Agboola Stephen, Hale Timothy M, Masters Caitlin, Kvedar Joseph, Jethwani Kamal
Partners Healthcare Center for Connected Health, Boston, MA, United States.
JMIR Res Protoc. 2014 Dec 17;3(4):e75. doi: 10.2196/resprot.3459.
Currently, the increasing interest in telehealth and significant technological breakthroughs of the past decade create favorable conditions for the widespread adoption of telehealth services. Therefore, expectations are high that telehealth can help alleviate prevailing challenges in health care delivery. However, in order to translate current research to policy and facilitate adoption by patients and health care providers, there is need for compelling evidence of the effectiveness of telehealth interventions. Such evidence is gathered from rigorously designed research studies, which may not always be practical in many real-world settings.
Our aim was to summarize current telehealth evaluation strategies and challenges and to outline practical approaches to conduct evaluation in real-world settings using one of our previously reported telehealth initiatives, the Diabetes Connect program, as a case study.
We reviewed commonly used current evaluation frameworks and strategies, as well as best practices based on successful evaluative efforts to date to address commonly encountered challenges in telehealth evaluation. These challenges in telehealth evaluation and commonly used frameworks are described relevant to the evaluation of Diabetes Connect, a 12-month Web-based blood glucose monitoring program.
Designers of telehealth evaluation frameworks must give careful consideration to the elements of planning, implementation, and impact assessment of interventions. Evaluating performance at each of these phases is critical to the overall success of an intervention. Although impact assessment occurs at the end of a program, our review shows that it should begin at the point of problem definition. Critical to the success of an evaluative strategy is early planning that involves all stakeholders to identify the overall goals of the program and key measures of success at each phase of the program life cycle. This strategy should enable selection of an appropriate evaluation strategy and measures to aid in the ongoing development and implementation of telehealth and provide better evidence of program impact.
We recommend a pragmatic, multi-method, multi-phase approach to telehealth evaluation that is flexible and can be adapted to the characteristics and challenges unique to each telehealth program.
当前，人们对远程医疗的兴趣日益浓厚，且过去十年取得了重大技术突破，这为远程医疗服务的广泛应用创造了有利条件。因此，人们对远程医疗有望帮助缓解医疗服务中普遍存在的挑战寄予厚望。然而，为了将当前的研究转化为政策，并促进患者和医疗服务提供者的采用，需要有令人信服的证据证明远程医疗干预措施的有效性。此类证据来自精心设计的研究，但在许多实际环境中可能并不总是可行的。
我们的目标是总结当前的远程医疗评估策略和挑战，并以我们之前报道的一项远程医疗计划“糖尿病连接”项目为例，概述在实际环境中进行评估的实用方法。
我们回顾了当前常用的评估框架和策略，以及基于迄今为止成功评估工作的最佳实践，以应对远程医疗评估中常见的挑战。这些远程医疗评估中的挑战和常用框架与对“糖尿病连接”的评估相关，该项目是一个为期12个月的基于网络的血糖监测项目。
远程医疗评估框架的设计者必须仔细考虑干预措施的规划、实施和影响评估等要素。在每个阶段评估绩效对于干预措施的整体成功至关重要。尽管影响评估在项目结束时进行，但我们的综述表明，它应从问题定义阶段就开始。评估策略成功的关键在于早期规划，即让所有利益相关者参与进来，确定项目的总体目标以及项目生命周期各阶段的关键成功指标。这种策略应有助于选择合适的评估策略和指标，以协助远程医疗的持续开发和实施，并提供更好的项目影响证据。
我们建议采用一种务实、多方法、多阶段的远程医疗评估方法，该方法灵活且可适应每个远程医疗项目的独特特征和挑战。
