When the COVID-19 pandemic swept communities across the country last spring and led to mass illness, hospitalizations and deaths, leaders from many patient care organizations began mobilizing both for optimal patient care and for what managed to reduce hospitalizations at a time when many hospitals were filled to capacity. How to properly care for patients with COVID-19 who do not need to be hospitalized but require intensive care?

In California, leaders of the Kaiser Permanente Southern California Integrated Health System, which includes hospitals, medical groups and a health care plan, quickly developed a clinical home monitoring program to reduce the burden on the health care system while keeping patient safety at the forefront. The program was commissioned by Kaiser Permanente’s Southern California regional executive leadership as well as Southern California Permanente Medical Group leaders. A working group was formed that included clinical and operational leaders from pulmonology, infectious diseases, hospital medicine, emergency medicine, continuity of care and population health management. Through a partnership with the organization’s health care innovation department, a set of care pathways was developed in which patients who are given equipment, including a pulse oximeter and thermometer, are given access to an app on a smartphone or computer in which they enter their daily vital signs and symptoms. The program is enhanced with patient education and real-time support in English or Spanish. All of this is supported by a centralized clinical pool of nurses and physicians working 24/7.

To date, more than 16,000 patients have participated in the program, of whom approximately 95 percent have recovered and completed the program and 10 percent have been hospitalized for timely treatment. A higher percentage of patients who died or were hospitalized were found to have comorbidities. Of the patients included in the program, 47 percent were admitted from an inpatient unit, 25 percent from an emergency department and 28 percent from an emergency or outpatient unit. The large number of demographically diverse patients was handled in a short period of time, and the program served as a safe alternative for treating patients outside the organization’s inpatient facilities. For this groundbreaking work, Healthcare Innovation editors honored the Kaiser Permanente Southern California and Southern Permanente Medical Group team as the third place winner in the Healthcare Innovation 2021 Innovator Awards program.

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