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Report Says Telehealth Has Clinical Benefits for Acute-Chronic Consultations

Posted by Michael Greiwe, MD | August 23, 2018 |
Michael Greiwe, MD

We know that telehealth virtual visits offer a number of clinical benefits tied to improved outcomes. In the orthopedic space, we’ve seen improvements for post-op wound assessments and in workers compensation cases. The data shows convenience, appointment compliance, and improved access brings a higher quality of care to our patients. Around the country, clinicians are using the telehealth visit for patients in many specialties with positive results.

Last year, a study from the U.S. Department of Health and Human Services took a systematic look at using the virtual visit for acute and chronic care consultations between physicians. What are the benefits and drawbacks? What does the research really tell us?

This article looks at that report.

Telehealth Study – Key Questions for Systematic Review

“Telehealth for consultations uses technology to involve another provider, often a specialist, which can allow medical expertise to be available where and when it is needed, minimizing potential time or geographic barriers to care and maximizing the efficient use of scarce resources."

Telehealth for Acute and Chronic Care Consultations

The U.S. Department of Health and Human Services Agency for Healthcare Research and Quality conducted a research review of the available studies on telehealth. While researchers noted there is a large volume of evidence that shows the efficacy of telehealth applications in a variety of settings, they also commented that adoption has been slow. However, reimbursement and licensure challenges have begun to lift, necessitating a careful analysis of where and how telehealth brings the most benefits to patients and providers in a clinical setting.

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The purpose of this study focused on provider-to-provider telehealth consultative applications with the stated goal as “To evaluate the effectiveness of telehealth consultations for inpatient, emergency, and outpatient care.”

While telehealth consultations have been studied extensively over the past three decades, the HHS study was one of the first that sought to quantify all the existing data that looked at provider-to-provider interactions in an acute or chronic care setting. They noted that these studies may or may not include the patient, but that they used telehealth in a way that was “designed to facilitate collaboration between providers, often involving a specialist consultant, or among clinical team members.”

The study, called Telehealth for Acute and Chronic Care Consultations, sought to quantify the end result of telemedicine. The committee, made up of clinicians, researchers, and government administrators, first sought to quantify the questions used in their literature review:

  • Are telehealth consultations effective in improving clinical and economic outcomes?
    The study made note that telehealth can be used in any specialty and for many conditions, however, for the purpose of their review, they looked at research tied to acute or chronic care delivery.
  • Are telehealth consultations effective in improving intermediate outcomes?
    The committee defined intermediate outcomes as including (but not limited to) patient/provider satisfaction; service volume; healthcare processes; and clinical and behaviors.
  • Did the telehealth application result in hard or negative consequences?
    The team looked at the potential for inappropriate treatment, misdiagnosis, or a loss of privacy or breach of data.

The committee used the PRISMA checklist for evidence-based analysis. To read the methodology, go here.

Review of Telehealth Data

The qualitative literature review looked at studies published in the last 20 years. Their search yielded 7,714 telehealth studies. Using their criteria, they excluded 7,071 studies from the analysis. The remaining 643 studies were culled and analyzed. The final research review included 145 articles in the following categories:

  • 31 studies on inpatient consultations;
  • 33 emergency care studies;
  • and 81 outpatient treatment reports.

While 46% of the articles were from studies conducted in the U.S., the remaining percentage was from studies in other countries. Whether this invalidated the research simply because of differences between U.S. healthcare and other developed countries was not addressed.

Telehealth Study – Key Findings

The study divided their research into three patient care settings: Inpatient, ER, and outpatient. Some of the specific instances of care included intensivists, critical care nurses, administrative assistants, and a variety of specialty providers.

When reviewing these chronic/acute care studies, the researchers “generally found telehealth either better or no different than comparators on some outcomes.” The findings suggested:

  • Remote ICU consultations between clinical providers are “likely” to reduce ICU length of stay and ICU mortality. This applies to remote intensive care units and hospital inpatient settings.
  • Specialty telehealth consultations are likely to reduce the time patients spend in the ER.
  • Remote consultations between providers for outpatient care likely improve access and a range of clinical outcomes.

With that said, the researchers carefully noted that more research must happen to further confirm the following outcomes:

  • The supposition that telehealth consultations reduce inpatient LOS and cost.
  • That telehealth may improve outcomes and reduce costs for ER care due to a lessened volume of patient transfers.
  • That telehealth may reduce travel costs and outpatient visits for chronic care.

The study concluded the following:

In general, the evidence supports the effectiveness of telehealth consultations; however, the evidence is stronger for some applications, and less strong or insufficient for others.

Given that there are three populations affected by telehealth; the patient, the clinician, and the payer, the study noted that future research should collect data on the economic impact for each of these different end users.

Telehealth – One Tool in a Clinicians Toolkit

The HHS study sought to quantify the impact on patients, providers, and payers of using telehealth applications in three different chronic and acute care settings. The findings were overall positive although more research needs to occur, especially in the areas of cost and care quality.

Whether the provider-to-provider consultation was tied to orthopedics or neurosurgery, this is a solid attempt to quantify data under a measurable outcome for a particular service and delivery method. Beyond showing some positive outcomes and highlighting areas for more research, it illustrates an important point; telehealth is, in fact, one tool in a multi-faceted clinical toolkit. While telehealth is not appropriate for every patient and every situation, it’s an important technology that can be applied in a number of settings to benefit everyone involved.

If you’d like to find out more about telehealth technology, contact the OrthoLive team.

Topics: "telehealth", "telemedicine", acute care

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