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Comparative Effectiveness of Telehealth Consultations

By May 2, 2019Commentary

The Agency for Healthcare Research & Quality conducts comprehensive research to assess the effects of various health care treatments and approaches.  It recently released a report on telehealth consultations, that is communications between two or more providers regarding a patient’s care, which might also involve the consulting clinician directly assessing the patient.   (AHRQ Report)   The researchers included 233 research studies; 106 were related to outpatient consultations, 73 to ER ones and 54 to inpatient consultations.  They were compiling both clinical and cost outcomes.  In general, the report found that telehealth consultations either improved outcomes or were no worse than the comparative approaches.  The findings with the greatest strength of evidence were that for intensive care unit patients, telehealth appeared to improve both ICU and hospital mortality, with no effect on length-of-stay in either the ICU or the hospital; in the emergency room, using specialty telehealth consultations reduced total time in the ER and reduced mortality for heart attack patients; and in the outpatient setting remote telehealth consultations improved access and some clinical outcomes.  Findings that were positive, but with a lower strength of evidence include that for inpatient consultations, there was decrease in length of stay and costs; that in the ER, there may be an improvement in clinical outcomes and a decline in costs, primarily due to fewer transfers; and in the outpatient setting, there may be a decrease in visits and costs, primarily due to less travel.  A number of other outcomes in various settings had insufficient evidence to say that telehealth consultations created better outcomes, but there was no suggestion in any study that it produced worse ones.  The report further discussed possible models for future research.

It is fairly obvious that in several settings, telehealth allows for the delivery of relatively scarce specialized resources, which should improve both access and quality outcomes; and telehealth should be able to be provided less expensively that in-person consultations, particularly when travel costs are taken into account.

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