AHRQ Draft Review of Telemedicine

Telemedicine, broadly defined, is one of the health care delivery innovations that I actually think has real promise, primarily because quality appears to be good, unit costs can be significantly lower and access, especially for sub-specialty services, can be extended to underserved populations.  The Agency for Healthcare Research & Quality has issued a draft review of research regarding outcomes from telemedicine use.   (AHRQ Review)    After an exhaustive literature search, the authors used 145 research articles on various forms of telemedicine, 31 on inpatient consultations, 33 on emergency care and 81 on outpatient services.  Much of the research focussed on consultations between providers; i.e. a primary care doctor consulting a specialist, but often the patient was directly involved.  Headline summarized findings across the research include that telemedicine generally produced as good, and often better, care compared to in person services; that telemedicine may lower length of stay and reduce other costs; and that it may reduce travel and other costs for patients.  As may be expected given the wide variety of forms of telemedicine, and the usual variable nature and quality of research studies, the evidence is stronger or weaker for different types of telemedicine.

One of the strongest conclusions was in regard to remote management of ICU patients, where telemedicine was found to likely reduce mortality and length of stay in the ICU, although not necessarily total hospital length of stay.  The studies were inconsistent on whether remote ICU management resulted in cost savings.  Similarly, there was fairly good evidence that specialty tele-consultations for inpatients improved some clinical outcomes, like mortality and morbidity, but there was again insufficient evidence to make conclusions about cost savings.  Remote specialty consultations for patients in the ER also generally showed improved clinical outcomes in the research, with some low-strength evidence for cost-savings.  Telemedicine for routine outpatient care clearly improved access and some clinical outcomes, while there was again low-strength positive evidence for the impact on utilization and costs.  As is often the case, the authors laid out suggestions for future research to strengthen conclusions about the value of telemedicine.