Telehealth for Acute and Chronic Care Consultations

Project Summary Title and Description

Title
Telehealth for Acute and Chronic Care Consultations
Description
Objectives: To conduct a systematic review to identify and summarize the available evidence about the effectiveness of telehealth consultations and to explore using decision modeling techniques to supplement the review. Telehealth consultations are defined as the use of telehealth to facilitate collaboration between two or more providers, often involving a specialist, or among clinical team members, across time and/or distance. Consultations may focus on the prevention, assessment, diagnosis, and/or clinical management of acute or chronic conditions. Data Sources. We searched Ovid MEDLINE®, the Cochrane Central Register of Controlled Trials (CCRCT), and the Cumulative Index to Nursing and Allied Health Literature (CINAHL®) to identify studies published from 1996 to May 2018. We also reviewed reference lists of identified studies and systematic reviews, and we solicited published or unpublished studies through an announcement in the Federal Register. Data for the model came both from studies identified via the systematic review and from other sources. Methods. We included comparative studies that provided data on clinical, cost, or intermediate outcomes associated with the use of any technology to facilitate consultations for inpatient, emergency, or outpatient care. We rated studies for risk of bias and extracted information about the study design, the telehealth interventions, and results. We assessed the strength of evidence and synthesized the findings using quantitative and qualitative methods. An exploratory decision model was developed to assess the potential economic impact of telehealth consultations for traumatic brain injuries in adults. Results. The search yielded 9,366 potentially relevant citations. Upon review, 8,356 were excluded and the full text of 1,010 articles was pulled for review. Of these, 233 articles met our criteria and were included—54 articles evaluated inpatient consultations, 73 emergency care, and 106 outpatient care. The overall results varied by setting and clinical topic, but generally the findings are that telehealth improved outcomes or that there was no difference between telehealth and the comparators. Remote intensive care unit (ICU) consultations likely reduce ICU and total hospital mortality with no significant difference in ICU or hospital length of stay; specialty telehealth consultations likely reduce the time patients spend in the emergency department; telehealth for emergency medical services likely reduces mortality for patients with heart attacks, and remote consultations for outpatient care likely improve access and a range of clinical outcomes (moderate strength of evidence in favor of telehealth). Findings with lower confidence are that inpatient telehealth consultations may reduce length of stay and costs; telehealth consultations in emergency care may improve outcomes and reduce costs due to fewer transfers and also may reduce outpatient visits and costs due to less travel (low strength of evidence in favor of telehealth). Current evidence reports no difference in clinical outcomes with inpatient telehealth specialty consultations, no difference in mortality but also no difference in harms with telestroke consultations, and no difference in satisfaction with outpatient telehealth consultations (low strength of evidence of no difference). Too few studies reported information on potential harms from outpatient telehealth consultations for conclusions to be drawn (insufficient evidence). An exploratory cost model underscores the importance of perspective and assumptions in using modeling to extend evidence and the need for more detailed data on costs and outcomes when telehealth is used for consultations. For example, a model comparing telehealth to transfers and in-person neurosurgical consultations for acute traumatic brain injury identified that the impact of telehealth on costs may depend on multiple factors including how alternatives are organized (e.g., if the telehealth and in-person options are part of the same health care system) and whether the cost of a telehealth versus an in-person consultation differ. Conclusions. In general, the evidence indicates that telehealth consultations are effective in improving outcomes or providing services with no difference in outcomes; however, the evidence is stronger for some applications, and less strong or insufficient for others. Exploring the use of a cost model underscored that the economic impact of telehealth consultations depends on the perspective used in the analysis. The increase in both interest and investment in telehealth suggests the need to develop a research agenda that emphasizes rigor and focuses on standardized outcome comparisons that can inform policy and practice decisions.
