COVID-19 community care in Israel-- A nationwide cohort study from a
large health maintenance organization
Abstract
Introduction: Among the many medical challenges presented by the
COVID-19 pandemic, management of the majority of COVID-19 patients in
community outpatient settings rather than in hospital is crucial for the
resource allocation of healthcare systems. This real-life study
describes COVID-19 patients in three management settings: two outpatient
settings and one inpatient. Methods: A retrospective database cohort
study was conducted in a large Israeli Health Maintenance Organization.
All laboratory-confirmed SARS-CoV-2 cases diagnosed 2/28/2020-6/20/2020,
were included. Cases in the community setting were managed by physicians
and other healthcare personnel through a nationwide remote monitoring
center, using preliminary telehealth triage, 24/7 virtual care , all
based on the individual patient’s clinical and social circumstances.
Data were extracted from medical records. Outcome parameters included
hospital admission, disease severity, need for respiratory support and
mortality. Results: 5,525 cases tested positive. Seventy-seven cases who
live in long- term facilities were excluded. 5448 cases, aged
36.36±20.31 (range 0-97 years) were enrolled. 88.7% were initially
managed as outpatient either at home or in designated hotels, and 11.3%
were hospitalized. 3.1% and 2.1% of the patients who were initially
allocated for home or hotel stay, respectively, later required
hospitalization. The main reason for hospitalization was dyspnea; twelve
were diagnosed with severe disease. Fifty-six patients (1.3%) died,
five (0.1%) of whom were initially allocated to the outpatient
settings. Conclusions: Care for appropriately selected COVID-19 patients
in the community provides a safe and effective option. This can
contribute to reducing the hospitalization burden, with no evidence of
increased morbidity or mortality.