Outcomes and Methods in Telemedicine Evaluation

Author: Noriaki Aoki, MD

Primary Advisor: Kim Dunn, MD, PhD (co-author)

Committee Members: Kathy A. Johnson, PhD (co-author); James P. Turley, PhD, RN (co-author)

Masters thesis, The University of Texas School of Health Information Sciences at Houston.

One hundred four articles, published from 1966 to 2000, were reviewed to investigate the current status of telemedicine evaluation in terms of outcomes and methods. A total of 112 evaluations were reported in these104 articles. Two types of evaluations, clinical and non-clinical, were identified in the reviewed articles. Within clinical evaluation, there were 3 clinical effectiveness evaluations reported, 26 patient satisfactions 49 diagnostic accuracies and 9 cost analyses. In non-clinical evaluations, 15 articles discussed technical issues in digital images, such as bandwidth, resolution and colors, and 10 articles assessed management issues concerning efficiency of care, which focused on avoiding unnecessary patient transfer or using telemedicine to save time. Out of 112 evaluations, 72 evaluations used ad hoc methods, such as descriptive analysis. The main methods used in remaining 40 articles were quantitative methods. Nineteen articles used some types of statistics including specific methodological techniques, such as receiver operating characteristics curve (3 evaluations) and kappa values (7 evaluations), which are useful for comprehensive telemedicine evaluation. In contrast, only 1 article within these 40 articles utilized qualitative approach to investigate detail information in telemedicine practice. Currently, there are a number of good reports for diagnostic accuracy, satisfaction and non-clinical evaluation. However, clinical effectiveness and cost-effectiveness are import criteria, which have rarely been reported. Since telemedicine evaluations intend to explore various outcomes, telemedicine evaluation is needed to be done by using multi methods approach with appropriate analytical methods to conduct multidisciplinary and comprehensive evaluations to improve and sustain telemedicine programs.