Attribution
N/A
Authors of Report
N/A
Methodology description
The conduct of this systematic review followed the Methods Guide for Effectiveness and Comparative Effectiveness Reviews, and it is reported according to the PRISMA checklist. The scope, Key Questions, and inclusion criteria of this review were developed in consultation with a group of technical experts. Detailed methods are available in the full report and the posted protocol. A research librarian created the search strategy and another research librarian reviewed it before searching Ovid MEDLINE®, the Cochrane Central Register of Controlled Trials (CCRCT), and the Cumulative Index to Nursing and Allied Health Literature (CINAHL®) to identify studies published from 1996 through May 2018. We also reviewed reference lists of identified studies and systematic reviews, and solicited suggestions through an announcement in the Federal Register. We limited our study inclusion to the use of telehealth for consultations and outcomes that measure clinical and cost effectiveness. Otherwise our criteria were broad, and we included any technology and any comparative study, including before-after and retrospective as well as prospective designs, with quantitative outcomes data. Studies could compare telehealth consultations to consultations done in a different mode (e.g., in-person or telephone), no access to specialty care, or usual care which could be an unspecified mix of these options. We excluded descriptive studies, studies assessing only diagnostic concordance, studies where there was no nontelehealth comparison, and modeling studies that used hypothetical data. Two team members independently reviewed all abstracts and two reviewers independently assessed each full-text article. Disagreements were resolved by discussion among investigators. For included articles, investigators abstracted key characteristics and data about the studies for quantitative and qualitative synthesis. We were able to conduct meta-analyses for some but not all topics and outcomes due to the heterogeneity of outcome measures, study designs, and telehealth interventions. Two investigators independently rated the risk of bias of each study using predefined criteria consistent with the chapter, “Assessing the Risk of Bias of Individual Studies When Comparing Medical Interventions” in the Methods Guide for Effectiveness and Comparative Effectiveness Reviews. Risk of bias for economic evaluations were assessed using a modified version of the Consensus Health Economic Criteria. Disagreements were resolved by consensus. Strength of evidence was assessed for each outcome and Key Question as described in the Methods Guide for Effectiveness and Comparative Effectiveness Reviews. We assigned a strength of evidence grade of high, moderate, low, or insufficient for the body of evidence for each Key Question, based on evaluation of four domains: study limitations, consistency, directness, and precision. High, moderate, and low ratings reflect our confidence in the accuracy and validity of the findings and whether future studies might alter these findings (magnitude or direction). We gave a rating of insufficient when we were unable to draw conclusions due to serious inconsistencies, serious methodological limitations, or lack of evidence.
PROSPERO
CRD42017058304
DOI
10.26300/q74h-pe74
Notes
DOI: https://doi.org/10.23970/AHRQEPCCER216 The data of this project was entered retrospectively by uploading data to the project from other software and file format such as Excel or Word. Sheets uploaded: Emergency Setting-Evidence Table Inpatient Setting-Evidence Table Outpatient Setting-Evidence Table Risk of Bias-All study designs
Funding Source
Agency for Healthcare Research and Quality (AHRQ), Contract No. 290-2015-00009-I

Key Questions

1. Are telehealth consultations effective in improving clinical and economic outcomes? Clinical and economic outcomes may include, but are not limited to: mortality and morbidity, patient-reported outcomes, quality of life, utilization of health services, and cost of services.
2. Are telehealth consultations effective in improving intermediate outcomes? Intermediate outcomes include both outcomes that precede the ultimate outcomes of interest (e.g., mediators) and secondary outcomes. Intermediate outcomes may include, but are not limited to, access to care, patient and provider satisfaction, behavior, and decisions (e.g., patient completion of treatment, provider antibiotic stewardship); volume of services; and health care processes (e.g., time to diagnosis or treatment).
3. Do telehealth consultations result in harms, adverse events, or negative unintended consequences?
4. What are the characteristics of telehealth consultations that have been the subject of comparative studies? The characteristics may include clinical conditions, characteristics of the providers and patients and their relationships, telehealth modalities and characteristics of settings including the type of care and health care organization, payment models, as well as geographic and economic characteristics.
5. Do clinical, economic, intermediate, or negative outcomes (i.e., the outcomes in Key Questions 1, 2, and 3) vary across telehealth consultation characteristics (Key Question 4)?

Associated Extraction Forms

Associated Studies (each link opens a new tab)

TitleAuthorsYear
Comparison of Video and In-person Free Flap Assessment following Head and Neck Free Tissue Transfer.2017
Impact of telemedicine implementation in thrombolytic use for acute ischemic stroke: the University of Pittsburgh Medical Center telestroke network experience.2013
Impact of e-consults on return visits of primary care patients.-- Not Found --
Impact of Telemedicine on Mortality, Length of Stay, and Cost Among Patients in Progressive Care Units: Experience From a Large Healthcare System.2018
Outcomes of treatment for hepatitis C virus infection by primary care providers.2011
Time-to-reperfusion in STEMI undergoing interhospital transfer using smartphone and WhatsApp messenger.
