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This publication is provided for historical reference only and the information may be out of date.

Cover of Telemedicine for the Medicare Population

Telemedicine for the Medicare Population

Evidence Reports/Technology Assessments, No. 24

Investigators: , MD, Principal Investigator, , BA, , PhD, RN, , MSN, RN, , PhD, , , MS, , PhD, and , MD, MPH, EPC Director.

Rockville (MD): Agency for Healthcare Research and Quality (US); .
Report No.: 01-E012ISBN-10: 1-58763-044-3

Structured Abstract

Objectives:

The goal of this report was to assess telemedicine services that substitute for face-to-face medical diagnosis and treatment and that may apply to the Medicare population. We focused on three distinct telemedicine study areas -- store-and-forward, self-monitoring/testing, and clinician-interactive services.

Search Strategy:

We conducted two searches -- a general-literature search for information about ongoing telemedicine programs, activities, and services throughout the world, and a search in the peer-reviewed literature for studies assessing the efficacy and cost of telemedicine in the study areas. The former search included literature databases, the World Wide Web, and other resources, while the latter focused on peer-reviewed articles in the MEDLINE, EMBASE, CINAHL, and HealthSTAR databases. We also identified relevant from experts and reference lists in relevant papers.

Selection Criteria:

The criterion for inclusion in the general literature review was that the article described an activity in at least one of the three study areas. The inclusion criteria for the systematic review were that the study was relevant to at least one of the three study areas; addressed at least one key question in the analytic framework for that study area; and contained reported results. We excluded articles that did not study the Medicare population (e.g., children and pregnant adults) or used a service that historically required face-to-face encounters (e.g., not radiology or pathology diagnosis).

Data Collection and Analysis:

We used the articles included in the general-literature review to develop an inventory of relevant programs and activities. The abstracted data were entered into a relational database for aggregation and interpretation. For the systematic review, included articles were categorized by the key question(s) they addressed. For each study area, we constructed a summary table of activities and the strength of the evidence for each key question.

Main Results:

A total of 455 telemedicine programs were identified, representing 30 medical specialties and serving many diverse populations. The number of telemedicine encounters has increased steadily. The evidence for the diagnostic effectiveness of store-and-forward telemedicine is strongest in dermatology. The benefit is more equivocal for other specialties, as it is for improved access, provider or patient satisfaction, and cost benefit. The evidence for self-monitoring/testing telemedicine is equivocal for all specialties, with positive results tempered by compromised study designs. The benefit of clinician-interactive telemedicine services is also questionable, with teledermatology faring less well and the results in other specialties limited by marginal study designs.

Conclusions:

Existing telemedicine programs demonstrate that the technology can be made operational, but most of the studies assessing the efficacy or cost are insufficient to permit definitive statements about the evidence supporting (or not supporting) the use of telemedicine. Future studies should focus on the use of telemedicine in conditions where burden of illness and/or barriers to access for care are significant. Recent innovations in the design of randomized controlled trials for emerging technologies should be adopted. Journals publishing telemedicine-evaluation studies must set high standards for methodologic quality so that evidence reports need not rely on studies with marginal methodologies.

Contents

2101 East Jefferson Street, Rockville, MD 20852. www​.ahrq.gov

Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services.1 Contract No. 290-97-0018. Prepared by: Oregon Health Sciences University, Portland, OR.

Suggested citation:

Hersh WR, Wallace JA, Patterson PK, et al. Telemedicine for the Medicare Program. Evidence Report/Technology Assessment No. 24 (Prepared by Oregon Health Sciences University, Portland, OR under Contract No. 290-97-0018). AHRQ Publication No. 01-E012. Rockville (MD) Agency for Healthcare Research and Quality. July 2001.

On December 6, 1999, under Public Law 106-129, the Agency for Health Care Policy and Research (AHCPR) was reauthorized and renamed the Agency for Healthcare Research and Quality (AHRQ). The law authorizes AHRQ to continue its research on the cost, quality, and outcomes of health care and expands its role to improve patient safety and address medical errors.

This report may be used, in whole or in part, as the basis for development of clinical practice guidelines and other quality enhancement tools, or a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.

The authors of this report are responsible for its content. Statements in the report should not be construed as endorsement by the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services of a particular drug, device, test, treatment, or other clinical service.

1

2101 East Jefferson Street, Rockville, MD 20852. www​.ahrq.gov

Bookshelf ID: NBK33341
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