Leveraging Telemedicine for Quality Assessment

Hernáez, Rubén; Kanwal, Fasiha

doi:10.1002/cld.1205

Cited by 6 publications

(4 citation statements)

References 12 publications

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“…Although TH is potentially effective, who might be the best candidates? Hernaez and Kanwal [64] suggested that ideal patients have stable liver disease, where a complete physical exam or immediate laboratory testing is unnecessary. Examples may include management of compensated cirrhosis, treatment of HCV or HBV, HCC follow-up after initial treatment, and initial liver transplant evaluation.…”

Section: Discussionmentioning

confidence: 99%

Telehealth interventions in patients with chronic liver diseases: A systematic review

et al. 2023

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Background and Aim: Telehealth interventions may improve access to care, disease-specific, and quality outcomes in chronic liver diseases (CLDs). We aimed to systematically evaluate outcomes of telehealth interventions in CLDs. Materials and Methods: We used key terms and searched PubMed/ EMBASE from inception to January 10, 2022. Two authors independently screened abstracts. Disagreements were resolved by a third reviewer. We included any type of CLD, including posttransplant patients, and extracted outcomes as defined by authors for each etiology of CLD (sustained virological response in HCV or weight loss in NAFLD). Meta-analysis was not performed because of the heterogeneity of data. Quality assessment was performed using the Newcastle-Ottawa Scale for observational studies and the Cochrane Risk of Bias tool for clinical trials.Results: Of 4250 studies screened, 43 met the inclusion criteria. Of these, 28 reported HCV treatment outcomes. All studies showed no statistically significant differences between sustained virological response rates in TH groups compared with control groups or historic cohorts. Eight studies evaluating liver transplant-related processes and outcomes demonstrated improved rates of transplant evaluation and referrals and decreased shortterm readmission rates. Three randomized controlled trials and 1 observational study on NAFLD showed improved weight loss outcomes. One retrospective study showed reduced mortality risk in CLD patients with at least 1 TH encounter.

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Section: Discussionmentioning

confidence: 99%

Telehealth interventions in patients with chronic liver diseases: A systematic review

et al. 2023

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“…It is conceivable that future models that are employed in PCP setting involve NAFLD teams that include a registered dietician, endocrinologist, and exercise therapist along with a hepatologist and other related specialties as needed. Given the increased applications of telehealth, a virtual room with providers from multiple disciplines with the patient at one location (home or hepatology clinics) may be another feasible option 29. How the IPU's virtual room would be reimbursed needs attention.…”

Section: Element #1: Organization Into Integrated Practice Unitsmentioning

confidence: 99%

“…Given the increased applications of telehealth, a virtual room with providers from multiple disciplines with the patient at one location (home or hepatology clinics) may be another feasible option. [29] How the IPU's virtual room would be reimbursed needs attention. The insurance should cover for these additional services upfront.…”

Section: Element #1: Organization Into Integrated Practice Unitsmentioning

confidence: 99%

Patient‐centered care: Key elements applicable to chronic liver disease

et al. 2022

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Chronic liver disease (CLD) is a progressive illness with high symptom burden and functional and cognitive impairment, often with comorbid mental and substance use disorders. These factors lead to significant deterioration in quality of life, with immense burden on patients, caregivers, and healthcare. The current healthcare system in the United States does not adequately meet the needs of patients with CLD or control costs given the episodic, reactive, and fee-for-service structure. There is also a need for clinical and financial accountability for CLD care. In this context, we describe the key elements required to shift the CLD care paradigm to a patient-centered and value-based system built upon the Porter model of value-based health care. The key elements include (1) organization into integrated practice units, (2) measuring and incorporating meaningful patientreported outcomes, (3) enabling technology to allow innovation, (4) bundled care payments, (5) integrating palliative care within routine care, and (6) formalizing centers of excellence. These elements have been shown to improve outcomes, reduce costs, and improve overall patient experience for other chronic illnesses and should have similar benefits for CLD. Payers need to partner with providers and systems to build upon these elements and help align reimbursements with patients' values and outcomes. The national organizations such as the American Association for Study of Liver Diseases need to guide key stakeholders in standardizing these elements to optimize patient-centered care for CLD.

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“…Telemedicine and its quality have been examined from a specialty point of view, but there has not been a comprehensive look across specialties. Telemedicine has been studied for its quality implications in diabetes [ 8 ]; liver disease [ 9 ]; pediatrics [ 10 ]; gastroenterology [ 11 ]; ears, nose, and throat [ 12 ]; respiratory care [ 13 ]; rheumatoid arthritis [ 14 ]; and alcohol use disorder [ 15 ]. Each study provides a mix of reviews on quality [ 16 - 18 ].…”

Section: Introductionmentioning

confidence: 99%

Analyzing the Effect of Telemedicine on Domains of Quality Through Facilitators and Barriers to Adoption: Systematic Review

Kruse¹,

Molina-Nava²,

Kapoor³

et al. 2023

J Med Internet Res

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Background Telemedicine has a long history; however, its efficacy has been reported with mixed reviews. Studies have reported a wide range of quality implications when using the telemedicine modality of care. Objective This study aimed to analyze the effectiveness of telemedicine through 6 domains of quality through an analysis of randomized controlled trials (RCTs) published in the literature published, to date, in 2022. Methods A total of 4 databases were searched using a standard Boolean string. The 882,420 results were reduced to 33 for analysis through filtering and randomization. The systematic literature review was conducted in accordance with the Kruse Protocol and reported in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses; 2020). Results The Cohen κ statistic was calculated to show agreement between the reviewers (Cohen κ=0.90, strong). Medical outcomes associated with the telemedicine modality were 100% effective with a weighted average effect size of 0.21 (small effect). Many medical outcomes were positive but not statistically better than treatment as usual. RCTs have reported positive outcomes for physical and mental health, medical engagement, behavior change, increased quality of life, increased self-efficacy, increased social support, and reduced costs. All 6 domains of quality were identified in the RCTs and 4 were identified in 100% of the studies. Telemedicine is highly patient-centered because it meets digital preferences, is convenient, avoids stigma, and enables education at one’s own pace. A few barriers exist to its wide adoption, such as staff training and cost, and it may not be the preferred modality for all. Conclusions The effectiveness of telemedicine is equal to or greater than that of traditional care across a wide spectrum of services studied in this systematic literature review. Providers should feel comfortable offering this modality of care as a standard option to patients where it makes sense to do so. Although barriers exist for wide adoption, the facilitators are all patient facing. Trial Registration PROSPERO CRD42022343478; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=343478

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Leveraging Telemedicine for Quality Assessment

Abstract: Content available: Author Interview and Audio Recording

Cited by 6 publications

References 12 publications

Telehealth interventions in patients with chronic liver diseases: A systematic review

Telehealth interventions in patients with chronic liver diseases: A systematic review

Patient‐centered care: Key elements applicable to chronic liver disease

Analyzing the Effect of Telemedicine on Domains of Quality Through Facilitators and Barriers to Adoption: Systematic Review

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