COVID-19, caused by the SARS-CoV-2 virus, is a highly contagious disease with the potential to cause serious complications, requiring the isolation of infected individuals and appropriate clinical follow-up. While severe cases require hospitalization, patients with mild symptoms can remain at home and be monitored regularly by primary healthcare physicians — at the beginning of the COVID-19 pandemic, this follow-up was almost daily. Globally, the use of digital tools has proven to be essential in controlling the pandemic. In Portugal, the Shared Services of the Ministry of Health (SPMS) developed the Trace COVID-19® online platform to identify at-risk contacts and monitor infected individuals remotely. However, in early 2021, during the third wave of COVID-19 pandemic, the sharp rise in cases, along with the mobilization of healthcare professionals to vaccination centres and nursing homes, caused a significant overload on primary healthcare services. As a consequence, there were delays of more than 72 hours in the first medical contact after the confirmation of a positive COVID-19 case, compromising the timely and effective response to the clinical follow-up of patients.

Home / Publications / Publication

Home / Publications / Publication

Trace COVID-19

Publication type: Article Summary
Original title: Gestão de crise em pandemia: trabalho de melhoria de qualidade na abordagem a novos infetados na Trace COVID-19
Article publication date: March 2025
Source: Revista Portuguesa de Medicina Geral e Familiar
Authors: André Melícia, Sara Figueira & Ana Sofia Vitorino

What is the goal, target audience, and areas of digital health it addresses?
     The main objective of this study was to accelerate medical contact with COVID-19 positive cases registered on the Trace COVID-19® online platform. This work is mainly aimed at primary healthcare physicians and falls into digital health areas related to remote patient monitoring, digital tracking and clinical task management through digital platforms.

What is the context?
     COVID-19, caused by the SARS-CoV-2 virus, is a highly contagious disease with the potential to cause serious complications, requiring the isolation of infected individuals and appropriate clinical follow-up. While severe cases require hospitalization, patients with mild symptoms can remain at home and be monitored regularly by primary healthcare physicians — at the beginning of the COVID-19 pandemic, this follow-up was almost daily.

     Globally, the use of digital tools has proven to be essential in controlling the pandemic. In Portugal, the Shared Services of the Ministry of Health (SPMS) developed the Trace COVID-19® online platform to identify at-risk contacts and monitor infected individuals remotely. However, in early 2021, during the third wave of COVID-19 pandemic, the sharp rise in cases, along with the mobilization of healthcare professionals to vaccination centres and nursing homes, caused a significant overload on primary healthcare services. As a consequence, there were delays of more than 72 hours in the first medical contact after the confirmation of a positive COVID-19 case, compromising the timely and effective response to the clinical follow-up of patients.

What was the approach in place at the time of the study?
     At the time of the study, the process of monitoring suspected cases of COVID-19 began, in most situations, with a call from the patient to the SNS24 line, answered by a nurse. This professional performed a clinical assessment based on symptoms, being able to prescribe a molecular test, notify the suspicion to the National Epidemiological Surveillance System (SINAVE) plataform, assess the feasibility of home isolation, exclude signs of severity that would justify hospital evaluation, and clarify doubts. All suspected or confirmed cases were then registered on the Trace COVID-19® online platform and assigned to the patient’s Family Health Unit (USF). The clinical surveillance was the responsibility of primary healthcare physicians under the task type called “Vigilância Sobreativa” (Enhanced Surveillance), involving telephone contact until discharge criteria were met. According to guidelines of the Directorate-General of Health (DGS), the first medical contact should occur within the first 24 hours after the case is registered on the platform.

     At USF Alcais, three mandatory moments of contacts were defined: the first within 24 hours of registration on the platform, the second upon the test result, and the third on the estimated date for isolation discharge. However, it became evident that priority should be given to contacting patients who tested positive, especially in cases identified by self-tests or mass screening, where no prior clinical assessment or verification of isolation conditions had occurred. Still, rapid identification of these cases was limited by the lack of awareness about certain functionalities of the Trace COVID-19® online platform, limiting the effectiveness of the clinical follow-up process.