Effects of the implementation of a telemedical stroke network: the Telemedic Pilot Project for Integrative Stroke Care (TEMPiS) in Bavaria, Germany.2006
Long-term effects of specialized stroke care with telemedicine support in community hospitals on behalf of the Telemedical Project for Integrative Stroke Care (TEMPiS).2009
Medical and economic benefits of telehealth in low- and middle-income countries: results of a study in four district hospitals in Mali.2014
Impact of Sleep Telemedicine Protocol in Management of Sleep Apnea: A 5-Year VA Experience.2016
A prospective randomized controlled study of a virtual clinic integrating primary and specialist care for patients with Type 2 diabetes mellitus.2016
Feasibility of prehospital teleconsultation in acute stroke--a pilot study in clinical routine.2012
Model for equitable care and outcomes for remote full care hemodialysis units.2010
Consultation via telemedicine and access to operative care for patients with head and neck cancer in a Veterans Health Administration population.2016
Implementation of Store-and-Forward Teledermatology and Its Associated Effect on Patient Access in a Veterans Affairs Dermatology Clinic.2015
Telemedicine ophthalmology consultation in remote Queensland.-- Not Found --
Victorian Stroke Telemedicine Project: implementation of a new model of translational stroke care for Australia.2015
Robot-assisted remote echocardiographic examination and teleconsultation: a randomized comparison of time to diagnosis with standard of care referral approach.2014
Telemedicine in dermatology: a randomised controlled trial.2006
A randomized controlled trial of telemedicine in an emergency department.1998
Effect of a multiple-site intensive care unit telemedicine program on clinical and economic outcomes: an alternative paradigm for intensivist staffing.2004
A two-period assessment of changes in specialist contact in a high-risk pregnancy telemedical program.2006
Treatment of Acute Coronary Syndrome by Telemedically Supported Paramedics Compared With Physician-Based Treatment: A Prospective, Interventional, Multicenter Trial.2016
Analgesia by telemedically supported paramedics compared with physician-administered analgesia: A prospective, interventional, multicentre trial.2016
Patient satisfaction with telemedical access to specialty services in rural California.2002
Pre-hospital electrocardiogram triage with tele-cardiology support is associated with shorter time-to-balloon and higher rates of timely reperfusion even in rural areas: data from the Bari- Barletta/Andria/Trani public emergency medical service 118 registry on primary angioplasty in ST-elevation myocardial infarction.2014
Videoconferencing could reduce the number of mental health patients transferred from outlying facilities to a regional mental health unit.2012
Telemedicine: teleproctored endoscopic sinus surgery.2002
Randomized controlled trial of a multisite speech pathology telepractice service providing swallowing and communication intervention to patients with head and neck cancer: Evaluation of service outcomes.2017
Mobile teledermatology for a prompter and more efficient dermatological care in rural Mongolia.2015
Management of Type 2 Diabetes Mellitus through Telemedicine.
Creation of an Internal Teledermatology Store-and-Forward System in an Existing Electronic Health Record: A Pilot Study in a Safety-Net Public Health and Hospital System.2017
Improved survival associated with pre-hospital triage strategy in a large regional ST-segment elevation myocardial infarction program.2012
Do teleoncology models of care enable safe delivery of chemotherapy in rural towns?2015
The role of telenursing in the provision of geriatric outreach services to residential homes in Hong Kong.2001
A pilot study of the Tele-Airway Management System in a hospital emergency department.2011
Using telemedicine to facilitate thrombolytic therapy for patients with acute stroke.2006
Telemedicine versus face-to-face evaluation in the delivery of thrombolysis for acute ischaemic stroke: a single centre experience.2012
Veterans Affairs Telemedicine: Bringing Urologic Care to Remote Clinics.2015
Cost implications of outpatient teleneurology.2001
The impact of a tele-ICU on provider attitudes about teamwork and safety climate.2010
Telemedicine coverage for post-operative ICU patients.
