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Economic Review of Teleophthalmology As a Screening Strategy for Chronic Eye Disease in Adults Appendix 1

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Economic Review of Teleophthalmology As a Screening Strategy for Chronic Eye Disease in Adults Appendix 1 Economic review of teleophthalmology as a screening strategy for chronic eye disease in adults Appendix 1: Systematic Review Search Protocol Title: Teleophthalmology: A Systematic Review Research Team members and contact information Noha Sharafeldin, MD PhD E-mail: [email protected] Atsushi Kawaguchi, MD PhD(s) E-mail: [email protected] Sandy Campbell, BA MLS E-mail : [email protected] Karim F. Damji, MD MBA E-mail: [email protected] Aishwarya Sundaram E-mail: [email protected] Matt Tennant, MD E-mail: [email protected] Chris Rudnisky, MD E-mail: [email protected] Ezekiel Weis, MD MPH E-mail: [email protected] 1. Introduction Teleophthalmology is a branch of telemedicine that uses telecommunications technology for medical diagnosis and patient eye care delivery. Recent, widespread interest among healthcare providers has become apparent with the development and increased feasibility of technological advances as well as the projected increase in chronic eye disease with the aging population and shortage of trained ophthalmologists to meet this demand. This is of specific importance to patients in rural and underserved areas who may not have access to ophthalmologic care because of barriers related to travel distance, time, and expense. Similarly, in urban areas, patients of low socioeconomic status benefit from improved access to screening services and teleophthalmology can be utilized to improve patient access and efficiency (see for example Arora et al CJO 2014). Several aspects relating to the effectiveness and cost- effectiveness of teleophthalmology systems need to be assessed. 2. Objectives The objective of this review is to conduct an up-to-date systematic review to evaluate the clinical effectiveness, as well as the economic value of teleophthalmology compared to face-to-face patient care. 3. Methods 3.1 Types of studies Randomized controlled trials Controlled clinical trials Interrupted time series analyses Controlled before and after studies Cohort studies 3.2 PICO Population 1 Patients receiving care from any qualified health care practitioner through the medium of teleophthalmology, compared with those receiving the equivalent face-to-face care. Interventions Teleophthalmology Comparative group Traditional face-to-face care No comparative group for non-comparative studies 3.3 Outcome Primary outcomes Clinical outcomes of care (e.g. diagnostic accuracy of diabetic retinopathy, age related macular degeneration, glaucoma) Secondary outcomes 1. Economic measures in terms of cost-utility and cost-effectiveness of teleophthalmology. 2. Acceptability of care to patients and staff 3. Patient satisfaction 4. Health care resources utilization 3.4 Search methods for identification of studies Electronic searches We will identify studies from Journal literature and conference proceedings via systematic searches of bibliographic databases including 1. The Cochrane Library (Cochrane Database of Systematic Reviews, Cochrane Controlled Trials Register and the EPOC Register) 2. MEDLINE 3. EBMR: Evidence Based Medicine Reviews (OVID) 4. EMBASE 5. DARE (NHS CRD) 6. HEALTHSTAR (to access US reports) 7. CINAHL We will search electronic databases using the following search terms (Table). The search strategy will use MeSH terms unless indicated otherwise including text word variations and spelling variations (e.g. use of hyphen): Table. List of search terms Set A terms Teleophthalmology; Teleretina; Teleglaucoma; Telemedicine; (Combined by OR) Telediagnosis; Videoconferencing; Teleconferencing; Real- Technology time consultation; Store-and-forward consultation; Teleconsultation; Remote consultation; Telecommunications; E-health; Mobile health 2 Teleoncology: restricted to ocular oncology/eye oncology Set B terms Cost utility; Cost effectiveness; Comparative effectiveness (Combined by OR) Economic measures Set C terms diabetic retinopathy; age related macular degeneration; (Combined by OR) retinal vascular disease; retinal vein or artery occlusion; Clinical retinopathy of prematurity, glaucoma; amblyopia and/or outcomes strabismus; corneal diseases; neuro ophthalmic disease; vision rehabilitation or low vision; oculoplastics; intraocular and extraocular tumors Set D terms Self-care; Home care (services); Rural (health services); (Combined by OR) Patient satisfaction; Care partner satisfaction; Family Care and Patient satisfaction satisfaction vs “underserved OR rural OR satisfaction” Set E terms Clinical trials; Clinical nursing research; Clinical research; (Combined by OR) Population studies; Community-based programs; Random Research assignment; Pretest-posttest design; Prospective