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Collaborative healthcare delivery research from investigators across MedStar Health aimed to describe the referral, selection process, and deployment of outpatient monoclonal infusion clinics, as well as the impact of monoclonal antibody therapy in COVID-positive patients on the rate of emergency department visits and hospitalizations. This is critical research as we remain steadfast in identifying the best way to deliver care and deploy treatment for our community and patient populations. “Impact of Rapidly Deployed COVID-19 Monoclonal Antibody Infusion Clinics on Rate of Hospitalization” was published in Infectious Diseases in Clinical Practice.
Last year, FDA approved an Emergency Use Authorization (EUA) of two monoclonal antibody treatments for outpatient management of mild to moderate COVID-19. At the time of authorization, these drugs were indicated for non-hospitalized, symptomatic patients within 10 days of first symptom onset, who were at high risk for progression to severe COVID-19 or hospitalization. Clinical trials have shown that monoclonal antibodies decrease healthcare utilization yet challenges with logistics and operations to implement infusion clinics have resulted in underutilization of monoclonal antibody therapy on a national level.
This implementation study describes the rapid build-out and operations of 2 hospital-based outpatient infusion centers in Washington, D.C. and Maryland. The research team, made up of frontline clinicians, pharmacists, and hospital administration, educated referring providers, developed a network of referrals and communication, and identified high-risk patients to create a model for delivering the monoclonal antibody to patients soon after they received a positive test result for COVID-19. The study team developed a scoring system to identify eligible patients and ensure that patients with the highest risk factors would be prioritized for treatment with the constrained supply of monoclonal antibody medication. This scoring system tool allowed providers to identify patients in minutes within busy primary care, urgent care, and emergency department facilities. Those who received the monoclonal antibody infusion were the treatment group, whereas those who did not receive the monoclonal treatment but were referred were the control group.
Since the launch of the infusion clinics in 2020, there have been more than 7000 infusions given to patients to reduce hospitalization and manage the treatment of COVID-19. The study found that monoclonal antibody treatment is effective in preventing hospitalization in patients with mild to moderate COVID-19. The scoring system was also successful in helping providers identify patients who could benefit from this treatment the most.
Leveraging the health system's distributed care network of primary, specialty, and urgent care extending out into communities to bring health care closer to patients was critical in the successful of this program. System-wide communication led by clinical leaders in infectious disease, emergency medicine, urgent care, and primary care worked together on system-wide communications about the benefits of monoclonal antibody treatment and how to identify patients for treatment effectively. The study team also collaborated with other healthcare providers in the community to identify and refer high-risk patients for monoclonal antibody infusion.
While the COVID-19 pandemic has challenged health systems and public health infrastructure alike, collaboration at every level of healthcare has been critical to managing the incredibly dynamic and often unpredictable virus. Involving the right people and having access to real-time data allowed the research team to overcome hurdles such as drug supply shortages, logistics to transfer patients to and from the infusion clinics, and risk mitigation strategies among clinic staff. This infrastructure has proven to be the most efficient in providing safe and effective therapy to patients in the outpatient setting.
The research team included Bonnie Levin, PharmD, MBA , Glenn W. Wortmann, MD; Princy N. Kumar, MD; Bronson Delasobera, MD; Tara Saggar, MD, Jennifer N. Goodwin, MBA; Joy Amanda, MS, PA-C; Kiersten N. Henry DNP, ACNP-BC; David D. Hager, MD; Joel McAlduff, MD; Sameer DeSale, PhD; and Xavier Owens, MHSA
Infectious Diseases in Clinical Practice, DOI: 10.1097/IPC.0000000000001109