A cohort study of early neurological consultation by telemedicine on the care of neurological inpatients.2004
Diabetic Retinopathy Screening and Monitoring of Early Stage Disease in Australian General Practice: Tackling Preventable Blindness within a Chronic Care Model.2016
An evaluation of telemedical support for a minor treatment centre.1996
Cost and Utility Analysis of a Store-and-Forward Teledermatology Referral System: A Randomized Clinical Trial.2015
Does minority racial-ethnic status moderate outcomes of collaborative care for depression?2011
Impact of Telemedicine on Severity of Illness and Outcomes Among Children Transferred From Referring Emergency Departments to a Children's Hospital PICU.2016
The use of a telematic connection for the follow-up of hypertensive patients improves the cardiovascular prognosis.2005
Stroke team remote evaluation using a digital observation camera in Arizona: the initial mayo clinic experience trial.2010
Telemedicine consultations and medication errors in rural emergency departments.2013
Impact of critical care telemedicine consultations on children in rural emergency departments.2013
The financial impact of a pediatric telemedicine program: a children's hospital's perspective.2013
Implementation of Telemedicine and Stroke Network in thrombolytic administration: comparison between walk-in and referred patients.2010
A cost analysis of a tele-oncology practice.
Telemedicine in pediatric and perinatal cardiology: economic evaluation of a service in English hospitals.2007
Impact of telemedicine upon rural trauma care.2008
Teledermatologic consultation and reduction in referrals to dermatologists: a cluster randomized controlled trial.2009
Telemedicine in vascular surgery: does it work?2001
Remote real-time monitoring of free flaps via smartphone photography and 3G wireless Internet: a prospective study evidencing diagnostic accuracy.2011
Teledermatology-based presurgical management for nonmelanoma skin cancer: a pilot study.2007
Telephone and Teleradiology-Guided Thrombolysis Can Achieve Similar Outcome as Thrombolysis by Neurologist On-site.2015
A health system-based critical care program with a novel tele-ICU: implementation, cost, and structure details.2014
Telemedicine-based collaborative care for posttraumatic stress disorder: a randomized clinical trial.
Practice-based versus telemedicine-based collaborative care for depression in rural federally qualified health centers: a pragmatic randomized comparative effectiveness trial.2013
Timeliness and access to healthcare services via telemedicine for adolescents in state correctional facilities.2007
Evaluation of a telementoring intervention for pain management in the Veterans Health Administration.2015
Costs and cost-effectiveness of a telemedicine intensive care unit program in 6 intensive care units in a large health care system.2011
A program of telementoring in laparoscopic bariatric surgery.2016
Telemedicine and clinical genetics: establishing a successful service.2001
Comparison of teleconsultations and face-to-face consultations: preliminary results of a United Kingdom multicentre teledermatology study.1998
Does teleradiology improve inter-hospital management of head-injury?1997
Use of telemedicine can reduce hospitalizations of nursing home residents and generate savings for medicare.2014
Geriatric ward rounds by video conference: a solution for rural hospitals.-- Not Found --
eICU reduces mortality in STEMI patients in resource-limited areas.2014
Telemedicine in acute stroke: remote video-examination compared to simple telephone consultation.2008
Clinical effectiveness and cost analysis of patient referral by videoconferencing in orthopaedics.
