Electronic consultations (E-consults) and their outcomes: a systematic review.

Autor:	Vimalananda VG; Center for Healthcare Organization and Implementation Research, Bedford VA Medical Center, Bedford, Massachusetts, USA.; Section of Endocrinology, Diabetes, and Metabolism, Boston University School of Medicine, Boston, Massachusetts, USA., Orlander JD; Department of General Medicine, VA Boston Healthcare System, Boston, Massachusetts, USA.; Evans Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA., Afable MK; Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts, USA.; Department of Quality, Safety and Value, Partners Healthcare System, Boston, Massachusetts, USA., Fincke BG; Center for Healthcare Organization and Implementation Research, Bedford VA Medical Center, Bedford, Massachusetts, USA.; Section of Health Law, Policy & Management, Boston University School of Public Health, Boston, Massachusetts, USA., Solch AK; Center for Healthcare Organization and Implementation Research, Bedford VA Medical Center, Bedford, Massachusetts, USA., Rinne ST; Center for Healthcare Organization and Implementation Research, Bedford VA Medical Center, Bedford, Massachusetts, USA.; Section of Pulmonary, Allergy, Sleep, and Critical Care Medicine, Boston University School of Medicine, Boston, Massachusetts, USA., Kim EJ; Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts, USA.; Division of General Internal Medicine, Zucker School of Medicine, Hofstra Northwell, Manhasset, New York, USA., Cutrona SL; Center for Healthcare Organization and Implementation Research, Bedford VA Medical Center, Bedford, Massachusetts, USA.; Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA., Thomas DD; Center for Healthcare Organization and Implementation Research, Bedford VA Medical Center, Bedford, Massachusetts, USA.; Section of Endocrinology, Diabetes, and Metabolism, Boston University School of Medicine, Boston, Massachusetts, USA., Strymish JL; Department of Medicine, Harvard Medical School, Cambridge, Massachusetts, USA.; Department of Medicine and Infectious Diseases, VA Boston Healthcare System, Boston, Massachusetts, USA., Simon SR; Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts, USA.; Department of Medicine, Harvard Medical School, Cambridge, Massachusetts, USA.; Geriatrics and Extended Care Service, VA Boston Healthcare System, Boston, Massachusetts, USA.
Jazyk:	angličtina
Zdroj:	Journal of the American Medical Informatics Association : JAMIA [J Am Med Inform Assoc] 2020 Mar 01; Vol. 27 (3), pp. 471-479.
DOI:	10.1093/jamia/ocz185
Abstrakt:	Objective: Electronic consultations (e-consults) are clinician-to-clinician communications that may obviate face-to-face specialist visits. E-consult programs have spread within the US and internationally despite limited data on outcomes. We conducted a systematic review of the recent peer-reviewed literature on the effect of e-consults on access, cost, quality, and patient and clinician experience and identified the gaps in existing research on these outcomes. Materials and Methods: We searched 4 databases for empirical studies published between 1/1/2015 and 2/28/2019 that reported on one or more outcomes of interest. Two investigators reviewed titles and abstracts. One investigator abstracted information from each relevant article, and another confirmed the abstraction. We applied the GRADE criteria for the strength of evidence for each outcome. Results: We found only modest empirical evidence for effectiveness of e-consults on important outcomes. Most studies are observational and within a single health care system, and comprehensive assessments are lacking. For those outcomes that have been reported, findings are generally positive, with mixed results for clinician experience. These findings reassure but also raise concern for publication bias. Conclusion: Despite stakeholder enthusiasm and encouraging results in the literature to date, more rigorous study designs applied across all outcomes are needed. Policy makers need to know what benefits may be expected in what contexts, so they can define appropriate measures of success and determine how to achieve them. (Published by Oxford University Press on behalf of the American Medical Informatics Association 2019. This work is written by US Government employees and is in the public domain in the US.)
Databáze:	MEDLINE
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