Effectiveness of Telehealth in Rural and Remote Emergency Departments: Systematic Review
Emergency telehealth has been used to improve access of patients residing in rural and remote areas to specialist care in the hope of mitigating the significant health disparities that they experience. Patient disposition decisions in rural and remote emergency departments (EDs) can be complex and l...
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| Veröffentlicht in: | Journal of medical Internet research Jg. 23; H. 11; S. e30632 |
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| Format: | Journal Article |
| Sprache: | Englisch |
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Gunther Eysenbach MD MPH, Associate Professor
26.11.2021
JMIR Publications |
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| ISSN: | 1438-8871, 1439-4456, 1438-8871 |
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| Abstract | Emergency telehealth has been used to improve access of patients residing in rural and remote areas to specialist care in the hope of mitigating the significant health disparities that they experience. Patient disposition decisions in rural and remote emergency departments (EDs) can be complex and largely dependent on the expertise and experience available at local (receiving-end) hospitals. Although there has been some synthesis of evidence of the effectiveness of emergency telehealth in clinical practice in rural and remote EDs for nonacute presentations, there has been limited evaluation of the influence of contextual factors such as clinical area and acuity of presentation on these findings.
The aims of this systematic review are to examine the outcome measures used in studying the effectiveness of telehealth in rural and remote EDs and to analyze the clinical context in which these outcome measures were used and interpreted.
The search strategy used Medical Subject Headings and equivalent lists of subject descriptors to find articles covering 4 key domains: telehealth or telemedicine, EDs, effectiveness, and rural and remote. Studies were selected using the Population, Intervention, Comparator, Outcomes of Interest, and Study Design framework. This search strategy was applied to MEDLINE (Ovid), Cochrane Library, Scopus, CINAHL, ProQuest, and EconLit, as well as the Centre for Reviews and Dissemination databases (eg, National Health Service Economic Evaluation Database) for the search period from January 1, 1990, to May 23, 2020. Qualitative synthesis was performed on the outcome measures used in the included studies, in particular the clinical contexts within which they were interpreted.
A total of 21 full-text articles were included for qualitative analysis. Telehealth use in rural and remote EDs demonstrated effectiveness in achieving improved or equivalent clinical effectiveness, appropriate care processes, and-depending on the context-improvement in speed of care, as well as favorable service use patterns. The definition of effectiveness varied across the clinical areas and contexts of the studies, and different measures have been used to affirm the safety and clinical effectiveness of telehealth in rural and remote EDs. The acuity of patient presentation emerged as a dominant consideration in the interpretation of interlinking time-sensitive clinical effectiveness and patient disposition measures such as transfer and discharge rates, local hospital admission, length of stay, and ED length of stay. These, together with clinical area and acuity of presentation, are the outcome determination criteria that emerged from this review.
Emergency telehealth studies typically use multiple outcome measures to determine the effectiveness of the services. The outcome determination criteria that emerged from this analysis are useful when defining the favorable direction for each outcome measure of interest. The findings of this review have implications for emergency telehealth service design and policies.