Patient referral by telemedicine: effectiveness and cost analysis of an Intranet system.2000
Clinical efficacy of telemedicine in emergency radiotherapy for malignant spinal cord compression.2001
The feasibility of telemedicine for orthopaedic outpatient clinics--a randomized controlled trial.2000
Outcomes of Spoke-Retained Telestroke Patients Versus Hub-Treated Patients After Intravenous Thrombolysis: Telestroke Patient Outcomes After Thrombolysis.2015
Management of impacted third molars based on telemedicine: a pilot study.2011
The impact of store-and-forward teledermatology on skin cancer diagnosis and treatment.2008
The availability of telecardiology consultations and transfer patterns from a remote neonatal intensive care unit.2008
Stroke Thrombolysis in a Centralized and a Decentralized System (Helsinki and Telemedical Project for Integrative Stroke Care Network).2016
The use of telemedicine in combination with a new stroke-code-box significantly increases t-PA use in rural communities.2005
Acute ischemic stroke and thrombolysis location: comparing telemedicine and stroke center treatment outcomes.2009
Telemedicine in Prehospital Stroke Evaluation and Thrombolysis: Taking Stroke Treatment to the Doorstep.2016
School-centered telemedicine for children with type 1 diabetes mellitus.2009
Teleconsultation as a replacement for referral to an outpatient clinic.2002
Virtual outreach: economic evaluation of joint teleconsultations for patients referred by their general practitioner for a specialist opinion.2003
Fracture diagnostics, unnecessary travel and treatment: a comparative study before and after the introduction of teleradiology in a remote general practice.2015
Telemedicine in acute stroke care: the TESSA model.2011
A comparative study on the utility of telehealth in the provision of rheumatology services to rural and northern communities.2004
Telemedicine broadening access to care for complex cases.2017
ICU Telemedicine and Critical Care Mortality: A National Effectiveness Study.2016
A multicenter population-based effectiveness study of teleintensive care unit-directed ventilator rounds demonstrating improved adherence to a protective lung strategy, decreased ventilator duration, and decreased intensive care unit mortality.2014
Telemedicine collaboration improves perinatal regionalization and lowers statewide infant mortality.2013
Clinical outcomes on real-time telemetry system in developing emergency medical service system.2011
Management of patients with traumatic intracranial injury in hospitals without neurosurgical service.2010
The impact of telemedicine on outcomes of chronic wounds in the home care setting.2000
The effect of ICU telemedicine on mortality and length of stay.2012
Potential use of telemedicine to provide outpatient care for inflammatory bowel disease.2011
The challenges of following patients and assessing outcomes in teledermatology.2004
TELEMAM: a cluster randomised trial to assess the use of telemedicine in multi-disciplinary breast cancer decision making.2007
The impact of telemedicine intensivist support and a pediatric hospitalist program on a community hospital.2013
A cost study of teleconsultation for primary-care ophthalmology and dermatology.2001
Cost-benefit analysis of telehealth in pre-hospital care.
Osteoporosis screening and treatment among veterans with recent fracture after implementation of an electronic consult service.2014
Hospital mortality, length of stay, and preventable complications among critically ill patients before and after tele-ICU reengineering of critical care processes.2011
ICU Telemedicine Program Financial Outcomes.2017
Better, sooner, more convenient: a successful teledermoscopy service.2012
Patient cost-benefit analysis of teledermatology measured in a randomized control trial.1999
A randomized controlled trial to assess the clinical effectiveness of both realtime and store-and-forward teledermatology compared with conventional care.2000
A cost-minimization analysis of the societal costs of realtime teledermatology compared with conventional care: results from a randomized controlled trial in New Zealand.2001
Ultrasound in telemedicine: its impact in high-risk obstetric health care delivery.2014
Impact of Chest Pain Protocol with Access to Telemedicine on Implementation of Pharmacoinvasive Strategy in a Private Hospital Network.2016
Impact of a telemedicine eICU cart on sepsis management in a community hospital emergency department.
An evaluation of the role of a store-and-forward teledermatology system in skin cancer diagnosis and management.2005
Financial benefits of a pediatric intensive care unit-based telemedicine program to a rural adult intensive care unit: impact of keeping acutely ill and injured children in their local community.2004
The use of telemedicine to provide pediatric critical care consultations to pediatric trauma patients admitted to a remote trauma intensive care unit: a preliminary report.2004
Implementation of the myocardial infarction system of care in city of Belo Horizonte, Brazil.2013
The effect of telestroke systems among neighboring hospitals: more and better? The Madrid Telestroke Project.2014
Web-based (online) comprehensive geriatric assessment is more time efficient, and as reliable, as reading patient medical records and conducting traditional in person consultations.2016
Importance and limits of pre-hospital electrocardiogram in patients with ST elevation myocardial infarction undergoing percutaneous coronary angioplasty.2011
The use of telemedicine to aid in assessing patients prior to aeromedical retrieval to a tertiary referral centre.
TRUST-tPA trial: Telemedicine for remote collaboration with urgentists for stroke-tPA treatment.2017
Association of health information technology and teleintensivist coverage with decreased mortality and ventilator use in critically ill patients.2010
A fetal telecardiology service: patient preference and socio-economic factors.2012
Efficacy of site-independent telemedicine in the STRokE DOC trial: a randomised, blinded, prospective study.2008
Psychiatric inpatient care planning via telemedicine.2000
Teleconsulting for minor head injury: the Piedmont experience.
