Totten AM, Womack DM, Eden KB, McDonagh MS, Griffin JC, Grusing S, Hersh WR, et al.
. Date of publication 2016 Jun 1;volume ():.
1. Telehealth: Mapping the Evidence for Patient Outcomes From Systematic Reviews
[Internet].
Totten AM(1), Womack DM(1), Eden KB(1), McDonagh MS(1), Griffin JC(1), Grusing
S(1), Hersh WR(1).
Rockville (MD): Agency for Healthcare Research and Quality (US); 2016 Jun. Report
No.: 16-EHC034-EF.
AHRQ Comparative Effectiveness Technical Briefs.
Author information:
(1)Pacific Northwest Evidence-based Practice Center
BACKGROUND: Telehealth includes a wide range of technologies used to fulfill many
functions in in health care for patients with a variety of clinical conditions.
For this evidence map, telehealth is defined as the use of information and
telecommunications technology in health care delivery for a specific patient
involving a provider across distance or time. Various types of telehealth
interventions have been evaluated in thousands of research studies and hundreds
of systematic reviews. The vast size of the literature and the variations in how
the literature has been collected, evaluated, and synthesized make it challenging
to determine what is known about the effectiveness of telehealth for specific
purposes and what questions remain unanswered.
PURPOSE: The purpose of this brief is to provide an overview of the large and
disparate body of evidence about telehealth for use by decisionmakers. The
approach used was to create an evidence map of systematic reviews published to
date that assess the impact of telehealth on clinical outcomes. This evidence map
describes a limited number of key characteristics of the systematic reviews
currently available in order to evaluate the bodies of evidence available to
inform practice, policy, and research decisions about telehealth.
METHODS: An evidence map is a specific type of rapid or abbreviated review. While
the creation of the evidence map is based on systematic review methodology, its
goal is to describe rather than synthesize available research and to use graphics
when possible to represent selected characteristics of the evidence. We included
systematic reviews that synthesized the impact of telehealth interventions on
clinical outcomes, utilization, or cost. We created bubble plots to separately
examine the distribution of the evidence from systematic reviews in terms of
volume (number of reviews, number of patients in the included studies),
conclusions about benefit by clinical focus area, and telehealth function. We
also determined how much evidence is available about combinations of clinical
areas and telehealth functions reported in existing systematic reviews. We
supplemented this by summarizing the topics covered in excluded reviews and the
results of exploratory searches for primary studies on selected topics in order
to assess the need for future systematic reviews or primary studies in key
telehealth domains.
FINDINGS: We identified 1,494 citations about telehealth, from which 58
systematic reviews met our inclusion criteria. A large volume of research
reported that telehealth interventions produce positive outcomes when used for
remote patient monitoring, broadly defined, for several chronic conditions and
for psychotherapy as part of behavioral health. The most consistent benefit has
been reported when telehealth is used for communication and counseling or remote
monitoring in chronic conditions such as cardiovascular and respiratory disease,
with improvements in outcomes such as mortality, quality of life, and reductions
in hospital admissions. Given sufficient evidence of effectiveness for these
topics, the focus of future research should shift to implementation and
practice-based research. Topics with an evidence base that could be the focus of
future systematic reviews include telehealth for consultation, uses in intensive
care units, and applications in maternal and child health. We also identified
topics with a limited evidence base such as telehealth for triage in
urgent/primary care, management of serious pediatric conditions, patient outcomes
for teledermatology, and the integration of behavioral and physical health that
may be best addressed by additional primary research. Finally, telehealth
research should be integrated into evaluation of new models of care and payment
so that the potential of telehealth can be assessed across the continuum of care
in organizations that are implementing these reforms. Box 1 below summarizes the
key messages of this report.
PMID: 27536752
