An outpatient model of care for COVID ‐19 infected kidney transplant patients – The hospital‐at‐home

作者：Ian Tatt Liew, Woei Jen Michelle Tan, Quan Yao Ho, Shimin Jasmine Chung, Sobhana Thangaraju, Jinhua Yong, Eleanor Ng, Xia He, Natelie Kwan, Terence Kee · 发表于：Nephrology · 年份：2023 · DOI：10.1111/nep.14155 · 被引用次数：11 · 研究领域：SARS-CoV-2 and COVID-19 Research、COVID-19 Clinical Research Studies、COVID-19 and healthcare impacts

Abstract Background The COVID‐19 pandemic is protracted and episodic surges from viral variants continue to place significant strain on healthcare systems. COVID‐19 vaccines, antiviral therapy and monoclonal antibodies have significantly reduced COVID‐19 associated morbidity and mortality. Concurrently, telemedicine has gained acceptance as a model of care and a tool for remote monitoring. These advances allow us to safely transit our inpatient‐based care for COVID‐19 infected kidney transplant recipients (KTRs) to a hospital‐at‐home (HaH) model of care. Methods KTRs with PCR‐proven COVID‐19 infection were triaged by teleconsult and laboratory tests. Suitable patients were enrolled into the HaH. Remote monitoring via teleconsults were conducted daily until patients were de‐isolated based on a time‐based criterion. Monoclonal antibodies were administered in a dedicated clinic where indicated. Results Eighty‐one KTRs with COVID‐19 were enrolled into the HaH between February and June 2022, 70 (86.4%) completed HaH recovery without complications. Eleven (13.6%) patients required inpatient hospitalization for medical issues ( n = 8) and weekend monoclonal antibody infusion ( n = 3). Patients requiring inpatient hospitalization had longer transplant vintage (15 years vs. 10 years, p = .03), anaemia (haemoglobin 11.6 g/dL vs. 13.1 g/dL, p = .01), lower eGFR (39.8 vs. 62.9 mL/min/1.73 m 2 , p < .05) and lower RBD levels (<50 AU/mL vs. 1435 AU/mL, p = .02). HaH saved 753 inpatie...