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Background: The surge of coronavirus 2019 (COVID-19) hospitalizations in New York City required rapid discharges to maintain hospital capacity. Objective: To determine whether lenient provisional discharge guidelines with remote monitoring after discharge resulted in safe discharges home for patients hospitalized with COVID-19 illness. Design: Retrospective case series Setting: Tertiary care medical center Patients: Consecutive adult patients hospitalized with COVID-19 illness between March 26, 2020, and April 8, 2020, with a subset discharged home Interventions: COVID-19 Discharge Care Program consisting of lenient provisional inpatient discharge criteria and option for daily telephone monitoring for up to 14 days after discharge Measurements: Fourteen-day emergency department (ED) visits and hospital readmissions Results: Among 812 patients with COVID-19 illness hospitalized during the study time period, 15.5% died prior to discharge, 24.1% remained hospitalized, 10.0% were discharged to another facility, and 50.4% were discharged home. Characteristics of the 409 patients discharged home were mean (SD) age 57.3 (16.6) years; 245 (59.9%) male; 27 (6.6%) with temperature ≥ 100.4 °F; and 154 (37.7%) with oxygen saturation < 95% on day of discharge. Over 14 days of follow-up, 45 patients (11.0%) returned to the ED, of whom 31 patients (7.6%) were readmitted. Compared to patients not referred, patients referred for remote monitoring had fewer ED visits (8.3% vs 14.1%; OR 0.60, 95% CI 0.31–1.15, p = 0.12) and readmissions (6.9% vs 8.3%; OR 1.15, 95% CI 0.52–2.52, p = 0.73). Limitations: Single-center study; assignment to remote monitoring was not randomized. Conclusions: During the COVID-19 surge in New York City, lenient discharge criteria in conjunction with remote monitoring after discharge were associated with a rate of early readmissions after COVID-related hospitalizations that was comparable to the rate of readmissions after other reasons for hospitalization before the COVID pandemic. [ABSTRACT FROM AUTHOR]

Telemedicine use has rapidly increased across the US health system during the COVID-19 pandemic.[1] Although telemedicine has been heralded as a way to reduce disparities in healthcare,[2] concerns remain that lack of access to technology or digital health literacy can exacerbate technology-driven disparities as telemedicine use expands.[2]-[4] As recent regulatory and policy changes allowed reimbursement for telephonic telemedicine visits in addition to visits facilitated by audio-video technology,[1] there is a unique opportunity to examine technology-driven disparities as manifested through how telemedicine services are accessed differently by different patient populations. OBJECTIVE We sought to assess disparities in whether patients received audio-video telemedicine visits or telephonic ones, using data from a telemedicine expansion initiative at a major academic medical center. Nonetheless, we are amongst the first to illustrate potential technology-driven disparities resulting from large-scale telemedicine expansion in the USA, highlighting the urgent need to identify policies and interventions to ensure that telemedicine technology can be equitably accessed by patients and does not further exacerbate disparities due to gaps in technology access and digital health literacy. [Extracted from the article]