Impact of telemedicine on the quality of forensic sexual abuse examinations in rural communities.2014
Emergency Department Telemedicine Is Used for More Severely Injured Rural Trauma Patients, but Does Not Decrease Transfer: A Cohort Study.
Economic evaluation of a store-and-forward teledermatology system for skin cancer patients.2009
Clinical and economic outcomes of the electronic intensive care unit: results from two community hospitals.2010
Comparison of parent satisfaction with care for childhood obesity delivered face-to-face and by telemedicine.2011
Rural Victorian Telestroke project.2012
Clinical Impact of Telemedicine Network System at Rural Hospitals Without On-Site Cardiac Surgery Backup.2016
Impact of a Telepsychiatry Program at Emergency Departments Statewide on the Quality, Utilization, and Costs of Mental Health Services.2015
Impact of an intensive care unit telemedicine program on patient outcomes in an integrated health care system.2014
Using tele-emergency to avoid patient transfers in rural emergency departments: An assessment of costs and benefits.2018
Novel Telestroke Program Improves Thrombolysis for Acute Stroke Across 21 Hospitals of an Integrated Healthcare System.2018
Use of telemedicine for pre-implant dental assessment - a comparative study.2008
Quality of diabetes care among patients managed by teleconsultation.2008
A cost-consequences analysis of minor injuries telemedicine.2005
A comparative study of teleconsultations versus face-to-face consultations.2001
Usefulness of prehospital triage in patients with cardiogenic shock complicating ST-elevation myocardial infarction treated with primary percutaneous coronary intervention.2007
Clinical impact of direct referral to primary percutaneous coronary intervention following pre-hospital diagnosis of ST-elevation myocardial infarction.2006
Plastic surgery telehealth consultation expedites Emergency Department treatment.2017
Store-and-forward teledermatology results in similar clinical outcomes to conventional clinic-based care.2007
A Prospective Pilot Study of the Use of Telemedicine During Pediatric Transport: A High-Quality, Low-Cost Alternative to Conventional Telemedicine Systems.2015
Field triage reduces treatment delay and improves long-term clinical outcome in patients with acute ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention.2009
Impact of a telemedicine system on acute stroke care in a community hospital.2009
Remote supervision of IV-tPA for acute ischemic stroke by telemedicine or telephone before transfer to a regional stroke center is feasible and safe.2010
Impact of a store-and-forward teledermatology intervention versus usual care on delay before beginning treatment: A pragmatic cluster-randomized trial in ambulatory care.2017
The comparative impact of video-consultation on neurosurgical health services.2001
The effect of telemedicine on neonatal intensive care unit length of stay in very low birthweight infants.1998
Effect size and experimental power analysis in a paediatric cardiology telemedicine system.1997
Implementation of a model of robotic tele-presence (RTP) in the neuro-ICU: effect on critical care nursing team satisfaction.2012
A More Rapid, Rapid Response.2016
Perceived benefit of a telemedicine consultative service in a highly staffed intensive care unit.2012
Intensive care unit telemedicine: alternate paradigm for providing continuous intensivist care.2000
Clinical outcomes of hepatitis C treated with pegylated interferon and ribavirin via telemedicine consultation in Northern California.2013
Using nursing expertise and telemedicine to increase nursing collaboration and improve patient outcomes.2012
Telemedicine intervention improves ICU outcomes.2013
Telemedicine evaluation of acute burns is accurate and cost-effective.2009
Two years of Finnish Telestroke: thrombolysis at spokes equal to that at the hub.2011
Establishment of a Regional Virtual Tumor Board Program to Improve the Process of Care for Patients With Hepatocellular Carcinoma.2015
Telemedicine as an effective tool for the management of temporomandibular joint disorders.2012
The STAT-MI (ST-Segment Analysis Using Wireless Technology in Acute Myocardial Infarction) trial improves outcomes.2011
Long-term outcome after thrombolysis in telemedical stroke care.2007
Effect on treatment delay of prehospital teletransmission of 12-lead electrocardiogram to a cardiologist for immediate triage and direct referral of patients with ST-segment elevation acute myocardial infarction to primary percutaneous coronary intervention.2008
Teledermatology as a means to improve access to inpatient dermatology care.2016
Screening fetal echocardiography by telemedicine: efficacy and community acceptance.2003
A comparison of telepaediatric activity at two regional hospitals in Queensland.2002
The Effect of Telemedicine Follow-up Care on Diabetes-Related Foot Ulcers: A Cluster-Randomized Controlled Noninferiority Trial.2018
Telemental health evaluations enhance access and efficiency in a critical access hospital emergency department.2014
Evaluating the cost of one telehealth application connecting an acute and long-term care setting.2001
A cost analysis of participation via personal attendance versus telemedicine at a head and neck oncology multidisciplinary team meeting.2005
Satisfaction with telemedicine presentation at a multidisciplinary tumour meeting among patients with head and neck cancer.2003
Impact of telemedicine in hospital culture and its consequences on quality of care and safety.-- Not Found --
Pressure ulcer multidisciplinary teams via telemedicine: a pragmatic cluster randomized stepped wedge trial in long term care.
