The Impact of Telehealthcare on the Quality and Safety of Care: A Systematic Overview
The Impact of Telehealthcare on the Quality and Safety of Care: A Systematic Overview
复制标题
DOI：
10.1371/journal.pone.0071238
复制
发表时间：
2013-08-19
期刊：
影响因子：
3.7
通讯作者：
Pagliari, Claudia
中科院分区：
文献类型：
--
作者：
McLean, Susannah;Sheikh, Aziz;Pagliari, Claudia
背景：远程保健涉及利用信息和通信技术远距离提供保健服务，并通过远程监测和个性化反馈支持患者自我管理。现在是时候仔细审查有关远程医疗的好处、风险和成本的证据。方法与发现：两位审评者检索了1997年1月至2011年11月发表的相关系统综述：Cochrane Library、MEDLINE、EMBASE、LILACS、IndMed和PakMed。审稿人使用关键评价技能计划（CASP）工具进行系统评价，对研究进行独立的质量评估。共发现1782篇综述文章，从中选择80篇系统综述纳入。其中涵盖了一系列远程医疗模型，包括提供者和患者之间的同步（实时）和异步（存储转发）交互。许多研究表明，远程保健和常规保健的结果没有差别。几项审查强调了大量短期（< 12个月）可行性研究，参与者少于20人。几次审查报告了远程保健对保健服务指标的影响，特别是减少住院人数。据报告，远程保健干预对长期患病患者的临床效果似乎在那些病情更严重、住院和死亡风险较高的患者中效果最好。由于许多研究未能充分描述干预措施，因此很难区分技术因素和人/组织因素对报告结果的影响。关于远程医疗的成本效益的证据仍然很少。评估性远程医疗文献中缺乏对患者安全的考虑。结论：决策者和规划者需要意识到，对远程医疗的投资不一定会产生临床或经济效益。对于严重后果风险最高的患者，可能会获得最大的收益。有必要进行长期研究，以确定在时间有限的试验中显示的益处是否能够持续。
Background: Telehealthcare involves the use of information and communication technologies to deliver healthcare at a distance and to support patient self-management through remote monitoring and personalised feedback. It is timely to scrutinise the evidence regarding the benefits, risks and costs of telehealthcare.Methods and Findings: Two reviewers searched for relevant systematic reviews published from January 1997 to November 2011 in: The Cochrane Library, MEDLINE, EMBASE, LILACS, IndMed and PakMed. Reviewers undertook independent quality assessment of studies using the Critical Appraisal Skills Programme (CASP) tool for systematic reviews. 1,782 review articles were identified, from which 80 systematic reviews were selected for inclusion. These covered a range of telehealthcare models involving both synchronous (live) and asynchronous (store-and-forward) interactions between provider and patients. Many studies showed no differences in outcomes between telehealthcare and usual care. Several reviews highlighted the large number of short-term (< 12 months) feasibility studies with under 20 participants. Effects of telehealthcare on health service indicators were reported in several reviews, particularly reduced hospitalisations. The reported clinical effectiveness of telehealthcare interventions for patients with long-term conditions appeared to be greatest in those with more severe disease at high-risk of hospitalisation and death. The failure of many studies to adequately describe the intervention makes it difficult to disentangle the contributions of technological and human/organisational factors on the outcomes reported. Evidence on the cost-effectiveness of telehealthcare remains sparse. Patient safety considerations were absent from the evaluative telehealthcare literature.Conclusions: Policymakers and planners need to be aware that investment in telehealthcare will not inevitably yield clinical or economic benefits. It is likely that the greatest gains will be achieved for patients at highest risk of serious outcomes. There is a need for longer-term studies in order to determine whether the benefits demonstrated in time limited trials are sustained.