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A referral source for healthcare providers to help their patients navigate through the complexities of COVID-19 related serious illness.

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Palliative care focuses on helping patients live well.

As the COVID-19 pandemic continues to spread, taking precious lives and sending others to the hospital, the Arizona Hospital and Healthcare Association (AzHHA) offers a valuable resource to healthcare providers.

Palliative care telehealth services are available for patients experiencing acute or chronic COVID-19 symptoms and related complications in any setting such as clinics, home healthcare, long term care, assisted living and hospitals.

Blog 1: Introduction to the AZ Palliative Care Telehealth Program

The COVID-19 Pandemic has impacted patients and providers across the United States. With an influx of patients in hospitals, healthcare workers are in need of a cutting-edge program to help their patients navigate the symptoms and complications associated with COVID-19. The Arizona Hospital and Healthcare Association launched the Palliative Care Telehealth program for providers to give patients palliative care remotely - reducing the burden on emergency rooms and other primary care facilities where patients might otherwise seek this level of care. Collaborating with a steering team of diverse healthcare leaders, AZHHA is delivering innovation that will alleviate the current surge on hospital systems, while simultaneously providing care to individuals affected by COVID-19. The goal of this blog is to provide insight and track the progress of the Palliative Care Telehealth program.

We, the AZHHA intern team, have been following the progress of the Palliative Care Telehealth program, and we would like to introduce ourselves. We are Nigel, a sophomore at Lehigh University studying neuroscience; Naomi, a third year at the CUNY School of Medicine Sophie Davis Program; and Skye, a junior at The George Washington University’s Elliott School of International Affairs. Nigel and Naomi are from New York City, and Skye is from the DC area. We have a driving passion for healthcare, and felt it is necessary for us to help out during the COVID-19 pandemic.

Seeing the need for everyone having the resources to receive care, especially during a pandemic, the AZHHA telehealth initiative offers valuable learnings that may ultimately inform a broader strategy for other states and facilities across the country. The innovative approach enables patients to receive palliative care services in all care settings, including at home, in clinics, long-term care facilities, skilled nursing facilities, long term acute care hospitals, and via home health agencies. With the ability to get care from facilities other than emergency rooms, patients who have no access to transportation, or feeling the effects of COVID-19, can still seek quality of life treatment, without placing additional burden on already strained resources. Furthermore, this program offers the opportunity for families to receive extra relief and support, during a very stressful and emotional time.

This blog post is the first in a series of posts that will detail the experiences and learnings of the team as they set out to stand up a functional telehealth program, with an eye toward capturing the lessons that may be applicable to other settings across the country. Our insights are based on participation in planning meetings, first person interviews, and additional supplementary research. We will aim to post bi-weekly to keep you up to date as the rollout transpires! Please reach out to aztelehealthpilot@usciviliancorps.org with any questions.

LONG COVID by Chikal A. Patel, M.D
Medical Director, Complex Care Management - Optum

In a 6-month follow-up cohort study, Huang et al. followed 733 patients after hospital discharge. Those with more severe illness during hospital stay tended to have more severe impaired pulmonary diffusion capacities and abnormal chest imaging manifestation. Of additional concern, 1 in 5 patients who did not require supplemental oxygen during hospitalization had reduced lung function 6 months after "recovery."

Of the 1,733 patients followed by Huang et al, 76% had at least one ongoing symptom 6-months after initial COVID-19 diagnosis. Among 70 non-hospitalized patients in France, Salmon-Ceron et al pointed out that while many patients had persistent symptoms of fatigue, muscle weakness, chest pressure, dyspnea, tachycardia and problems with taste and smell, more than ¼ of patients developed new neurological symptoms AFTER their acute COVID-19 illness resolved. These findings of decreased lung function 6 months after diagnosis and new neurologic symptoms after acute illness prompt the need for continued post-COVID-19 monitoring for lung dysfunction or new neurologic symptoms.

Assessment/Management of Long-COVID

Not much is understood regarding this condition and more studies are needed. Things you can do as a clinician:

  • Be aware of it
  • Be empathetic
  • Baseline and serial comprehensive reviews of systems and physical exams may better document possible long COVID manifestations
  • Symptomatic and supportive care for most symptoms, esp. neurological
  • Address and readdress goals of care conversations
Additional information on Long-COVID-19

COCA Crisis Standards of Care (cdc.gov) – Long COVID-19 Presentation from 1/28/21

Late Sequelae of COVID-19 | CDC – CDC update as of November 2020 on COVID-19 Late Sequelae