This quality improvement project evaluates the efficacy of an outpatient COVID-19 telehealth monitoring program intended to increase access to care, decrease emergency room/urgent care visits, and hospital admissions among telehealth observed adult patients in a rural area while providing safe home monitoring during acute illness.


Prior to COVID-19 pandemic, healthcare systems within the United States encountered several challenges including healthcare inequality and decreased healthcare access, particularly in rural communities. These gaps became more apparent when a novel COVID-19 pandemic emerged straining healthcare systems in the United States and throughout the world. Challenges ranged from overwhelmed emergency room (ER) and urgent care (UC) visits to decreased hospital bed availability, medications, supplies, and staffing. Innovative methods such as telehealth programs became a means to provide outpatient COVID-19 care. Such programs increased access to care while maintaining social distancing mandates.

Theoretical Framework

This quality improvement project used the Model for Improvement & Plan, Do, Study, Act (PDSA) theoretical framework.


Patients were stratified into three groups based on a protocol developed for rural telehealth monitoring of COVID-19 positive patients in an outpatient setting. The project leader randomly reviewed 100 patient charts (50 consented to monitoring/50 declined monitoring) ranging from May 2020 through May 2021. Results were analyzed in Excel and Wizard 2 Data Analysis for effectiveness of intervention at 1-year post-implementation.

Outcomes Achieved

There was a statistically significant increase in ER/UC and hospital admissions in the consent to monitoring group when compared to the declined monitoring group x2 (1, n = 50) = 3.933, p = .047. There were no at home deaths in the consent or decline to monitoring groups (P > .05). However, the declined monitoring group encountered three patients lost to follow up. This telehealth monitoring program increased access to healthcare in a rural area with a total of 5,137 visits between August 2020 to May 31, 2021. Project analysis suggests that this telehealth monitoring program for COVID-19 positive patients is safe for outpatient monitoring.


To assist with challenges a pandemic places on hospital systems, developing telehealth monitoring programs for rural communities provides increased access to outpatient COVID-19 care during acute illness. It also provides close and safe patient monitoring via video or telephone. Although it increased ER/UC and hospital admissions among monitored patients, it may have prevented patients from deteriorating at home as a result of close patient monitoring. Telehealth monitoring of COVID-19 patients in rural communities is a new and rapidly developing modality to monitor rural patients. More studies are needed to learn from effectiveness of COVID-19 pandemic interventions to create better responses to future pandemics.



Document Type

Scholarly Project

Degree Name

Doctor of Nursing Practice (DNP)

Level of Degree



SARs-CoV-2, COVID-19, telehealth, rural health, telemedicine, emergency room, urgent care, virtual ward, outpatient, home monitoring