Electronic Consultations (E-consults): Advancing Infectious Disease Care in a Large Veterans Affairs Healthcare System.2017
Reduction in time to treatment in prehospital telemedicine evaluation and thrombolysis.2017
Improving diabetic retinopathy screening ratios using telemedicine-based digital retinal imaging technology: the Vine Hill study.2007
Cost savings from a telemedicine model of care in northern Queensland, Australia.2013
Using routine data for quality assessment in NeuroNet telestroke care.2013
Association of telemedicine for remote monitoring of intensive care patients with mortality, complications, and length of stay.2009
Emergency department physician telemedical triage.2013
The effectiveness of video-telemedicine for screening of patients requesting emergency air medical transport (EAMT).2007
Economic evaluation of telemedicine for a remotely located population: the case of two Greek islands.2005
The application of teleophthalmology in examining patients with glaucoma: a pilot study.1999
Costs and benefits of tele-endoscopy clinics in a remote location.2010
Web-based consultation between general practitioners and nephrologists: a cluster randomized controlled trial.2017
Telemedicine for acute plastic surgical trauma and burns.2008
Impact of telemedicine on hospital transport, length of stay, and medical outcomes in infants with suspected heart disease: a multicenter study.2013
An economic analysis of a store and forward teledermatology consult system.2003
Effect of store and forward teledermatology on quality of life: a randomized controlled trial.2013
Clinical outcomes after telemedicine intensive care unit implementation.2012
Addition of primary care-based retinal imaging technology to an existing eye care professional referral program increased the rate of surveillance and treatment of diabetic retinopathy.2005
A cost minimisation analysis of a telepaediatric otolaryngology service.2008
Appropriateness of disposition following telemedicine consultations in rural emergency departments.2015
Improved virologic suppression with HIV subspecialty care in a large prison system using telemedicine: an observational study with historical controls.2014
Perioperative cataract OP management by means of teleconsultation.2002
Telestroke-guided intravenous tissue-type plasminogen activator treatment achieves a similar clinical outcome as thrombolysis at a comprehensive stroke center.2011
Impact of prehospital diagnosis in the management of ST elevation myocardial infarction in the era of primary percutaneous coronary intervention: reduction of treatment delay and mortality.2008
Expert advice provided through telemedicine improves healing of chronic wounds: prospective cluster controlled study.2015
Teleradiology for remote consultation using iPad improves the use of health system human resources for paediatric fractures: prospective controlled study in a tertiary care hospital in Italy.2014
Are videoconferenced consultations as effective as face-to-face consultations for hereditary breast and ovarian cancer genetic counseling?2011
A web-based telestroke system facilitates rapid treatment of acute ischemic stroke patients in rural emergency departments.2009
A novel interface for the telementoring of robotic surgery.2015
An economic evaluation of the Highlands and Islands teledentistry project.2002
Outcomes of telemedicine intervention in a regional intensive care unit: a before and after study.2017
The effectiveness of digital imaging and remote expert wound consultation on healing rates in chronic lower leg ulcers in the Kimberley region of Western Australia.2004
Telemedicine for multidisciplinary lung cancer meetings.2004

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