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Telehealth for Acute and Chronic Care Consultations Draft Comparative Effectiveness Review Number xx Telehealth for Acute and Chronic Care Consultations Prepared for: Agency for Healthcare Research and Quality U.S. Department of Health and Human Services 5600 Fishers Lane Rockville, MD 20857 www.ahrq.gov ThisThis information information is is distributed distributed solely solely for for the the purposes purposes of of predissemination predissemination peer peer review. review. It It has has not not been formallybeen formally disseminated disseminated by the bAgencyy the Agency for Healthcare for Healthcare Research Research and Quality and Qu (AHRQ).ality. Th eThe findings findings are are subjectsubject to t ochange change based based on on the the literature literature identified identified in in the the interim interim and and peer-review/public peer-review/public comments comments and shouldand should not be not referenced be referenced as definitive. as definitive. It does It notdoes represent not represent and should and should not be not construed be construed to represent to an represent an Agency for Healthcare Research and Quality or Department of Health and Human AHRQ or Department of Health and Human Services determination or policy. Services (AHRQ) determination or policy. Contract No. To be added for final version. Prepared by: To be added for final version. Investigators: To be added for final version. AHRQ Publication No. xx-EHCxxx <Month Year> Purpose of Review To evaluate the effectiveness of telehealth consultations for inpatient, emergency, and outpatient care. Key Messages • Remote intensive care unit (ICU) consultations likely reduce ICU mortality and ICU length of stay (LOS); specialty telehealth consultations likely reduce the time patients spend in the emergency department; and remote consultations for outpatient care likely improve access and a range of clinical outcomes (moderate strength of evidence in favor of telehealth). • Findings with lower confidence are that telehealth consultations may: reduce inpatient LOS and costs; may improve outcomes and reduce costs for emergency care due to fewer transfers; and may reduce outpatient visits and costs due to travel (low strength of evidence in favor of telehealth). • Current evidence reports no difference in overall hospital LOS with remote ICUs, no difference in clinical outcomes with inpatient telehealth specialty consultations, no difference in mortality but also no difference in harms with telestroke consultations; and no difference in satisfaction with outpatient telehealth consultations (low strength of evidence of no difference). • Too few studies reported information on potential harms from telehealth consultations for conclusions to be drawn (insufficient evidence). • An exploratory cost model underscores the importance of perspective and assumptions in using modeling to extend evidence and the need for more detailed data on costs as well as outcomes when telehealth is used for consultations. This report is based on research conducted by the XXXXX Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. XXX-20XX-XXXXX). The findings and conclusions in this document are those of the authors, who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services. None of the investigators have any affiliations or financial involvement that conflicts with the material presented in this report. The information in this report is intended to help health care decisionmakers—patients and clinicians, health system leaders, and policymakers, among others—make well-informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances presented by individual patients. This report is made available to the public under the terms of a licensing agreement between the author and the Agency for Healthcare Research and Quality. This report may be used and reprinted without permission except those copyrighted materials that are clearly noted in the report. Further reproduction of those copyrighted materials is prohibited without the express permission of copyright holders. AHRQ or U.S. Department of Health and Human Services endorsement of any derivative products that may be developed from this report, such as clinical practice guidelines, other quality enhancement tools, or reimbursement or coverage policies may not be stated or implied. Persons using assistive technology may not be able to fully access information in this report. For assistance contact [email protected]. Suggested citation: <Authors>. <Topic>. Evidence Report/Technology Assessment. No. <#>. (Prepared by <EPC Name> under Contract No. <##>.) AHRQ Publication No. 14-XXXXX>. Rockville, MD: Agency for Healthcare Research and Quality; <Month, Year>. www.effectivehealthcare.ahrq.gov/reports/final/cfm. ii The Agency for Healthcare Research and Quality (AHRQ), through its Evidence-based Practice Centers (EPCs), sponsors the development of systematic reviews to assist public- and private-sector organizations in their efforts to improve the quality of health care in the United States. These reviews provide comprehensive, science-based information on common, costly medical conditions, and new health care technologies and strategies. Systematic reviews are the building blocks underlying evidence-based practice; they focus attention on the strength and limits of evidence from research studies about the effectiveness and safety of a clinical intervention. In the context of developing recommendations for practice, systematic reviews can help clarify whether assertions about the value of the intervention are based on strong evidence from clinical studies. For more information about AHRQ EPC systematic reviews, see www.effectivehealthcare.ahrq.gov/reference/purpose.cfm AHRQ expects that these systematic reviews will be helpful to health plans, providers, purchasers, government programs, and the health care system as a whole. Transparency and stakeholder input are essential to the Effective Health Care Program. Please visit the Web site (www.effectivehealthcare.ahrq.gov) to see draft research questions and reports or to join an e- mail list to learn about new program products and opportunities for input. If you have comments on this systematic review, they may be sent by mail to the Task Order Officer named below at: Agency for Healthcare Research and Quality, 540 Gaither Road, Rockville, MD 20850, or by email to [email protected]. Gopal Khanna, M.B.A. Arlene S. Bierman, M.D., M.S. Director Director Agency for Healthcare Research and Quality Center for Evidence and Practice Improvement Agency for Healthcare Research and Quality Stephanie Chang, M.D., M.P.H. Elise Berliner, PhD Director Task Order Officer Evidence-based Practice Center Program Center for Evidence and Practice Center for Evidence and Practice Improvement Improvement Agency for Healthcare Research and Quality Agency for Healthcare Research and Quality iii Acknowledgments To be added for final version. Key Informants In designing the study questions, the EPC consulted several Key Informants who represent the end-users of research. The EPC sought the Key Informant input on the priority areas for research and synthesis. Key Informants are not involved in the analysis of the evidence or the writing of the report. Therefore, in the end, study questions, design, methodological approaches, and/or conclusions do not necessarily represent the views of individual Key Informants. Key Informants must disclose any financial conflicts of interest greater than $10,000 and any other relevant business or professional conflicts of interest. Because of their role as end-users, individuals with potential conflicts may be retained. The TOO and the EPC work to balance, manage, or mitigate any conflicts of interest. The list of Key Informants who provided input to this report will be added for the final version. Technical Expert Panel In designing the study questions and methodology at the outset of this report, the EPC consulted several technical and content experts. Broad expertise and perspectives were sought. Divergent and conflicted opinions are common and perceived as healthy scientific discourse that results in a thoughtful, relevant systematic review. Therefore, in the end, study questions, design, methodologic approaches, and/or conclusions do not necessarily represent the views of individual technical and content experts. Technical Experts must disclose any financial conflicts of interest greater than $10,000 and any other relevant business or professional conflicts of interest. Because of their unique clinical or content expertise, individuals with potential conflicts may be retained. The TOO and the EPC work to balance, manage, or mitigate any potential conflicts of interest identified. The list of Technical Experts who reviewed the report will be added for the final version. Peer Reviewers Prior to publication of the final evidence report, EPCs sought input from independent Peer
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