What does innovation consist of? How is the impact of this study assessed?
     The innovation introduced consisted of implementing a structured quality improvement protocol. The protocol included the daily identification of new positive cases assigned to the USF Alcais through the platform’s search function, the verification that it is a new case (and not a repeat test), the registration of these cases in an Excel sheet at the beginning and end of the day, and at the end of the day, check how many tasks have been completed, with the calculation of the execution rate. For the cases that remained pending, the elapsed time between registration on the platform and the first medical contact was analysed.

     To prioritise initial contacts with patients who tested positive, the filter “Comunicar resultado positivo” (Communicate positive result) was applied. At the same time, tasks at USF Alcais were reorganised into two types  “Vigilância Ativa” (Active Surveillance), for asymptomatic contacts, under the responsibility of the nursing team; and “Vigilância Sobreativa” (Enhanced Surveillance), for symptomatic cases, under the responsibility of the medical team.

     The impact of the protocol was evaluated through a quasi-experimental study, conducted between January and February 2021, involving the entire medical team of USF Alcais. The intervention began with an internal training session. The pre-intervention phase took place in the first week of February, followed by two post-intervention evaluation periods: one immediate (second week) and another later (fourth week). The main success indicator was the rate of new infections over the total, which measures how many of the new cases were contacted in less than 24 hours after registering on the Trace COVID-19® online platform per week. This indicator allowed monitoring the improvement of the weekly response, with three levels of quality were defined: insufficient (<50%), good (50–80%) and very good (>80%).

What are the main results? What is the impact of these results? What is the future of this technology?
     In the week before the intervention, only 12.8% of the newly infected were contacted in the first 24 hours after registration, which corresponds to an insufficient level of quality. In the second week, after the implementation of the improvement protocol, there was significant evolution with 85.7% of the cases being contacted within the time frame, reaching the very good quality level. In the last week of evaluation, all new cases were contacted on the same day, corresponding to 100% efficacy rate, maintaining the level of quality. Despite the very positive results, a limitation of the study was the reduction in the number of new cases between the weeks evaluated, which resulted in a lighter workload for USF Alcais and may have influenced the outcomes obtained.

     This study demonstrated that, even with limited resources, it is possible to significantly improve clinical efficacy with simple and well-organized measures. Setting priority tasks and communicating well among the medical team proved to be fundamental to achieving the success of the intervention. In the future, this protocol may be replicable in other health units, contributing to a more efficient response in clinical surveillance contexts, especially in scenarios of high demand and pressure on primary health care.

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Home / Publications / Publication

Trace COVID-19

Publication type: Article Summary
Original title: Gestão de crise em pandemia: trabalho de melhoria de qualidade na abordagem a novos infetados na Trace COVID-19
Article publication date: March 2025
Source: Revista Portuguesa de Medicina Geral e Familiar
Authors: André Melícia, Sara Figueira & Ana Sofia Vitorino

What is the goal, target audience, and areas of digital health it addresses?
     The main objective of this study was to accelerate medical contact with COVID-19 positive cases registered on the Trace COVID-19® online platform. This work is mainly aimed at primary healthcare physicians and falls into digital health areas related to remote patient monitoring, digital tracking and clinical task management through digital platforms.

What is the context?
     COVID-19, caused by the SARS-CoV-2 virus, is a highly contagious disease with the potential to cause serious complications, requiring the isolation of infected individuals and appropriate clinical follow-up. While severe cases require hospitalization, patients with mild symptoms can remain at home and be monitored regularly by primary healthcare physicians — at the beginning of the COVID-19 pandemic, this follow-up was almost daily.

     Globally, the use of digital tools has proven to be essential in controlling the pandemic. In Portugal, the Shared Services of the Ministry of Health (SPMS) developed the Trace COVID-19® online platform to identify at-risk contacts and monitor infected individuals remotely. However, in early 2021, during the third wave of COVID-19 pandemic, the sharp rise in cases, along with the mobilization of healthcare professionals to vaccination centres and nursing homes, caused a significant overload on primary healthcare services. As a consequence, there were delays of more than 72 hours in the first medical contact after the confirmation of a positive COVID-19 case, compromising the timely and effective response to the clinical follow-up of patients.

