Transitioning to telehealth? A guide to evaluating outcomes

Abstract

Objectives: Telehealth use has surged since the onset of the coronavirus disease 2019 (COVID-19) pandemic, but the evaluation of telehealth outcomes and performance has not necessarily matched the pace of its uptake. In this article we aim to guide the design of a telehealth evaluation system encompassing all four domains of the outcome measurement framework developed by the National Quality Forum (NQF) - access to care, cost, experience, and effectiveness. We aim to achieve this through proposing survey items that can be distributed to patients or clinicians as a questionnaire and providing suggestions on areas of focus for evaluation studies.

Methods: Using PubMed and Google Scholar search engines, we performed a literature review of articles related to the evaluation of telehealth outcomes that were published in English since 2000.

Results: We found existing survey tools to assist the development of an evaluation questionnaire, and categorized items into the four NQF outcome domains. For each outcome domain, we also summarize existing work on evaluation and make recommendations on areas for future assessment. In particular, we found that telehealth accessibility and accommodations have been historically under-studied and provide tools to address this.

Conclusions: Evaluating telehealth outcomes is critical to ensure efficient and high-quality care delivery, and we believe establishing an evaluation system will help practices assess and improve their telehealth systems as well as their ability to use telehealth to respond to the diverse needs of patients.

Public interest summary: Since the start of the coronavirus disease 2019 (COVID-19) pandemic, telehealth use has been on the rise. Evaluating outcomes related to telehealth is critically important, but given the urgency of telehealth uptake, many health systems and practices may not yet have evaluation systems in place. This article guides the design of a telehealth evaluation system by proposing several validated and novel survey questions that can be used as part of a patient or clinician questionnaire and suggesting important measures of outcome for evaluation studies to assess across the four domains of telehealth quality as outlined by the National Quality Forum (NQF) - access to care, cost, experience, and effectiveness. We present tools to reach priority populations who often lack access to remote care, including older adults, underrepresented minorities, and people with disabilities.

Keywords: Access; Evaluation; Telehealth; Telemedicine.

Fig. 1

The four NQF domains and corresponding subdomains.

Fig. 2

An example evaluation workflow.