Public Health Emergency - Leading a Nation Prepared
This document includes promising practices and recommendations from Maryland’s success in increasing the utilization of COVID-19 monoclonal antibody treatments. These findings provide inspiration and information to those working to build treatment awareness and demand and can supplement individual plans and provide context to playbooks and planning discussions with leadership.
The Maryland Department of Health (MDH) developed a data-driven initiative to bring monoclonal antibodies to high-risk COVID-19 patients across the state. Monoclonal antibody infusions were made accessible to hard hit and underserved communities - 7,210 patients were treated since December (a 33% increase). As of April 2021, it is estimated that about 338 hospitalizations were avoided, and 139 deaths prevented because of Maryland’s efforts.
When the Emergency Use Authorization (EUA) for monoclonal antibody treatment was issued in November 2020, the MDH:
Success Factors in Maryland
The following section provides topical key recommendations based on Maryland’s experience.
Existing Command Structures Accelerated the Roll-Out
Maryland used its Incident Command System (ICS) structure to quickly imbed the Monoclonal team and establish clear lines of communication, and to roll-out COVID-19 programs and resources. The Monoclonal team assumed associated responsibilities for execution and established a cadence of standing meetings and communication channels with providers and other stakeholders.
Use of the State HIE Streamlined Referrals
The Chesapeake Regional Information System for our Patients (CRISP) is the designated Health Information Exchange (HIE) in Maryland and the District of Columbia. CRISP data helped identify areas where COVID-19 cases were increasing and to establish infusion sites.
The Monoclonal team developed a COVID-19 specific online, bidirectional, near-real time referral form to
make referrals easier and more efficiently connect patients to COVID-19 antibody treatment infusion sites.
Prior Experience with Inventory Managment Eased Provision of Monoclonal Antibodies
In spring/ summer 2020, Maryland expanded its technology systems and developed an
inventory management system to support remdesivir distribution which increased this system’s capacity for the allocation, distribution, and tracking of monoclonal antibody treatment. This mix of data and infrastructure allowed the state to focus resources on high-need areas. This
existing system and prior experience eased the provision of monoclonal antibody treatment under the EUA.
Under its guiding principle of continual process improvement, Maryland will expand its data collection by incorporating outcome measures into its analysis. The state is using its referral form (in CRISP) to analyze additional information (metrics such as BMI, symptoms, co-morbidities and referring provider information), which may inform decision making.
Equitable access to monoclonal antibody treatments is challenging as many patient referrals are by larger and well-connected healthcare facilities (e.g., hospitals, private practices) rather than smaller, community-based healthcare facilities. The Monoclonal team together with hospital and community-based infusion partners educate eligible patients and referring healthcare providers who may be unfamiliar with monoclonal antibody treatment criteria.
These improvements support a greater understanding of the current COVID-19 situation and inform a robust streamlined referral and treatment processes. As the situation moves from a pandemic to an endemic, Maryland’s framework is envisioned as agnostic, and adaptable to future public health emergencies.
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