studies designs Search Operators: A AND B AND E A AND C AND E A AND D AND E We will not limit by date We will not limit by language We will include unpublished materials Grey Literature Grey literature search will be conducted as follows. We will make efforts to contact study investigators for additional information or data for an unpublished work. Clinical trial registries (Cochrane Central Register of controlled trials, controlled- trials.com and ClinicalTrials.gov) to identify recent and ongoing studies. Web of Science/Scopus searches of the sentinel papers from each of the reviews will be completed at the end of the searches to identify any additional potentially relevant studies. Google Scholar web search Dissertations and Theses Hand searches of the most recent conference abstracts associated with Canadian and research meetings to identify recently completed but not yet published studies including: American academy of Ophthalmology, Association for research in vision and ophthalmology (ARVO), ARVO – Asia Pacific, American Glaucoma Society, American retina society, 3 American telemedicine association), European ophthalmology meetings e.g. EVER and others including European retina and glaucoma societies, Canadian Ophthalmology Society, Suggest also checking major ophthalmology society meetings in India, Australia, Great Britain etc. Bibliographies from included studies, known reviews and text for additional citations. 4. Data collection and analysis 4.1 Selection of studies At least two reviewers will screen the titles and abstracts generated from the literature search. The two reviewers (NS and AK) will select the studies independently, and the kappa statistic will be calculated to estimate agreement between the two reviewers. All studies selected by the two reviewers will be retrieved for full article review. Two reviewers will review the full articles and decide independently on their eligibility for inclusion. In cases of disagreement, the two reviewers (NS and AK) will discuss the article and either come to an agreement, or a third, independent reviewer will read the full article, discuss it with the other reviewers, and decide on whether to include the study or exclude it. The Preferred Reporting Items for Systematic Review and Meta-Analysis flow diagram PRISMA will be used to illustrate the results of the study selection process. 4.2 Quality Assessment (Risk of Bias): To assess the quality of controlled trials, the reviewers will use the Cochrane collaboration risk of bias ROB tools and for observational studies will use the New-Castle Ottawa tool. The reviewers will assign a level of evidence for each included study based on the Center of Evidence Based Medicine CEBM levels of evidence. The reviewers will also present the overall quality of the included studies narratively. 4.3 Data extraction, analysis and synthesis: Two reviewers (NS and AK) will, independently, extract the data from each selected study into predefined data extraction forms. The main data elements that will be extracted are: 1) the attributes of the study (e.g. study author, country, year of publication, and context); 2) the study methods (e.g. design and population); and 3) the relevant outcomes of the study in terms of our primary and secondary objectives listed earlier. The reviewers will then tabulate the extracted data, and synthesize the results quantitatively and narratively. If applicable, the reviewers will conduct a meta-analysis of the relevant outcomes. 4 Appendix 2: Search Strategy An expert librarian conducted an electronic search of the following databases: OVID Medline, OVID EMBASE, OVID EBM Reviews - Cochrane Database of Systematic Reviews (2005 to April 2015), EBM Reviews - ACP Journal Club (1991 to April 2015), EBM Reviews - Database of Abstracts of Reviews of Effects (2nd Quarter 2015), EBM Reviews - Cochrane Central Register of Controlled Trials (April 2015), EBM Reviews - Cochrane Methodology Register (3rd Quarter 2012), EBM Reviews - Health Technology Assessment (2nd Quarter 2015), EBM Reviews - NHS Economic Evaluation Database (2nd Quarter 2015), OVID Global Health,EBSCO -CINAHL, SCOPUS, Proquest Dissertations, and Theses Global, OCLC Papers First and Web of Science Core Collection. Titles, abstracts, and articles were searched using MeSH terms of key words representing the concepts "telehealth", "ophthalmology", and “cost”. Search results were exported to RefWorks citation management system. Two review authors (NS and AK) independently assessed study eligibility in accordance with the specified inclusion criteria. Two rounds of an initial title and abstract screen were performed by the two reviewers to improve agreement (1st and 2nd round agreement: (kappa=0.522, SE=0.026) and (kappa=0.813, SE=0.021), respectively). A third reviewer (AS) assessed all the titles and abstracts that remained in disagreement.
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