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Impact of Consumer Health Informatics Applications: Evidence

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Impact of Consumer Health Informatics Applications: Evidence Evidence Report/Technology Assessment Number 188 Impact of Consumer Health Informatics Applications Prepared for: Agency for Healthcare Research and Quality U.S. Department of Health and Human Services http://www.ahrq.gov Contract No. HHSA 290-2007-120061-I Task Order No. 5 Prepared by: The Johns Hopkins University Evidence-based Practice Center Investigators M. Christopher Gibbons, M.D., M.P.H. Renee F. Wilson, M.S. Lipika Samal, M.D. Christoph U. Lehmann, M.D. Kay Dickersin, M.A., Ph.D. Harold P. Lehmann, M.D., Ph.D. Hanan Aboumatar, M.D. Joseph Finkelstein, M.D., Ph.D. Erica Shelton, M.D. Ritu Sharma, B.S. Eric B. Bass, M.D., M.P.H. AHRQ Publication No. 09(10)-E019 October 2009 This document is in the public domain and may be used and reprinted without permission except those copyrighted materials noted for which further reproduction is prohibited without the specific permission of copyright holders. Suggested Citation: Gibbons MC, Wilson RF, Samal L, Lehmann CU, Dickersin K, Lehmann HP, Aboumatar H, Finkelstein J, Shelton E, Sharma R, Bass EB. Impact of Consumer Health Informatics Applications. Evidence Report/Technology Assessment No. 188. (Prepared by Johns Hopkins University Evidence-based Practice Center under contract No. HHSA 290-2007-10061-I). AHRQ Publication No. 09(10)-E019. Rockville, MD. Agency for Healthcare Research and Quality. October 2009. No investigators have any affiliations or financial involvement (e.g., employment, consultancies, honoraria, stock options, expert testimony, grants or patents received or pending, or royalties) that conflict with material presented in this report. ii Preface The Agency for Healthcare Research and Quality (AHRQ), through its Evidence-Based Practice Centers (EPCs), sponsors the development of evidence reports and technology assessments to assist public- and private-sector organizations in their efforts to improve the quality of health care in the United States. The EPCs systematically review the relevant scientific literature on topics assigned to them by AHRQ and conduct additional analyses when appropriate prior to developing their reports and assessments. To bring the broadest range of experts into the development of evidence reports and health technology assessments, AHRQ encourages the EPCs to form partnerships and enter into collaborations with other medical and research organizations. The EPCs work with these partner organizations to ensure that the evidence reports and technology assessments they produce will become building blocks for health care quality improvement projects throughout the Nation. The reports undergo peer review prior to their release. AHRQ expects that the EPC evidence reports and technology assessments will inform individual health plans, providers, and purchasers as well as the health care system as a whole by providing important information to help improve health care quality. We welcome comments on this evidence report. 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 e-mail to [email protected]. Carolyn M. Clancy, M.D. Jean Slutsky, P.A., M.S.P.H. Director Director, Center for Outcomes and Evidence Agency for Healthcare Research and Quality Agency for Healthcare Research and Quality Beth A. Collins Sharp, R.N., Ph.D. Teresa Zayas-Cabán, Ph.D. Director, EPC Program Task Order Officer, Center for Primary Care, Agency for Healthcare Research and Quality Prevention, and Clinical Partnerships Agency for Healthcare Research and Quality iii Acknowledgments The EPC thanks Dr. Hosne Begum, Dr. Olaide Odelola, Dr. Christine Chang, Beth Barnett, Todd Noletto, and Rebecca Stainman for their assistance with the final assembly and formatting of this report, and Dr. Teresa Zayas-Cabán for her valuable insight throughout the project. iv Structured Abstract Objective. The objective of the report is to review the evidence on the impact of consumer health informatics (CHI) applications on health outcomes, to identify the knowledge gaps and to make recommendations for future research. Data sources. We searched MEDLINE®, EMBASE®, The Cochrane Library, ScopusTM, and CINAHL® databases, references in eligible articles and the table of contents of selected journals; and query of experts. Methods. Paired reviewers reviewed citations to identify randomized controlled trials (RCTs) of the impact of CHI applications, and all studies that addressed barriers to use of CHI applications. All studies were independently assessed for quality. All data was abstracted, graded, and reviewed by 2 different reviewers. Results. One hundred forty-six eligible articles were identified including 121 RCTs. Studies were very heterogeous and of variable quality. Four of five asthma care studies found significant positive impact of a CHI application on at least one healthcare process measure. In terms of the impact of CHI on intermediate health outcomes, significant positive impact was demonstrated in at least one intermediate health outcome of; all three identified breast cancer studies, 89 percent of 32 diet, exercise, physical activity, not obesity studies, all 7 alcohol abuse studies, 58 percent of 19 smoking cessation studies, 40 percent of 12 obesity studies, all 7 diabetes studies, 88 percent of 8 mental health studies, 25 percent of 4 asthma/COPD studies, and one of two menopause/HRT utilization studies. Thirteen additional single studies were identified and each found evidence of significant impact of a CHI application on one or more intermediate outcomes. Eight studies evaluated the effect of CHI on the doctor patient relationship. Five of these studies demonstrated significant positive impact of CHI on at least one aspect of the doctor patient relationship. In terms of the impact of CHI on clinical outcomes, significant positive impact was demonstrated in at least one clinical outcome of; one of three breast cancer studies, four of five diet, exercise, or physical activity studies, all seven mental health studies, all three identified diabetes studies. No studies included in this review found any evidence of consumer harm attributable to a CHI application. Evidence was insufficient to determine the economic impact of CHI applications. Conclusions: Despite study heterogeneity, quality variability, and some data paucity, available literature suggests that select CHI applications may effectively engage consumers, enhance traditional clinical interventions, and improve both intermediate and clinical health outcomes. v Contents Executive Summary.........................................................................................................................1 Evidence Report...........................................................................................................................11 Chapter 1. Introduction .................................................................................................................13 Consumer Health Informatics..................................................................................................13 Purpose of Evidence Report.....................................................................................................14 Chapter 2. Methods........................................................................................................................15 Recruitment of Technical Experts and Peer Reviewers...........................................................15 Key Questions..........................................................................................................................15 Conceptual Framework............................................................................................................16 Literature Search Methods.......................................................................................................16 Sources...............................................................................................................................18 Search terms and strategies................................................................................................18 Organization and tracking of the literature search.............................................................18 Title Review.............................................................................................................................18 Abstract Review.......................................................................................................................19 Article Review .........................................................................................................................19 Data Abstraction ......................................................................................................................19 Quality Assessment..................................................................................................................20 Data Synthesis..........................................................................................................................20 Data Entry and Quality Control ...............................................................................................20 Grading of the Evidence ..........................................................................................................21 Peer Review .............................................................................................................................21 Chapter 3. Results ..........................................................................................................................23
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