A Pilot Study of the Efficacy and Economical Sustainability of Acute Coronavirus Disease 2019 Patient Management in an Outpatient Setting.

Autor: De Lorenzo R; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.; Unit of Hospital-Primary Care Embedding, San Raffaele Hospital, Milan, Italy., Montagna M; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.; Unit of Hospital-Primary Care Embedding, San Raffaele Hospital, Milan, Italy., Bossi E; Clinical Governance Division, San Raffaele Hospital, Milan, Italy., Vitali G; Unit of Hospital-Primary Care Embedding, San Raffaele Hospital, Milan, Italy., Taino A; Unit of Internal Medicine, Luigi Sacco Hospital, Azienda Socio Sanitaria Territoriale - Fatebenefratelli (ASST-FBF)-Sacco, Milan, Italy., Cilla M; Unit of Hospital-Primary Care Embedding, San Raffaele Hospital, Milan, Italy., Pata G; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.; Unit of Hospital-Primary Care Embedding, San Raffaele Hospital, Milan, Italy., Lazorova L; Unit of Hospital-Primary Care Embedding, San Raffaele Hospital, Milan, Italy., Pesenti R; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy., Pomaranzi C; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.; Unit of Hospital-Primary Care Embedding, San Raffaele Hospital, Milan, Italy., Bussolari C; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.; Unit of Hospital-Primary Care Embedding, San Raffaele Hospital, Milan, Italy., Martinenghi S; Unit of Hospital-Primary Care Embedding, San Raffaele Hospital, Milan, Italy., Bordonaro N; Unit of Hospital-Primary Care Embedding, San Raffaele Hospital, Milan, Italy., Di Napoli D; Clinical Governance Division, San Raffaele Hospital, Milan, Italy., Rizzardini G; Unit of Infectious Diseases, Luigi Sacco Hospital, Azienda Socio Sanitaria Territoriale - Fatebenefratelli (ASST-FBF)-Sacco, Milan, Italy., Cogliati C; Unit of Internal Medicine, Luigi Sacco Hospital, Azienda Socio Sanitaria Territoriale - Fatebenefratelli (ASST-FBF)-Sacco, Milan, Italy., Morici N; Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) S. Maria Nascente - Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy., Rovere-Querini P; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.; Unit of Hospital-Primary Care Embedding, San Raffaele Hospital, Milan, Italy.
Jazyk: angličtina
Zdroj: Frontiers in medicine [Front Med (Lausanne)] 2022 Apr 27; Vol. 9, pp. 892962. Date of Electronic Publication: 2022 Apr 27 (Print Publication: 2022).
DOI: 10.3389/fmed.2022.892962
Abstrakt: Objective: To report a preliminary experience of outpatient management of patients with Coronavirus disease 2019 (COVID-19) through an innovative approach of healthcare delivery.
Patients and Methods: Patients evaluated at the Mild-to-Moderate COVID-19 Outpatient clinics (MMCOs) of San Raffaele University Hospital and Luigi Sacco University Hospital in Milan, Italy, from 1 October 2020 to 31 October 2021 were included. Patients were referred by general practitioners (GPs), Emergency Department (ED) physicians or hospital specialists (HS) in case of moderate COVID-19. A classification and regression tree (CART) model predicting ED referral by MMCO physicians was developed to aid GPs identify those deserving immediate ED admission. Cost-effectiveness analysis was also performed.
Results: A total of 660 patients were included. The majority (70%) was referred by GPs, 21% by the ED and 9% by HS. Patients referred by GPs had more severe disease as assessed by peripheral oxygen saturation (SpO 2 ), ratio of arterial oxygen partial pressure to fractional inspired oxygen (PaO 2 /FiO 2 ), C-reactive protein (CRP) levels and interstitial involvement at lung ultrasound. Among them, 18% were addressed to the ED following MMCO assessment. CART analysis identified three independent predictors, namely home-measured SpO 2 , age and body mass index (BMI), that robustly divide patients into risk groups of COVID-19 severity. Home-measured SpO 2 < 95% and BMI ≥ 33 Kg/m 2 defined the high-risk group. The model yielded an accuracy (95% CI) of 83 (77-88)%. Outpatient management of COVID-19 patients allowed the national healthcare system to spare 1,490,422.05 € when compared with inpatient care.
Conclusion: Mild-to-moderate COVID-19 outpatient clinics were effective and sustainable in managing COVID-19 patients and allowed to alleviate pressure on EDs and hospital wards, favoring effort redirection toward non-COVID-19 patients.
Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
(Copyright © 2022 De Lorenzo, Montagna, Bossi, Vitali, Taino, Cilla, Pata, Lazorova, Pesenti, Pomaranzi, Bussolari, Martinenghi, Bordonaro, Di Napoli, Rizzardini, Cogliati, Morici and Rovere-Querini.)
Databáze: MEDLINE
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