission preparation. This research project was supported in part by an anonymous gift to Children\u2019s Hospital Los Angeles. JCE\u2019s time was supported in part by grants (UL1TR001855 and UL1TR000130) from the National Center for Advancing Translational Science (NCATS) of the US National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Keywords
- Armenia
- COVID-19
- Yerevan
- global health care
- health care infrastructure
- home monitoring
- home oxygen therapy
- low and middle-income countries
- pandemic
- remote patient monitoring
- resource-constrained
- web platform
ASJC Scopus subject areas
- Health Informatics
- Public Health, Environmental and Occupational Health