PROSPERO CRD42019145903; https://tinyurl.com/ndmkr8ry. |
|---|---|
| AbstractList | Emergency telehealth has been used to improve access of patients residing in rural and remote areas to specialist care in the hope of mitigating the significant health disparities that they experience. Patient disposition decisions in rural and remote emergency departments (EDs) can be complex and largely dependent on the expertise and experience available at local (receiving-end) hospitals. Although there has been some synthesis of evidence of the effectiveness of emergency telehealth in clinical practice in rural and remote EDs for nonacute presentations, there has been limited evaluation of the influence of contextual factors such as clinical area and acuity of presentation on these findings.BACKGROUNDEmergency telehealth has been used to improve access of patients residing in rural and remote areas to specialist care in the hope of mitigating the significant health disparities that they experience. Patient disposition decisions in rural and remote emergency departments (EDs) can be complex and largely dependent on the expertise and experience available at local (receiving-end) hospitals. Although there has been some synthesis of evidence of the effectiveness of emergency telehealth in clinical practice in rural and remote EDs for nonacute presentations, there has been limited evaluation of the influence of contextual factors such as clinical area and acuity of presentation on these findings.The aims of this systematic review are to examine the outcome measures used in studying the effectiveness of telehealth in rural and remote EDs and to analyze the clinical context in which these outcome measures were used and interpreted.OBJECTIVEThe aims of this systematic review are to examine the outcome measures used in studying the effectiveness of telehealth in rural and remote EDs and to analyze the clinical context in which these outcome measures were used and interpreted.The search strategy used Medical Subject Headings and equivalent lists of subject descriptors to find articles covering 4 key domains: telehealth or telemedicine, EDs, effectiveness, and rural and remote. Studies were selected using the Population, Intervention, Comparator, Outcomes of Interest, and Study Design framework. This search strategy was applied to MEDLINE (Ovid), Cochrane Library, Scopus, CINAHL, ProQuest, and EconLit, as well as the Centre for Reviews and Dissemination databases (eg, National Health Service Economic Evaluation Database) for the search period from January 1, 1990, to May 23, 2020. Qualitative synthesis was performed on the outcome measures used in the included studies, in particular the clinical contexts within which they were interpreted.METHODSThe search strategy used Medical Subject Headings and equivalent lists of subject descriptors to find articles covering 4 key domains: telehealth or telemedicine, EDs, effectiveness, and rural and remote. Studies were selected using the Population, Intervention, Comparator, Outcomes of Interest, and Study Design framework. This search strategy was applied to MEDLINE (Ovid), Cochrane Library, Scopus, CINAHL, ProQuest, and EconLit, as well as the Centre for Reviews and Dissemination databases (eg, National Health Service Economic Evaluation Database) for the search period from January 1, 1990, to May 23, 2020. Qualitative synthesis was performed on the outcome measures used in the included studies, in particular the clinical contexts within which they were interpreted.A total of 21 full-text articles were included for qualitative analysis. Telehealth use in rural and remote EDs demonstrated effectiveness in achieving improved or equivalent clinical effectiveness, appropriate care processes, and-depending on the context-improvement in speed of care, as well as favorable service use patterns. The definition of effectiveness varied across the clinical areas and contexts of the studies, and different measures have been used to affirm the safety and clinical effectiveness of telehealth in rural and remote EDs. The acuity of patient presentation emerged as a dominant consideration in the interpretation of interlinking time-sensitive clinical effectiveness and patient disposition measures such as transfer and discharge rates, local hospital admission, length of stay, and ED length of stay. These, together with clinical area and acuity of presentation, are the outcome determination criteria that emerged from this review.RESULTSA total of 21 full-text articles were included for qualitative analysis. Telehealth use in rural and remote EDs demonstrated effectiveness in achieving improved or equivalent clinical effectiveness, appropriate care processes, and-depending on the context-improvement in speed of care, as well as favorable service use patterns. The definition of effectiveness varied across the clinical areas and contexts of the studies, and different measures have been used to affirm the safety and clinical effectiveness of telehealth in rural and remote EDs. The acuity of patient presentation emerged as a dominant consideration in the interpretation of interlinking time-sensitive clinical effectiveness and patient disposition measures such as transfer and discharge rates, local hospital