The implementation and evaluation of the Ontario COVID@Home Clinical Primary Care Pathway.

Abstract

Background: The COVID@Home Clinical Care Pathway (the Pathway) was developed and implemented as an evidence-based remote monitoring clinical care pathway for the integrated management of coronavirus disease 2019 (COVID-19) in the province of Ontario, Canada. We examine its effectiveness and rapid large-scale implementation.

Methods: Using a prospective longitudinal study design, we used electronic medical record clinical data, provider and patient surveys, web analytics, healthcare and provincial utilization, and government holdings data to evaluate reach, effectiveness, adoption, implementation, and maintenance outcomes, including patient mortality and health equity.

Results: The Pathway was widely accessed (19 474 Ontario unique users), contributed 28 816 oxygen saturation monitors, and achieved coverage across income levels and geography. Two-thirds of patients had > 1 encounter, monitored for a median of 4 days (Range: 1-57). Fifty percent of patients had > 1 chronic condition. Patients receiving Pathway care were less likely to die by 0.44% (20/4556), two times lower compared to the total mortality of a population-based representative patient cohort over a parallel time period in Ontario of 0.86% (1820/212 326, P = .0023). Patients were very satisfied with their care, and felt care was accessible, safe, and clear. Providers were very satisfied with the Pathway resources and reported strengthened relationships across the health system.

Conclusions: Primary care (PC) rapidly implemented a clinical care pathway during the COVID-19 crisis. The Pathway demonstrated the beneficial role and effectiveness of PC when patients are provided with timely, accessible, and comprehensive care. Public health responses should explicitly collaborate with PC to address population health.