Background
Methods
Study Class | Characteristic |
---|---|
I | • Properly designed random controlled trials |
II | • Random controlled trials that contain design flaws preventing |
• specification of Class I | |
• Properly designed trials with control groups not randomized | |
• Multi-center or population-based longitudinal (cohort) study | |
• Case control studies | |
III | • Descriptive studies (uncontrolled case series) |
• Clinical experience | |
• Expert opinion | |
• Case reports |
Study Class | Characteristic |
---|---|
A | Strong positive effect |
B | Weak positive effect |
C | Conflicting evidence for effect |
D | Negative effect (evidence that the technology is inferior or ineffective) |
Results
Outcomes | Quality Score | Clinical Specialty | Sample | Intervention | Effects |
---|---|---|---|---|---|
Flatley-Brennan[29] | I-B | AIDS | 57 patients | Social isolation and decision-making skill for home computer network (RCT) | Reduced social isolation when controlled for depression and improved confidence in decision-making with increased use |
Gustafson[30] | I-A | AIDS | 183 patients | Quality of life and hospitalizations (RCT) | Improvement in active life, negative emotions, cognitive functions, social support, and participation in health care; fewer hospitalizations |
Brennan[31] | I-B | Alzheimer's Disease | 102 caregivers | Social isolation and decision-making skill for home computer network (RCT) | Improved decision-making confidence but no improvement in decision-making skill or social isolation |
Sparks [32] | II-B | Cardiology | 20 patients | Comparison of home exercise program with transtelephonic exercise monitoring vs. hospital-based program (RCT) | Both groups improved equally in cardiac function, no medical emergencies in either group |
Mahmud [26] | III-B | Chronic Disease | 12 patients | Home telecare in chronic disease for frail elderly | Improved compliance and control of disease process; decreased hospitalization and nursing home placement |
Nakamura[25] | II-B | Chronic Disease | 32 patients | Home telecare in chronic disease for frail elderly | Improvement in activities of daily living, communication, and social cognition |
Johnston[24] | I-B | Chronic Disease | 212 patients | Home telecare in chronic disease for frail elderly (RCT) | Both groups had comparable medication compliance, knowledge of disease, and ability for self-care |
Ahring[17] | II-B | Diabetes Mellitus | 42 patients | Home blood sugar monitoring (RCT) | Computer group had HgbA1c drop from 10.6% to 9.2% (-13.2%); control group from 11.2% to 10.2% (-8.9%) |
Shultz[21] | II-B | Diabetes Mellitus | 20 patients | Home blood sugar monitoring (RCT) | Reduced HgbA1c levels in computer group but details not given |
Billiard[19] | II-B | Diabetes Mellitus | 22 patients | Home blood sugar monitoring (RCT) | Computer group had HgbA1c drop from 6.7% to 6.0%; control group from 6.8% to 6.7% |
DiBiase[22] | II-B | Diabetes Mellitus | 20 patients | Home blood sugar monitoring in gestational diabetes (RCT) | Computer group had HgbA1c drop from 6.4% to 5.0%; control group from 7.1% to 5.7% |
Frost[23] | II-B | Diabetes Mellitus | 21 patients | Home blood sugar monitoring in gestational diabetes | Computer group had HgbA1c drop from 6.1% to 5.4%; control group from 6.2% to 5.7% |
Marrero[16] | I-B | Diabetes Mellitus | 106 patients | Home blood sugar monitoring (RCT) | Computer group had HgbA1c rise from 9.4% to 10.0%; control group from 9.9% to 10.3%; no difference in ER visits, psychological status, or family functioning |
Mease[20] | II-B | Diabetes Mellitus | 28 patients | Home blood sugar monitoring (RCT) | Computer group had HgbA1c fall from 9.5% to 8.2% vs. 9.5% to 8.6% for control group |
Biermann[18] | II-B | Diabetes Mellitus | 46 patients | Home blood sugar monitoring (RCT) | Computer group had HgbA1c fall from 8.3% to 7.3% vs. 8.0% to 6.8% for control group |
Friedman[27] | I-A | Hypertension | 267 patients | Automated patient monitoring and counseling (RCT) | Adherence and diastolic blood pressure improved |
Cartwright[28] | I-B | Hypertension | 99 patients | Anxiety, blood pressure readings, and gestational age at delivery in home vs. hospital-monitored women (RCT) | Comparable levels of anxiety, mean blood pressure, and gestational age of delivery |
Gray[33] | I-B | Neonatology | 56 patients | Quality of care and hospitalization (RCT) | Trend towards earlier discharge from hospital |
Miyasaka[34] | III-B | Pulmonary | 10 patients | Amount of unscheduled care before and after installation of videophone access to physician | Reduction in number of house calls (5 vs. 0), unscheduled hospital visits (24 vs. 5), and hospital admission days (22 vs. 10) |
Outcomes | Quality Score | Clinical Specialty | Sample | Intervention | Effects |
---|---|---|---|---|---|
Wootton[37] | II-B | Dermatology | 204 patients | Need for special follow-up (RCT) | No difference in need for follow-up |
Brennan[36] | I-A | Emergency Medicine | 100 patients | Patients randomized to local or telemedicine care (RCT) | No difference in ER return or need for additional care |
Rosenfeld[38] | II-B | Intensive Care | 201 patients | Addition of remote intensivist to surgical ICU | Decreases in severity-adjusted ICU mortality (46–68%) and hospital mortality (30–33%). Decreases in ICU complications (44–50%) and ICU length of stay (30–34%). |
Rendina[39] | II-B | Neonatology | 314 patients | Length of stay in NICU for telemedicine vs. no telemedicine | Length of stay decreased significantly related to birth weight |
Goh[40] | III-B | Neurosurgery | 116 patients | Neurosurgery transfer before and after teleradiology | Fewer adverse events during transfer (8% vs. 32%) |
Goh[41] | III-B | Neurosurgery | 63 patients | Head injury patients with teleradiology | Fewer adverse events during transfer (6.4% vs. 32.1%) |
Home-based telemedicine
Diabetes Mellitus
General Chronic Disease Management
Hypertension
AIDS
Other areas
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An RCT of a home computer link for caregivers of patients with Alzheimer's Disease found improved decision-making confidence [31].
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An RCT of patients in a home-exercise program using transtelephonic exercise monitoring compared to a hospital-based program improved cardiac function by a similar amount [32]. (One caveat of this study was that it had such low statistical power that it would not be likely to detect any difference between the two interventions in efficacy or in complications even if they existed.)
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An RCT of an Internet-based telemedicine program for families of children in a neonatal intensive care unit found that among infants born with weight of <1,000 grams, there was a trend towards shorter hospital stays [33].
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A study of videophones for pediatric home ventilator patients found that the number of unscheduled hospital visits and hospital admission days was reduced significantly compared with historical controls [34].