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Technical Brief - Final – Jun. 30, 2016
Telehealth: Mapping the Evidence for Patient Outcomes From Systematic Reviews
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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.
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.
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.
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.
The key messages of this report are listed below.
- The research literature on telehealth is vast and varied, consisting of hundreds of systematic reviews and thousands of studies of use across various clinical conditions and health care functions.
- There is sufficient evidence to support the effectiveness of telehealth for specific uses with some types of patients, including—
- Remote patient monitoring for patients with chronic conditions;
- Communication and counseling for patients with chronic conditions;
- Psychotherapy as part of behavioral health.
For these telehealth applications, the research focus should shift to how to promote broader implementation and address barriers.
- Additional systematic reviews may be helpful for some topics, such as consultation and maternal and child health, where primary studies are available but these have not been synthesized.
- For other uses, such as triage for urgent care, telehealth is cited as offering value but limited primary evidence was identified, suggesting more studies are needed.
- Future research also should assess the use and impact of telehealth in new health care organizational and payment models.