Arnold Katrin, Scheibe Madlen, Müller Olaf, Schmitt Jochen
Zentrum für Evidenzbasierte Gesundheitsversorgung (ZEGV), Universitätsklinikum und Medizinische Fakultät Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Deutschland; Carus Consilium Sachsen GmbH (CCS), Dresden, Deutschland.
Zentrum für Evidenzbasierte Gesundheitsversorgung (ZEGV), Universitätsklinikum und Medizinische Fakultät Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Deutschland; Carus Consilium Sachsen GmbH (CCS), Dresden, Deutschland.
Z Evid Fortbild Qual Gesundhwes. 2016 Nov;117:9-19. doi: 10.1016/j.zefq.2016.04.011. Epub 2016 Sep 3.
The limited number of telemedicine applications being transferred to standard medical care in Germany may to some extent be explained by deficits in the current evaluation practice. Effectiveness and cost effectiveness can only be demonstrated to decision makers and potential users with methodologically sound and fully published evaluations. There is a lack of well-founded and mandatory standards for adequate, comparable evaluations of telemedicine applications.
As part of the project CCS Telehealth Eastern Saxony (CCS THOS), a systematic review on evaluation concepts for telemedicine applications (search period until September 2014, databases Medline, Embase, HTA-Database, DARE, NHS EED) as well as an additional selective literature search were conducted. Suggestions for evaluation fundamentals were derived from the results. These suggestions were subjected to a formal consensus process (nominal group process) with relevant stakeholder groups (healthcare payers, healthcare providers, health policy representatives, researchers).
19 papers were included in the systematic review. In accordance with the predefined inclusion criteria, each presented an evaluation concept for telemedicine applications that was based upon a systematic review and/or a consensus process. Via a formal consensus process, the suggestions for evaluation principles derived from the review and the selective literature search (23 papers) resulted in ten agreed evaluation principles. Eight of them were unanimously agreed upon, two were arrived at with one abstention each. The principles enclose criteria for the planning, conduct and reporting of telemedicine evaluations. Adherence to them is obligatory for users of the telemedical infrastructure provided by CCS THOS. Furthermore, right from the beginning the intention was very much for these principles to be seized upon by other projects and initiatives.
The agreed evaluation principles for telemedicine applications are the first in Germany to be based both upon evidence and consensus. Due to the methodology of development, they have a strong scientific and health policy legitimation. Therefore, and because of their general applicability, adherence to these principles beyond the context of the telemedicine platform developed within CCS THOS is recommended, namely throughout the German telemedicine scene.
在德国，转变成标准医疗服务的远程医疗应用数量有限，这在一定程度上可能是由于当前评估实践存在缺陷。只有通过方法合理且全面发表的评估，才能向决策者和潜在用户证明有效性和成本效益。目前缺乏针对远程医疗应用进行充分、可比评估的有充分依据的强制性标准。
作为“萨克森州东部CCS远程医疗”（CCS THOS）项目的一部分，对远程医疗应用的评估概念进行了系统综述（检索期截至2014年9月，数据库包括Medline、Embase、HTA数据库、DARE、NHS EED），并进行了额外的选择性文献检索。从结果中得出了评估基本原则的建议。这些建议与相关利益相关者群体（医疗保健支付方、医疗保健提供者、卫生政策代表、研究人员）进行了正式的共识达成过程（名义群体法）。
系统综述纳入了19篇论文。根据预先定义的纳入标准，每篇论文都提出了一个基于系统综述和/或共识过程的远程医疗应用评估概念。通过正式的共识达成过程，从综述和选择性文献检索（23篇论文）中得出的评估原则建议产生了十条达成一致的评估原则。其中八条获得一致同意，两条各有一人弃权。这些原则涵盖了远程医疗评估的规划、实施和报告标准。使用CCS THOS提供的远程医疗基础设施的用户必须遵守这些原则。此外，从一开始就非常希望这些原则能被其他项目和倡议所采用。
达成一致的远程医疗应用评估原则是德国首个基于证据和共识的原则。由于其制定方法，它们具有很强的科学和卫生政策合法性。因此，鉴于其普遍适用性，建议在CCS THOS内开发的远程医疗平台之外也遵守这些原则，即在整个德国远程医疗领域都应遵守。
