One of the issues with which we often grapple in the telehealth space is the relative lack of availability of studies and data when compared to other areas of the health care sector. Telehealth is relatively young and therefore has not had the time to build a voluminous body of data and evidence. But things are changing. Many stakeholders are doing exemplary work in telehealth research, and stakeholders like the Department of Veterans Affairs have longstanding evidence regarding the efficacy of telehealth. However, it’s a more recent document that has caught my attention.
A draft report prepared for the Agency for Healthcare Research and Quality (AHRQ) helps to clarify the existing research regarding telehealth. The report provides a framework and an evidence map of the available research regarding the impact of telehealth on health outcomes and care utilization. A detailed description of the methodology used is included in the report as well as an appendix detailing the included and excluded studies the authors considered.
The document is the result of a request from Senators John Thune (R-SD) and Bill Nelson (D-FL) for a literature review examining the value of telehealth and remote patient monitoring with a focus on expanding access to care and reducing costs. Some of my takeaways from the draft report:
- Initial searches confirmed that there is a large volume of literature consisting of both primary studies and systematic reviews regarding applications of telehealth.
- There is broad evidence about the effectiveness of telehealth, including over 200 systematic reviews and hundreds of primary studies published since 2006.
- A limitation of the authors’ literature review was the use of the term “telehealth” and how stakeholders have varied definitions of the term—making searching literature and identifying relevant studies challenging.
- Another challenge of the literature review was the uneven quality of studies within the reviews whereby lower-quality studies were less likely to find an effect even where one exists.
- Although the report found that many previous reviews were not structured in a way that would support current decisions related to telehealth, the report did identify 44 systematic reviews that addressed several important clinical focus areas.
- The largest volume of research reported that telehealth interventions produce positive results when used in the clinical areas of chronic conditions and behavioral health.
- Telehealth also yielded positive results when used for providing communication/counseling and monitoring/management.
- Areas that could be the focus of future systematic reviews include telehealth for consultation, acute care, and maternal/child health.
- Topics identified as having a limited evidence include telehealth for triage in urgent/primary care, management of serious pediatric conditions and the integration of behavioral and physical health.
- No studies have yet been able to assess the contribution of telehealth to value-based models given how relatively new these models are.
Report Recommendations
The authors of the draft report also make some interesting recommendations regarding the best ways to advance telehealth. First, they recommend developing additional research in a variety of clinical areas, including triage in urgent care and management of serious pediatric conditions. Second, the authors call for more systematic research reviews in consultation, acute care, and maternal/child health. Finally, the authors encourage research in emerging models of care such as value-based programs where telehealth may improve quality outcomes.
The draft report is very valuable in synthesizing some of the existing literature, and is open for comment until 11:59 p.m. Eastern time on January 5, 2016. When finalized, this report could have an influential impact on policymakers’ thinking. I plan on submitting comments regarding the draft (including my view that there are existing studies that should have been considered that were not). I urge all stakeholders to do the same.