The Role of Telehealth in an Evolving Health Care Environment by Tracy A. Lustig

Author:Tracy A. Lustig
Language: eng
Format: epub
Tags: ebook
Publisher: The National Academies Press
Published: 2012-12-16T00:00:00+00:00

Provider Readiness

One participant argued that there is still a role for studies of provider readiness, citing data on provider buy-in as a barrier to adoption, especially in the acute care setting where telemedicine can substantially disrupt workflow. Krupinski disagreed somewhat, stating that those studies can be useful on a local level to understand an individual organization or help to implement a new program, but that they do not need to be published widely.

Study Methodologies

One participant asked whether existing literature adequately reflects the right control groups. He noted that several speakers had called for telemedicine to be considered a tool for quality improvement in clinical care. He argued that because it is expensive, it should be compared to other less expensive quality-improvement tools (e.g., traditional education and outreach), rather than to nothing. He argued that comparing telemedicine to no intervention may introduce bias to make it appear that telemedicine is better than it might be if compared to a less expensive alternative. Krupinski stated that sometimes the intervention or treatment itself can define the control group. For example, she said, a clear comparison is someone coming into the door of a stroke center versus someone coming to the door of a non-stroke center. She added that the participant’s question directly related to the recommendation for more naturalistic settings, noting that many studies are now mixing interventions—that is, it is not “nothing” versus the intervention but instead, different degrees of telemedicine (e.g., telephone alone versus telephone with video versus telemedicine with supplemental nurse visitation).

Schwamm added that telehealth is an intersection between a technology and human behavior, and so there is an important role for involving social scientists in the study designs. He agreed that methodology questions are to a certain extent shaped by the actual intervention. He noted that the use of telehealth is a systematic change to the way care is provided, and so in his opinion, the more effective studies are those that use a cluster randomized design at the hospital level wherein a cohort of hospitals is identified to participate, and they are randomly allocated to treatment or control groups so that all subjects at the site are allocated to the same intervention, and the comparison is at the hospital level. This prevents cross contamination of the intervention into the control.

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