admission, length of stay, and ED length of stay. These, together with clinical area and acuity of presentation, are the outcome determination criteria that emerged from this review.Emergency telehealth studies typically use multiple outcome measures to determine the effectiveness of the services. The outcome determination criteria that emerged from this analysis are useful when defining the favorable direction for each outcome measure of interest. The findings of this review have implications for emergency telehealth service design and policies.CONCLUSIONSEmergency telehealth studies typically use multiple outcome measures to determine the effectiveness of the services. The outcome determination criteria that emerged from this analysis are useful when defining the favorable direction for each outcome measure of interest. The findings of this review have implications for emergency telehealth service design and policies.PROSPERO CRD42019145903; https://tinyurl.com/ndmkr8ry.TRIAL REGISTRATIONPROSPERO CRD42019145903; https://tinyurl.com/ndmkr8ry. BackgroundEmergency telehealth has been used to improve access of patients residing in rural and remote areas to specialist care in the hope of mitigating the significant health disparities that they experience. Patient disposition decisions in rural and remote emergency departments (EDs) can be complex and largely dependent on the expertise and experience available at local (receiving-end) hospitals. Although there has been some synthesis of evidence of the effectiveness of emergency telehealth in clinical practice in rural and remote EDs for nonacute presentations, there has been limited evaluation of the influence of contextual factors such as clinical area and acuity of presentation on these findings. ObjectiveThe aims of this systematic review are to examine the outcome measures used in studying the effectiveness of telehealth in rural and remote EDs and to analyze the clinical context in which these outcome measures were used and interpreted. MethodsThe search strategy used Medical Subject Headings and equivalent lists of subject descriptors to find articles covering 4 key domains: telehealth or telemedicine, EDs, effectiveness, and rural and remote. Studies were selected using the Population, Intervention, Comparator, Outcomes of Interest, and Study Design framework. This search strategy was applied to MEDLINE (Ovid), Cochrane Library, Scopus, CINAHL, ProQuest, and EconLit, as well as the Centre for Reviews and Dissemination databases (eg, National Health Service Economic Evaluation Database) for the search period from January 1, 1990, to May 23, 2020. Qualitative synthesis was performed on the outcome measures used in the included studies, in particular the clinical contexts within which they were interpreted. ResultsA total of 21 full-text articles were included for qualitative analysis. Telehealth use in rural and remote EDs demonstrated effectiveness in achieving improved or equivalent clinical effectiveness, appropriate care processes, and—depending on the context—improvement in speed of care, as well as favorable service use patterns. The definition of effectiveness varied across the clinical areas and contexts of the studies, and different measures have been used to affirm the safety and clinical effectiveness of telehealth in rural and remote EDs. The acuity of patient presentation emerged as a dominant consideration in the interpretation of interlinking time-sensitive clinical effectiveness and patient disposition measures such as transfer and discharge rates, local hospital admission, length of stay, and ED length of stay. These, together with clinical area and acuity of presentation, are the outcome determination criteria that emerged from this review. ConclusionsEmergency telehealth studies typically use multiple outcome measures to determine the effectiveness of the services. The outcome determination criteria that emerged from this analysis are useful when defining the favorable direction for each outcome measure of interest. The findings of this review have implications for emergency telehealth service design and policies. Trial RegistrationPROSPERO CRD42019145903; https://tinyurl.com/ndmkr8ry Background: Emergency telehealth has been used to improve access of patients residing in rural and remote areas to specialist care in the hope of mitigating the significant health disparities that they experience. Patient disposition decisions in rural and remote emergency departments (EDs) can be complex and largely dependent on the expertise and experience available at local (receiving-end) hospitals. Although there has been some synthesis of evidence of the effectiveness of emergency telehealth in clinical practice in rural and remote EDs for nonacute presentations, there has been limited evaluation of the influence of contextual factors such as clinical area and acuity of presentation on these findings. Objective: The aims of this systematic review are to examine the outcome measures used in studying the effectiveness of telehealth in rural and remote EDs and to analyze the clinical context in which these outcome measures were used and interpreted. Methods: The search strategy used Medical Subject Headings and equivalent lists of subject descriptors to find