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Impact of Consumer Health Informatics Applications
Evidence Reports/Technology Assessments, No. 188
Investigators: M Christopher Gibbons, MD, MPH, Renee F Wilson, MS, Lipika Samal, MD, Christoph U Lehmann, MD, Kay Dickersin, MA, PhD, Harold P Lehmann, MD, PhD, Hanan Aboumatar, MD, Joe Finkelstein, MD, PhD, Erica Shelton, MD, Sharma Ritu, BS, and Eric B Bass, MD, MPH.
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.
Contents
- Preface
- Acknowledgments
- Executive Summary
- 1. Introduction
- 2. Methods
- 3. Results
- Results of the Literature Search
- Description of the Types of Studies Retrieved
- Key Question 1a: What evidence exists that consumer health informatics applications impact health care process outcomes?
- Key Question 1b: What evidence exists that consumer health informatics applications impact intermediate outcomes?
- Key Question 1c: What evidence exists that consumer health informatics applications impact relationship-centered outcomes?
- Key Question 1d: What evidence exists that consumer health informatics applications impact clinical outcomes?
- Key Question 1e. What evidence exists that consumer health informatics applications impact economic outcomes?
- Key Question 2: What are the barriers that clinicians, developers, and consumers and their families or caregivers encounter that limit implementation of consumer health informatics applications?
- Key Question 3: What knowledge or evidence deficits exist regarding needed information to support estimates of cost, benefit, and net value with regard to consumer health informatics applications?
- Key Question 4: What critical information regarding the impact of consumer health informatics applications is needed in order to give consumers, their families, clinicians, and developers a clear understanding of the value proposition particular to them?
- Research in Progress
- 4. Discussion
- References and Included Studies
- Appendixes
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.
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