Cost-effectiveness Of Telehealth Research Articles

Effectiveness and cost-effectiveness of telehealth in rural and remote emergency departments: a systematic review protocol

BackgroundEmergency telehealth has been used to improve accessibility of rural and remote patients to specialist care. Evidence to date has demonstrated effectiveness and cost-effectiveness of telehealth in rural and remote emergency departments within a variety of contexts. However, systematic reviews to date have not focused on the rural and remote emergency departments. The purpose of this study is to review the outcome measures used in evaluations of emergency telehealth in rural and remote settings and assess evidence relating to their effectiveness and cost-effectiveness.MethodsRandomised controlled trials, non-randomised controlled trials, and full and partial economic evaluations (e.g. cost-effectiveness, cost-benefit, and cost-utility analyses) of telehealth in rural and remote emergency departments will be included. Comprehensive literature searches will be conducted in multiple electronic databases (from 1990 onwards): MEDLINE (Ovid), Cochrane Library, Scopus, CINAHL, ProQuest, EconLit, CRD databases (e.g. NHS Economic Evaluation database), and Tufts Cost-Effectiveness Registry. Two authors will independently screen all citations, full-text articles, and abstract data. The methodological quality (or risk of bias) of individual studies will be appraised using an appropriate tool. A systematic narrative synthesis will be provided with information presented in the text and tables to summarise and explain the characteristics and findings of the studies. If feasible, we will conduct random effects meta-analysis.DiscussionThis review will identify gaps in the current body of evidence relating to the effectiveness and cost-effectiveness of rural and remote emergency telehealth services. By confining to articles written in the English language, this analysis may be subjected to publication bias and results need to be interpreted accordingly. We believe the results of this review could be valuable for the design of future economic evaluations of emergency telehealth services implemented in the rural and remote context.Systematic review registrationPROSPERO CRD42019145903

Abstract 370: First of a Kind Telehealth Implementation Study in Singapore: Methodology and Challenge to Tailor to Asian Healthcare System

Introduction: The Eastern Health Alliance (EHA) and Changi General Hospital (CGH), Singapore, implemented a new, localized telehealth (TH) program for heart failure (HF) patients. The first of its kind in Singapore, the program allows healthcare professionals to remotely monitor, provide clinical intervention and educate HF patients after they have been discharged. The current long-term HF outpatient management does not allow the cardiologist to provide close monitoring of patients at home in the immediate post discharge period. Without a common platform for primary care physicians (PCP) and specialists to monitor HF patients, it is challenging for the PCPs to be involved in the post discharge care. Currently, patient education and coaching, essential for enabling effective self-management, is mostly done in person in the outpatient setting by HF nurses. It is challenging to scale the program to cover the whole HF population. Methods: EHA and CGH worked with the service provider to develop a localized TH program supplementing the existing post-discharge care pathway. The program leverages on the use of tablet devices adapted to the needs of local population - 3 languages, look and feel and educational content. This is particularly important as Singapore is a multi-ethnic country where elderly patients prefer to communicate in their own native language. TH coaching component is focused on engaging the patient in his health management. TH will enable educating and coaching patients remotely using videos and quizzes to test information retention. TH will allow time for the nurses to identify and address knowledge gaps during their interaction with the patients. The program aims to recruit a family physician to provide further clinical management advice and support. The program addresses challenges in long-term HF management on scalability, patient engagement, safety, clinical- and cost-effectiveness. The program comprises of two phases: Phase I is used to prove patient safety of the intervention and phase II will focus on reducing the number of unplanned HF hospitalizations (primary outcome), mortality, hospital service utilisation, patient satisfaction, quality of life and disease knowledge (secondary outcomes). The outcomes are measured 12 months pre and post introduction of the program. In total, 200 patients will be enrolled to the program. Incremental cost-effectiveness of TH will be estimated against historical and additional control group without TH intervention. Expected results: The program is expected to reduce unplanned HF admissions and as secondary outcomes, reduce number of HF related bed days and length of stay, higher patient satisfaction and better patient HF knowledge levels, without compromising patient safety. A TH solution is expected to meet high standards in patient safety, clinical effectiveness and cost-effectiveness in Singapore.

Cost-effectiveness of telehealth in people with social care needs: the Whole Systems Demonstrator cluster randomised trial

The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 5.120 (2020 JCR, received in June 2021)The IJIC 20th Anniversary Issue was published in 2021.

Acceptability and cost-effectiveness of military telehealth mental health screening.

Telehealth has been touted as one solution to the shortage of mental health providers within the military. Despite developing evidence for the equivalence of telehealth mental health care, there is no research that covers the use of telehealth for population mental health screening, a standard component of postdeployment medical screening. This paper summarizes soldier perceptions of three separate screening events in which telehealth was used and the cost-effectiveness of telehealth versus in-person implementations of the same screening. Soldiers who have not been through telehealth screening report a strong preference for in-person screening. Soldiers who have been through telehealth screening still report preference for in-person screening, but they express more ambivalence about the screening method. Using telehealth-only mental health screening for large numbers of soldiers within a compressed time frame is more expensive than in-person screening. Telehealth resulted in higher referral rates than in-person screening. Government and military leaders should use care when making decisions about telehealth implementation. Although telehealth for small numbers may be sufficiently equivalent and economical, there is no evidence of cost savings or improved acceptability for telehealth mental health post-deployment screening.

A user-friendly decision-modelling tool to inform policy makers about the cost-effectiveness of telehealth: the case of COPD in Germany

The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 5.120 (2020 JCR, received in June 2021)The IJIC 20th Anniversary Issue was published in 2021.

The cost-effectiveness of telehealth in metropolitan hospitals.

We established a telehealth link between two inner-city health services about 10 km apart. The video-link between the sites was based on IP videoconferencing; ISDN connections were maintained as a form of system redundancy and to connect to sites beyond the local area network. The cost of a conventional consultation, in which the patient travelled to an outpatient appointment, was A$170. Because existing equipment and telecommunications could be used, the cost of a telehealth consultation was only A$74. During the study approximately 15 teleconsultations were completed and a number of patient transfers were cancelled because they were deemed clinically unnecessary. The preliminary results suggest that the cost-savings from telehealth can be substantial. In addition there were major benefits to continuity of patient care and clinical communication within the organization.