articles covering 4 key domains: telehealth or telemedicine, EDs, effectiveness, and rural and remote. Studies were selected using the Population, Intervention, Comparator, Outcomes of Interest, and Study Design framework. This search strategy was applied to MEDLINE (Ovid), Cochrane Library, Scopus, CINAHL, ProQuest, and EconLit, as well as the Centre for Reviews and Dissemination databases (eg, National Health Service Economic Evaluation Database) for the search period from January 1, 1990, to May 23, 2020. Qualitative synthesis was performed on the outcome measures used in the included studies, in particular the clinical contexts within which they were interpreted. Results: A total of 21 full-text articles were included for qualitative analysis. Telehealth use in rural and remote EDs demonstrated effectiveness in achieving improved or equivalent clinical effectiveness, appropriate care processes, and—depending on the context—improvement in speed of care, as well as favorable service use patterns. The definition of effectiveness varied across the clinical areas and contexts of the studies, and different measures have been used to affirm the safety and clinical effectiveness of telehealth in rural and remote EDs. The acuity of patient presentation emerged as a dominant consideration in the interpretation of interlinking time-sensitive clinical effectiveness and patient disposition measures such as transfer and discharge rates, local hospital admission, length of stay, and ED length of stay. These, together with clinical area and acuity of presentation, are the outcome determination criteria that emerged from this review. Conclusions: Emergency telehealth studies typically use multiple outcome measures to determine the effectiveness of the services. The outcome determination criteria that emerged from this analysis are useful when defining the favorable direction for each outcome measure of interest. The findings of this review have implications for emergency telehealth service design and policies. Trial Registration: PROSPERO CRD42019145903; https://tinyurl.com/ndmkr8ry Emergency telehealth has been used to improve access of patients residing in rural and remote areas to specialist care in the hope of mitigating the significant health disparities that they experience. Patient disposition decisions in rural and remote emergency departments (EDs) can be complex and largely dependent on the expertise and experience available at local (receiving-end) hospitals. Although there has been some synthesis of evidence of the effectiveness of emergency telehealth in clinical practice in rural and remote EDs for nonacute presentations, there has been limited evaluation of the influence of contextual factors such as clinical area and acuity of presentation on these findings. The aims of this systematic review are to examine the outcome measures used in studying the effectiveness of telehealth in rural and remote EDs and to analyze the clinical context in which these outcome measures were used and interpreted. The search strategy used Medical Subject Headings and equivalent lists of subject descriptors to find articles covering 4 key domains: telehealth or telemedicine, EDs, effectiveness, and rural and remote. Studies were selected using the Population, Intervention, Comparator, Outcomes of Interest, and Study Design framework. This search strategy was applied to MEDLINE (Ovid), Cochrane Library, Scopus, CINAHL, ProQuest, and EconLit, as well as the Centre for Reviews and Dissemination databases (eg, National Health Service Economic Evaluation Database) for the search period from January 1, 1990, to May 23, 2020. Qualitative synthesis was performed on the outcome measures used in the included studies, in particular the clinical contexts within which they were interpreted. A total of 21 full-text articles were included for qualitative analysis. Telehealth use in rural and remote EDs demonstrated effectiveness in achieving improved or equivalent clinical effectiveness, appropriate care processes, and-depending on the context-improvement in speed of care, as well as favorable service use patterns. The definition of effectiveness varied across the clinical areas and contexts of the studies, and different measures have been used to affirm the safety and clinical effectiveness of telehealth in rural and remote EDs. The acuity of patient presentation emerged as a dominant consideration in the interpretation of interlinking time-sensitive clinical effectiveness and patient disposition measures such as transfer and discharge rates, local hospital admission, length of stay, and ED length of stay. These, together with clinical area and acuity of presentation, are the outcome determination criteria that emerged from this review. Emergency telehealth studies typically use multiple outcome measures to determine the effectiveness of the services. The outcome determination criteria that emerged from this analysis are useful when defining the favorable direction for each outcome measure of interest. The findings of this review have implications for emergency telehealth service design and policies. PROSPERO CRD42019145903; https://tinyurl.com/ndmkr8ry. |
