Understanding the impact of COVID Oximetry @home programme among COVID-19 patients in England



  • Arne Wolters, Head of the Improvement Analytics Unit, The Health Foundation

Presenters 1:

  • Chris Sherlaw-Johnson, Senior Fellow, Nuffield Trust
  • Dr Holly Walton, Research Fellow, University College London
  • Dr Nadia Crellin, Fellow, Nuffield Trust

Presenters 2:

  • Dr Jonathan Clarke, Sir Henry Wellcome Postdoctoral Fellow, Centre for Mathematics of Precision Healthcare, Imperial College London
  • Dr Thomas Beaney, GP & Clinical Research Fellow, Department of Surgery and Cancer, Imperial College London

Presenter 3:

  • Stefano Conti, Senior Statistician, Improvement Analytics Unit, NHS England and Improvement

COVID Oximetry @home (CO@h) is an England-wide programme to remotely monitor oxygen saturation levels of people diagnosed with COVID-19 and at risk of health deterioration. It aims to escalate cases of health deterioration earlier to avoid invasive ventilation, ICU admission and death.

Three different evaluation teams are evaluating the effect of this programme on outcomes ranging from patient experience to rates of ICU admission and death. This workshop will focus mainly on the different approaches to evaluation but will also include some preliminary findings.

The RSET/BRACE team will first present an overview of the implementation of CO@h, the context into which they have been implemented and the different approaches being adopted. They will also present some initial findings from interviews and surveys of staff and patients, and describe their plans for the remaining evaluation.

The Institute of Global Health Innovation of Imperial College London will present the methodology for their quantitative evaluation of the CO@h pathway. Preliminary results will be reported for selected Clinical Commissioning Groups (CCGs) with complete data, relating to equity of access for different patient groups eligible for the CO@h pathway. Selected patient outcomes including secondary care utilisation and mortality will also be presented for those same CCGs, comparing rates before and after implementation of the CO@h pathway.

The Improvement Analytics Unit will describe their approaches to estimating the causal impact of this programme, in the absence of a randomised trial. One approach will take advantage of the change in eligibility criteria at age 65, by comparing outcomes of patients just above and below the 65-year threshold using a Regression Discontinuity Design. A second approach uses variation in the time of CO@h implementation by comparing early adopter areas to a carefully constructed comparison area with similar characteristics, created from later adopter areas, using a Generalised Synthetic Control method.