The following is a summary of “An outpatient model of care for COVID-19 infected kidney transplant patients – The hospital-at-home,” published in the May 2023 issue of Nephrology by Liew, et al.
The COVID-19 pandemic continued to pose challenges for healthcare systems, with periodic surges caused by viral variants. However, advancements in COVID-19 vaccines, antiviral therapy, monoclonal antibodies, and telemedicine have significantly reduced the morbidity and mortality associated with COVID-19. Telemedicine, in particular, has emerged as a valuable tool for remote monitoring and care. These developments have paved the way for adopting a hospital-at-home (HaH) model of care for kidney transplant recipients (KTRs) infected with COVID-19.
In the study, KTRs with confirmed COVID-19 infection underwent triage and laboratory tests through teleconsultation. Suitable patients were then enrolled in the HaH program, where daily remote monitoring via teleconsults was conducted. Patients remained in the HaH program until they met the criteria for de-isolation based on a predetermined time-based criterion. Monoclonal antibodies were administered in a dedicated clinic when indicated.
A total of 81 KTRs with COVID-19 were enrolled in the HaH program between February and June 2022. Among them, 70 (86.4%) completed their recovery in the HaH program without any complications. Eleven patients (13.6%) required inpatient hospitalization, either for medical issues (n = 8) or weekend monoclonal antibody infusion (n = 3). Patients who required inpatient hospitalization had longer time since transplantation (15 years vs. 10 years, P = .03), lower hemoglobin levels (11.6 g/dL vs. 13.1 g/dL, P = .01), lower estimated glomerular filtration rate (39.8 vs. 62.9 mL/min/1.73 m2, P < .05), and lower levels of receptor binding domain (RBD) antibodies (<50 AU/mL vs. 1,435 AU/mL, P = .02). The HaH program saved a total of 753 inpatient patient-days, with no deaths observed. The hospital admission rate from the HaH program was 13.6%, and patients requiring inpatient care were directly admitted without utilizing emergency department resources.
Selected KTRs with COVID-19 infection can be safely managed in a HaH program, which helps alleviate the strain on inpatient and emergency healthcare resources.
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