| Author | Hendrie, Delia Boyd, James Blakeman, Robert McDonnell, Josephine Waters, Stephanie Tsou, Christina Robinson, Suzanne Bosich, Kylie Jamieson, Andrew Yeung, Justin |
| AuthorAffiliation | 6 Command Centre WA Country Health Service Perth Australia 4 Consumer and Community Health Research Network Nedlands Australia 2 Innovation & Development WA Country Health Service Perth Australia 3 Digital Health La Trobe University Bundoora Australia 5 Consumer and Mental Health WA Cloverdale Australia 1 School of Population Health Curtin Univeristy Bentley Australia |
| AuthorAffiliation_xml | – name: 3 Digital Health La Trobe University Bundoora Australia – name: 4 Consumer and Community Health Research Network Nedlands Australia – name: 5 Consumer and Mental Health WA Cloverdale Australia – name: 1 School of Population Health Curtin Univeristy Bentley Australia – name: 6 Command Centre WA Country Health Service Perth Australia – name: 2 Innovation & Development WA Country Health Service Perth Australia |
| Author_xml | – sequence: 1 givenname: Christina orcidid: 0000-0001-6780-8117 surname: Tsou fullname: Tsou, Christina – sequence: 2 givenname: Suzanne orcidid: 0000-0001-5703-6475 surname: Robinson fullname: Robinson, Suzanne – sequence: 3 givenname: James orcidid: 0000-0002-8925-8811 surname: Boyd fullname: Boyd, James – sequence: 4 givenname: Andrew orcidid: 0000-0001-7382-2740 surname: Jamieson fullname: Jamieson, Andrew – sequence: 5 givenname: Robert orcidid: 0000-0002-5818-2877 surname: Blakeman fullname: Blakeman, Robert – sequence: 6 givenname: Justin orcidid: 0000-0003-3144-9110 surname: Yeung fullname: Yeung, Justin – sequence: 7 givenname: Josephine orcidid: 0000-0002-0425-1873 surname: McDonnell fullname: McDonnell, Josephine – sequence: 8 givenname: Stephanie orcidid: 0000-0002-6172-3259 surname: Waters fullname: Waters, Stephanie – sequence: 9 givenname: Kylie orcidid: 0000-0001-5077-0036 surname: Bosich fullname: Bosich, Kylie – sequence: 10 givenname: Delia orcidid: 0000-0001-5022-5281 surname: Hendrie fullname: Hendrie, Delia |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/34842537$$D View this record in MEDLINE/PubMed |
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| ContentType | Journal Article |
| Copyright | Christina Tsou, Suzanne Robinson, James Boyd, Andrew Jamieson, Robert Blakeman, Justin Yeung, Josephine McDonnell, Stephanie Waters, Kylie Bosich, Delia Hendrie. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 26.11.2021. 2021. This work is licensed under https://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. Christina Tsou, Suzanne Robinson, James Boyd, Andrew Jamieson, Robert Blakeman, Justin Yeung, Josephine McDonnell, Stephanie Waters, Kylie Bosich, Delia Hendrie. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 26.11.2021. 2021 |
| Copyright_xml | – notice: Christina Tsou, Suzanne Robinson, James Boyd, Andrew Jamieson, Robert Blakeman, Justin Yeung, Josephine McDonnell, Stephanie Waters, Kylie Bosich, Delia Hendrie. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 26.11.2021. – notice: 2021. This work is licensed under https://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. – notice: Christina Tsou, Suzanne Robinson, James Boyd, Andrew Jamieson, Robert Blakeman, Justin Yeung, Josephine McDonnell, Stephanie Waters, Kylie Bosich, Delia Hendrie. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 26.11.2021. 2021 |
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| Issue | 11 |
| Keywords | telemedicine rural population telehealth clinical effectiveness remote rural health treatment outcome |
| Language | English |
| License | Christina Tsou, Suzanne Robinson, James Boyd, Andrew Jamieson, Robert Blakeman, Justin Yeung, Josephine McDonnell, Stephanie Waters, Kylie Bosich, Delia Hendrie. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 26.11.2021. This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on https://www.jmir.org/, as well as this copyright and license information must be included. |
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| Snippet | Emergency telehealth has been used to improve access of patients residing in rural and remote areas to specialist care in the hope of mitigating the... Background: Emergency telehealth has been used to improve access of patients residing in rural and remote areas to specialist care in the hope of mitigating... BackgroundEmergency telehealth has been used to improve access of patients residing in rural and remote areas to specialist care in the hope of mitigating the... |
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| SubjectTerms | Clinical effectiveness Clinical medicine Clinical outcomes Context Cost analysis Criteria Dissemination Effectiveness Emergency Service, Hospital Emergency services Health care access Health disparities Health services Hospitalization Hospitals Humans Length of stay Medical technology Patients Qualitative research Registration Remote areas Review Rural areas Rural communities Rural Population Search strategies State Medicine Subject headings Systematic review Telecommunications Telemedicine Text Messaging Workforce |
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| Title | Effectiveness of Telehealth in Rural and Remote Emergency Departments: Systematic Review |
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