Research on the use of telehealth is vast and varied, yet there is evidence to support its effectiveness for specific uses, such as remote patient monitoring for patients with chronic conditions and psychotherapy as part of behavioral health, according to a final report from The Agency for Healthcare Research and Quality (AHRQ).
AHRQ, which is part of the U.S. Department of Health and Human Services (HHS), released the 125-page report on the effectiveness of telehealth as the finalization of a 52-page draft report released in December. The purpose of the report is to provide a framework and an evidence map of the available research regarding the impact of telehealth on health outcomes and healthcare utilization that can be used to inform policy and practice decisions and guide future work.
The study, titled “Telehealth: Mapping the Evidence for Patient Outcomes from Systematic Reviews,” was prepared by the Pacific Northwest Evidence-based Practice Center.
The study was requested by Senators Bill Nelson (R-Fla.) and John Thune (R-S.D.), who asked for a literature review on the value of telehealth and remote patient monitoring, particularly for the chronically ill, with a focus on expanding access to care and reducing costs. A coalition of stakeholders, including several medical, patient advocacy and industry groups, supported the call for a report in a letter sent to Nelson and Senator Susan Collins (R-Maine).
According to the report, AHRQ researchers analyzed the available research and studies on telehealth use and found that 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,” the report authors stated.
“Our searches confirmed that there is a large, broad evidence base about the effectiveness of telehealth, including over 200 systematic reviews and hundreds of primary studies published since 2006. Although we found that many reviews are not structured or conducted in a way that would support current decisions related to telehealth, we did identify a substantial amount of evidence—58 systematic reviews that covered several important clinical focus areas and met our inclusion criteria,” the study authors wrote.
And, the researchers concluded that future research should shift to how to promote broader implementation and address barriers. And, continued 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 researchers stated.
“Going forward, research should be conducted in emerging models of care, particularly value-based models where use of telehealth may improve the ability to share risk and attain quality and related outcomes. These studies of telehealth should consider combinations of applications of telehealth and outcomes that are important in these new models and that evaluate the specific contribution telehealth can make in these contexts,” the researchers wrote.
According to AHRQ researchers, additional systematic reviews could be helpful for some topics, such as telehealth for consultation, uses in intensive care units, and applications in maternal and child health, where primary studies are available but the studies have not been synthesized.
“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,” the report authors wrote.
The final report strikes a more positive tone about the effectiveness of telehealth compared to the December draft report, in which AHRQ analysts reported that there is not enough evidence about how effective telehealth is in order to shape policy decisions.
“Telehealth has been described as having great promise in the sense that it could leverage the $30 billion investment in electronic health records that ONC (Office of the National Coordinator for Health IT) has made in the last half-decade through the Health Information Technology for Economic and Clinical Health (HITECH) Act. While the potential benefits and possible uses have been extensively enumerated and described (e.g., improving quality, promoting safety, and expanding access) there is also a body of literature that outlines barriers as well as challenges to implementation and widespread adoption of telehealth,” the AHRQ draft report stated.
In the draft report, AHRQ noted that studies have proven the value of telehealth interventions to produce positive results when used in the clinical areas of chronic conditions and behavioral health and when telehealth is used for providing communication and counseling and monitoring or management, however, that finding was one of several bulleted findings. In the draft, the agency noted that many reviews on telehealth are not structured or conducted in a way that would support current decisions related to telehealth.
However, in the final report, the agency concluded, “This map confirms that there are important areas within telehealth with substantial evidence that can support broader implementation and spread. The fact that there are other areas where evidence is still minimal should not delay building on what we do know.”