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Pulse oximeter
An analysis of patient data from the Greater Manchester Care Record (GMCR) collected during the COVID-19 pandemic indicates that patients who were offered pulse oximeters to monitor their blood oxygen levels as part of the NHS COVID-19 Oximetry at Home programme (CO@h) were more likely to have been hospitalised for necessary treatment than those who did not.
The study suggests that the CO@h programme reduced the risk of mortality by as many as two deaths for every 1000 patients after 28 days, and by 10 deaths for every 1000 patients a year later.
This research, led by University of Manchester academics, funded by the National Institute for Health and Care Research (NIHR) and Applied Research Collaboration Greater Manchester (ARC-GM), adds to a body of evidence worldwide supporting the use of pulse oximeters as a valuable tool for health services, allowing COVID-19 patients to monitor their condition at home.
Pulse oximeters were widely used during the pandemic to detect low oxygen saturation levels in COVID-19-diagnosed patients at home, enabling healthcare workers to provide appropriate care, including same-day clinician review or even hospitalisation.
NHS England launched the CO@h programme in November 2020, offering pulse oximeters to patients diagnosed with COVID-19 who were deemed at risk of deterioration due to silent hypoxia. These included patients who were symptomatic and aged over 65, citizens who were ‘clinically extremely vulnerable’ to COVID-19, and those identified as being at high risk of deterioration by a health professional.
To assess the effectiveness of this intervention, researchers carried out a target trial using anonymised patient data collected from the GMCR. The GMCR brings together information from NHS and care services across all 10 Greater Manchester boroughs into one joined up record to help improve health and care services.
The analysis of data collected between February 2020 and June 2022 reveals that:
- The odds for an “unplanned” admission following COVID-19 diagnosis were between 50% and 80% higher among CO@h patients compared to those who were not enrolled on the programme.
- The expected reduction in mortality among CO@h patients was estimated at two deaths per 1000 after 28 days, six at 90 days, and 10 after a year.
- The mean length of stay for those admitted within 90 days of COVID-19 diagnosis was the same across both groups, at nine days.
Due to the sudden impact of COVID-19 on both clinical services and research, capacity to properly assess the impact of oximetry was limited at the time. However, subsequent studies have explored its benefits. These include research by the University of Southampton, Imperial College London and the University of Pennsylvania. This Greater Manchester study features a larger sample size and is the first to assess outcomes up to a year later, compared to 30 days.
While the organisations say the analysis is encouraging, the research team believes more assessment is needed on factors such as cost-effectiveness and patient quality of life.
Senior author Professor Evangelos Kontopantelis, Professor in Data Science and Health Services Research in the University of Manchester’s Division of Informatics, Imaging and Data Sciences said: “While not definitive, our study suggests that the use of pulse oximetry at home is likely effective for early detection of clinical deterioration, which could lead to timely and potentially life-saving intervention.
“Some work remains to be done, since it is important that we learn more about the effectiveness of measures such as this, particularly as we look to build our resilience against evolving pandemic threats around the world.
“To do this, we need to work together and share valuable insights and data. Resources such as the Greater Manchester Secure Data Environment are an excellent example of what can be achieved when collaboration is encouraged for the greater good – and it could provide the foundation for a range of transformative research in the future.”
Professor Peter Bower, Lead for Evaluation at NIHR ARC-GM and Chair in Health Services at The University of Manchester said: “At-home technologies such as pulse oximeters have the potential to play an important role in helping patients maintain their independence, while protecting the ongoing capacity of our health and care system.
“However, while their possible benefits are evident, so is the responsibility to ensure that they are an effective and efficient way to monitor and manage our health. As the report acknowledges, we need to rigorously consider the cost-effectiveness of this intervention, as well as its impact on patient quality of life and hospital capacity and efficiency.“We want to ensure that communities such as Greater Manchester benefit from advances in technology, while receiving the best and most responsive healthcare possible. Through research such as this, we believe we can help give decision-makers the insights to make the right decisions for patients.”
The full study, entitled Patient use of pulse oximetry to support management of COVID-19 in Greater Manchester: a non-randomised evaluation using a target trial approach, has been published in the PLOS One journal.
The research was also supported by a grant from the Manchester Academic Health Science Centre (MAHSC), part of Health Innovation Manchester.