What was the approach in place at the time of the study?
     At the time of the study, the process of monitoring suspected cases of COVID-19 began, in most situations, with a call from the patient to the SNS24 line, answered by a nurse. This professional performed a clinical assessment based on symptoms, being able to prescribe a molecular test, notify the suspicion to the National Epidemiological Surveillance System (SINAVE) plataform, assess the feasibility of home isolation, exclude signs of severity that would justify hospital evaluation, and clarify doubts. All suspected or confirmed cases were then registered on the Trace COVID-19® online platform and assigned to the patient’s Family Health Unit (USF). The clinical surveillance was the responsibility of primary healthcare physicians under the task type called “Vigilância Sobreativa” (Enhanced Surveillance), involving telephone contact until discharge criteria were met. According to guidelines of the Directorate-General of Health (DGS), the first medical contact should occur within the first 24 hours after the case is registered on the platform.

     At USF Alcais, three mandatory moments of contacts were defined: the first within 24 hours of registration on the platform, the second upon the test result, and the third on the estimated date for isolation discharge. However, it became evident that priority should be given to contacting patients who tested positive, especially in cases identified by self-tests or mass screening, where no prior clinical assessment or verification of isolation conditions had occurred. Still, rapid identification of these cases was limited by the lack of awareness about certain functionalities of the Trace COVID-19® online platform, limiting the effectiveness of the clinical follow-up process.

What does innovation consist of? How is the impact of this study assessed?
     The innovation introduced consisted of implementing a structured quality improvement protocol. The protocol included the daily identification of new positive cases assigned to the USF Alcais through the platform’s search function, the verification that it is a new case (and not a repeat test), the registration of these cases in an Excel sheet at the beginning and end of the day, and at the end of the day, check how many tasks have been completed, with the calculation of the execution rate. For the cases that remained pending, the elapsed time between registration on the platform and the first medical contact was analysed.

     To prioritise initial contacts with patients who tested positive, the filter “Comunicar resultado positivo” (Communicate positive result) was applied. At the same time, tasks at USF Alcais were reorganised into two types  “Vigilância Ativa” (Active Surveillance), for asymptomatic contacts, under the responsibility of the nursing team; and “Vigilância Sobreativa” (Enhanced Surveillance), for symptomatic cases, under the responsibility of the medical team.

     The impact of the protocol was evaluated through a quasi-experimental study, conducted between January and February 2021, involving the entire medical team of USF Alcais. The intervention began with an internal training session. The pre-intervention phase took place in the first week of February, followed by two post-intervention evaluation periods: one immediate (second week) and another later (fourth week). The main success indicator was the rate of new infections over the total, which measures how many of the new cases were contacted in less than 24 hours after registering on the Trace COVID-19® online platform per week. This indicator allowed monitoring the improvement of the weekly response, with three levels of quality were defined: insufficient (<50%), good (50–80%) and very good (>80%).

What are the main results? What is the impact of these results? What is the future of this technology?
     In the week before the intervention, only 12.8% of the newly infected were contacted in the first 24 hours after registration, which corresponds to an insufficient level of quality. In the second week, after the implementation of the improvement protocol, there was significant evolution with 85.7% of the cases being contacted within the time frame, reaching the very good quality level. In the last week of evaluation, all new cases were contacted on the same day, corresponding to 100% efficacy rate, maintaining the level of quality. Despite the very positive results, a limitation of the study was the reduction in the number of new cases between the weeks evaluated, which resulted in a lighter workload for USF Alcais and may have influenced the outcomes obtained.

     This study demonstrated that, even with limited resources, it is possible to significantly improve clinical efficacy with simple and well-organized measures. Setting priority tasks and communicating well among the medical team proved to be fundamental to achieving the success of the intervention. In the future, this protocol may be replicable in other health units, contributing to a more efficient response in clinical surveillance contexts, especially in scenarios of high demand and pressure on primary health care.

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Do you have an innovative idea in healthcare field?

Share it with us and see it come to life.
We will help bring your projects to life!

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