远程医疗在农村和偏远地区急诊科的效果和成本效益：系统评价方案。
Effectiveness and cost-effectiveness of telehealth in rural and remote emergency departments: a systematic review protocol.
机构信息
Curtin University, Kent Street, Bentley, Perth, WA, 6102, Australia.
La Trobe University, Plenty Rd & Kingsbury Dr, Bundoora, VIC, 3086, Australia.
出版信息
Syst Rev. 2020 Apr 17;9(1):82. doi: 10.1186/s13643-020-01349-y.
BACKGROUND
Emergency telehealth has been used to improve accessibility of rural and remote patients to specialist care. Evidence to date has demonstrated effectiveness and cost-effectiveness of telehealth in rural and remote emergency departments within a variety of contexts. However, systematic reviews to date have not focused on the rural and remote emergency departments. The purpose of this study is to review the outcome measures used in evaluations of emergency telehealth in rural and remote settings and assess evidence relating to their effectiveness and cost-effectiveness.
METHODS
Randomised controlled trials, non-randomised controlled trials, and full and partial economic evaluations (e.g. cost-effectiveness, cost-benefit, and cost-utility analyses) of telehealth in rural and remote emergency departments will be included. Comprehensive literature searches will be conducted in multiple electronic databases (from 1990 onwards): MEDLINE (Ovid), Cochrane Library, Scopus, CINAHL, ProQuest, EconLit, CRD databases (e.g. NHS Economic Evaluation database), and Tufts Cost-Effectiveness Registry. Two authors will independently screen all citations, full-text articles, and abstract data. The methodological quality (or risk of bias) of individual studies will be appraised using an appropriate tool. A systematic narrative synthesis will be provided with information presented in the text and tables to summarise and explain the characteristics and findings of the studies. If feasible, we will conduct random effects meta-analysis.
DISCUSSION
This review will identify gaps in the current body of evidence relating to the effectiveness and cost-effectiveness of rural and remote emergency telehealth services. By confining to articles written in the English language, this analysis may be subjected to publication bias and results need to be interpreted accordingly. We believe the results of this review could be valuable for the design of future economic evaluations of emergency telehealth services implemented in the rural and remote context.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO CRD42019145903.
背景
紧急远程医疗已被用于提高农村和偏远地区患者获得专科护理的可及性。迄今为止的证据表明，远程医疗在各种情况下的农村和偏远地区急诊部具有有效性和成本效益。然而，迄今为止的系统评价并未关注农村和偏远地区的急诊部。本研究的目的是审查农村和偏远地区远程医疗评估中使用的结果测量指标，并评估其有效性和成本效益的相关证据。
方法
将纳入农村和偏远地区急诊部的远程医疗随机对照试验、非随机对照试验以及全面和部分经济评估（例如成本效益、成本效益和成本效用分析）。将在多个电子数据库（从 1990 年开始）中进行全面的文献搜索：MEDLINE（Ovid）、Cochrane 图书馆、Scopus、CINAHL、ProQuest、EconLit、CRD 数据库（例如 NHS 经济评估数据库）和塔夫茨成本效益注册处。两名作者将独立筛选所有引用、全文文章和摘要数据。将使用适当的工具评估单个研究的方法学质量（或偏倚风险）。将提供系统的叙述性综合，以文本和表格中的信息总结和解释研究的特征和发现。如果可行，我们将进行随机效应荟萃分析。
讨论
本综述将确定农村和偏远地区远程急诊医疗服务有效性和成本效益方面现有证据的差距。通过仅将文章限制在英文书写，本分析可能会受到发表偏倚的影响，因此需要相应地解释结果。我们相信，本综述的结果对于设计未来在农村和偏远地区实施的紧急远程医疗服务的经济评估可能具有价值。
系统评价注册
PROSPERO CRD42019145903。
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