COVID-19 teleassistance and teleconsultation: a matched case-control study (MIRATO project, Lombardy, Italy)

Palmira Bernocchi; Giacomo Crotti; Elvira Beato; Francesco Bonometti; Vittorio Giudici; Patrizia Bertolaia; Elisa Perger; Andrea Remuzzi; Tiziana Bachetti; Maria Teresa La Rovere; Laura Adelaide Dalla Vecchia; Fabio Angeli; Gianfranco Parati; Gabriella Borghi; Michele Vitacca; Simonetta Scalvini

doi:10.3389/fcvm.2023.1062232

COVID-19 teleassistance and teleconsultation: a matched case-control study (MIRATO project, Lombardy, Italy)

Front Cardiovasc Med. 2023 Aug 14:10:1062232. doi: 10.3389/fcvm.2023.1062232. eCollection 2023.

Authors

Palmira Bernocchi¹, Giacomo Crotti², Elvira Beato², Francesco Bonometti¹, Vittorio Giudici³, Patrizia Bertolaia⁴, Elisa Perger⁵, Andrea Remuzzi⁶, Tiziana Bachetti⁷, Maria Teresa La Rovere⁸, Laura Adelaide Dalla Vecchia⁹, Fabio Angeli^{10

11}, Gianfranco Parati^{12

13}, Gabriella Borghi¹, Michele Vitacca¹⁴, Simonetta Scalvini^{1

15}

Affiliations

¹ Continuity Care and Telemedicine Service, Istituti Clinici Scientifici Maugeri IRCCS, Institute of Lumezzane, Brescia, Italy.
² Epidemiology Unit, Bergamo Health Protection Agency, Bergamo, Italy.
³ Department of Cardiac Rehabilitation, Bolognini Hospital, Azienda Socio Sanitaria Territoriale Bergamo Est, Bergamo, Italy.
⁴ Socio-Health Management Direction, Azienda Socio Sanitaria Territoriale Bergamo Est, Bergamo, Italy.
⁵ Istituto Auxologico Italiano, IRCCS, Sleep Disorders Center & Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy.
⁶ Department of Management, Information and Production Engineering, University of Bergamo, Bergamo, Italy.
⁷ Scientific Direction, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy.
⁸ Cardiac Rehabilitation Division, Istituti Clinici Scientifici Maugeri IRCCS, Institute of Montescano, Pavia, Italy.
⁹ Department of Cardiology, Istituti Clinici Scientifici Maugeri IRCCS, Institute of Milan, Milan, Italy.
¹⁰ Department of Medicine and Technological Innovativon (DiMIT), University of Insubria, Varese, Italy.
¹¹ Department of Medicine and Cardiopulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, Institute of Tradate, Varese, Italy.
¹² Department of Cardiology, Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Milan, Italy.
¹³ Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
¹⁴ Department of Respiratory Rehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, Institute of Lumezzane, Brescia, Italy.
¹⁵ Department of Cardiac Rehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, Institute of Lumezzane, Brescia, Italy.

Abstract

Background: During the COVID-19 pandemic, telemedicine has been recognised as a powerful modality to shorten the length of hospital stay and to free up beds for the sicker patients. Lombardy, and in particular the areas of Bergamo, Brescia, and Milan, was one of the regions in Europe most hit by the COVID-19 pandemic. The primary aim of the MIRATO project was to compare the incidence of severe events (hospital readmissions and mortality) in the first three months after discharge between COVID-19 patients followed by a Home-Based Teleassistance and Teleconsultation (HBTT group) program and those discharged home without Telemedicine support (non-HBTT group).

Methods: The study was designed as a matched case-control study. The non-HBTT patients were matched with the HBTT patients for sex, age, presence of COVID-19 pneumonia and number of comorbidities. After discharge, the HBTT group underwent a telecare nursing and specialist teleconsultation program at home for three months, including monitoring of vital signs and symptoms. Further, in this group we analysed clinical data, patients' satisfaction with the program, and quality of life.

Results: Four hundred twenty-two patients per group were identified for comparison. The median age in both groups was 70 ± 11 years (62% males). One or more comorbidities were present in 86% of the HBTT patients and 89% in the non-HBTT group (p = ns). The total number of severe events was 17 (14 hospitalizations and 3 deaths) in the HBTT group and 40 (26 hospitalizations and 16 deaths) in the non-HBTT group (p = 0.0007). The risk of hospital readmission or death after hospital discharge was significantly lower in HBTT patients (Log-rank Test p = 0.0002). In the HBTT group, during the 3-month follow-up, 5,355 teleassistance contacts (13 ± 4 per patient) were performed. The number of patients with one or more symptoms declined significantly: from 338 (78%) to 183 (45%) (p < 0.00001). Both the physical (ΔPCS12: 5.9 ± 11.4) component and the mental (ΔMCS12: 4.4 ± 12.7) component of SF-12 improved significantly (p < 0.0001). Patient satisfaction with the program was very high in all participants.

Conclusions: Compared to usual care, an HBTT program can reduce severe events (hospital admissions/mortality) at 3-months from discharge and improve symptoms and quality of life.

Clinical trial registration: www.ClinicalTrials.gov, NCT04898179.

Keywords: chronic disease; outcome; rehabilitation; symptoms; teleassistance; teleconsultation; telemedicine; telemonitoring.

Associated data

ClinicalTrials.gov/NCT04898179

Grants and funding

This work was supported by Regione Lombardia, ITALY, within the research grant n. RLJ12020012390-“Bando della DG welfare per il finanziamento di progetti di ricerca in ambito sanitario connessi all’emergenza da COVID-19- DGR XI/3017 del 30.03.2020”—Title: “Supporto MIRATO ai pazienti dimessi dopo un ricovero per infezione da Coronavirus SARS-CoV-2 e comorbidità”.