Coronavirus home treatment program helps prevent hospitalizations at the University of Iowa Hospitals and Clinics

IOWA CITY — While the health care system statewide grappled with a record number of coronavirus patients over the past several weeks, the University of Iowa Hospitals and Clinics’ “virtual hospital” program has helped alleviate some of the pressure, officials say.

The UIHC Home Treatment Team, which started early in the coronavirus pandemic, is a targeted initiative that provides daily direct care at home, in an effort to keep COVID-19 patients out of the hospital.

The team now has seen about 1,300 patients with high risk for complications of the virus. But to date, only 9 percent have required a hospital bed during their care. Only about 2 percent have required a bed in the intensive-care unit.

“I think that this program is something that’s helped keep our beds open to the best of our abilities,” said Dr. Andrew Bryant, clinical assistant professor of internal medicine and UI Health Care hospitalist. “Trying to manage any of these patients that we can at home makes that difference.”

According to the federal Centers for Disease Control and Prevention, the national rate of hospitalization for all adults without an underlying medical condition who are diagnosed with COVID-19 is about 9 percent.

That rate is comparable to UIHC’s rate of hospitalization for high-risk patients with complicating risk factors enrolled in the program, leading the Home Treatment Team to interpret that they have been successful in preventing hospitalizations.

“We’re having the same hospitalization rate with (a high risk group) that nationally they’re seeing among everybody, so I think that’s the best way we can make a comparison,” said Dr. Bradley Manning, clinical assistant professor of internal medicine and a hospitalist with UI Health Care.

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Officials noted it is hard to determine the precise number of patients that otherwise would have been admitted to the hospital without the Home Treatment Team, as the initiative has been in existence since April and the hospital doesn’t have a control group with which to compare it, Manning said.

However, Manning said other health care systems across the state that have modeled initiatives after UIHC’s care team have noted a marked difference in their hospitalization rates.

Genesis Health System in the Quad Cities, which spoke extensively with UIHC before establishing their own virtual hospital model for COVID-19 patients, have noted a decreased hospitalization rate ever since, Manning said.

Many who are diagnosed with COVID-19 don’t require a hospital visit, and the program aims to provide added support via telemedicine from nurses, physicians, pharmacists and other staff to patients recovering at home.

Patients in the program receive a monitoring kit, which includes a blood pressure cuff and pulse oximeter that allow providers to check vitals daily and assess their condition.

This also allows the care team to intervene quickly if the illness worsens. If a patient does require a hospital visit, providers have been able to streamline the admittance process for patients.

They’ve also been able to discharge some COVID-19 patients early.

Depending on their level of need, patients may receive daily calls from the team. For many, it simply can serve as a reminder to patients to drink plenty of fluids, as early symptoms for some make it hard for them to drink or eat enough, Manning said.

In addition to meeting their medical needs and reinforcing the importance of home isolation to prevent transmission to others, Bryant said counseling patients on the course of their disease has become a major piece.

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“There’s just a huge education component,” said Bryant, the UI Health Care hospitalist. “What’s kind of a black box initially for the patients gets described a little bit more so they know what to anticipate.”

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