AHRQ’s telehealth evidence map will lead the way to better policy

Advancing telehealth policy and practice was the goal of a draft technical brief released by the HHS Agency for Healthcare Research and Quality (AHRQ). Due to the rapid advancement and complexity of telehealth technology as well as an expansive quantity of research, AHRQ evaluated and synthesized literature and studies to arrive at an evidence map, which can be used to identify what is known about telehealth and what requires further investigation. The draft brief explains that the agency hopes that by identifying and describing available telehealth research, decision makers, and other stakeholders will be able to act on a straightforward and helpful body of information.

Telehealth

In the process of constructing the evidence map, AHRQ relied on the Health Resources and Services Administration (HRSA) definition of telehealth: “the use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health, and health administration.” In part due to the expansive nature of telehealth and the complex association it shares with related terms like ehealth, telemedicine, and telecare, multiple stakeholders—including Senators, medical, patient advocacy, and industry groups—supported a call for a comprehensive literature review. Because of the volume and variability of literature on telehealth, stakeholders realized that is not possible to quickly assess telehealth literature to determine if there is support for a particular policy decision.

Method

In order to meet stakeholder needs, AHRQ surveyed telehealth research and produced an evidence map. AHRQ describes the evidence map as “a form of rapid or abbreviated review.” Although the map is not intended to be exhaustive, the goal is to arrive at a practical and more useful body of information to direct stakeholders. To obtain information for the map, AHRQ conducted interviews, searches of databases, and reviewed literature. After identifying a subset of reviews, AHRQ extracted relevant telehealth data and synthesized it into an evidence map combining graphics, tables, and text.

Findings

Out of over 1,300 articles, AHRQ selected 562 for full-text review. Of those, AHRQ chose 44 that met the agency’s inclusion criteria for the evidence map. The agency only chose reviews with “content that was organized, analyzed, and presented in a way that could support policy and practice decisions about telehealth.” The most-often included reviews focused on more than one technology, mixed chronic conditions, and communication and counseling. As a result, it was those types of reviews that AHRQ identified as having the highest relative benefit from a literature review standpoint. The agency also examined gaps in the literature that still need to be closed. For example, AHRQ identified urgent/primary care as an area that has not been adequately reviewed.