Due to the current health scenario marked by the SARS-CoV-2 pandemic, the number of people who have required hospital admission in our country amounts to more than 124,000 patients as of 7th of June 2020.1 Health systems must articulate their resources in an efficient way to improve the continuity of the inter-level assistance, avoiding the risk of under-medical care due to lack of coordination among them.
Currently, post-discharge follow-up of these SARS-CoV-2 patients is usually done by regular telephone consultation. Therefore, there is no continuous, daily monitoring system that allows us to detect early warning symptoms of poor clinical evolution.
The widespread use of smartphones among the population brings with it a growing range of mobile health applications with very different objectives.2 The level of confidence that such applications deserve is widely debated; however, the role they can play in the increasingly near future is undisputed because of their speed, convenience, ease of use and the connectivity they provide.3
The development of COVID and CARE® application arises from the need to provide a continuous and quality home monitoring system to all outpatients discharged after having been hospitalized for SARS-CoV-2. It will allow us to provide a non-presential surveillance system in a period of increased vulnerability and clinical risk through a personalized remote monitoring.
COVID and CARE® is an easily access mobile application based on voluntary participation. After informing the consent, patients will be able to install it in their mobile phones from the first day of the hospital discharge. It has an intuitive and suitable interface for any type of user – including the patient himself or a family representative. The user will be provided with a registration number and a password in order to access and make the initial registration in the application.
In this first access, patients will login with a short questionnaire about age, sex, ICU stay, family support and avilability of pulsioximeter at home (‘yes or not’ in three last). The user will send twice a day an updated report of his clinical status. An alert will be generated in the device as a reminder in the enabled schedules, displaying a short survey of 5 questions about the clinical situation with default answers (Fig. 1): ‘how are you today?’, ‘do you feel shortness of breath?’, ‘do you have persistent cough?’, ‘temperature’ and ‘SatO2’ (just appears if patient answer avilability of pulsioximeter).
Each response has been assigned a numerical value according to severity criteria. Scores has been associated by physicians, trying to simulate the importance they give to these answers during a clinical interview in their medical experience, scoring higher objective signs that subjective symptoms, and according with recommendations given by Servicio Andaluz de Salud on telephone monitoring.4 The sum of points obtained on the day will reflect the patient's vulnerability; the higher the score, the greater the severity or the risk. The application will automatically order all the records, creating a list set up according to the score reflected, from highest to lowest, which will allow the physician to discern those patients who require earlier and closer attention and to prioritize their care. This will allow to optimize, but not replace, the work of the physician, who will check results daily (including answers receive, not just the final score) and will contact with those patients need it by his medical criteria.
The preliminary version of the application has already begun to be used and is being well received. Patients use to report their clinical status during two-three weeks after hospitalization, according with suggestions provided by posthospitalization follow-up physicians. This telematic service has received a positive feedback from the users, improving the satisfaction perceived in the outpatient follow-up.
In the future, COVID and CARE® could serve as a model for its extension to other hospital centres and/or lay the foundations for the development of new mobile applications for mass telematic monitoring of other pathologies.
Authors’ contributionsCristina Gómez Rebollo: Intellectual development of the application and main coordinator of the project, preparation of the manuscript.
Estefanía Mira Padilla: Intellectual development of the application, preparation of the manuscript.
Francisco Santos Luna: Use of application for patient monitoring, critical review of the manuscript.
José Manuel Vaquero Barrios: Critical review of the manuscript with important intellectual contributions.
FundingThe project has not received specific aid from public sector agencies, commercial sector or non-profit entities.
Conflict of interestThe authors declare that they have no conflict of interest directly or indirectly related to the contents of the manuscript.
To Carlos Montero Alhama, for altruistically carrying out the development of the mobile application and platform.
