Building the Evidence Base for Tele-Emergency Care: Efforts to Identify a Standardized Set of Outcome Measures

Publisher: Telemedicine and e-Health (published online ahead of print)
Jan 12, 2017
Yael Harris, Boyd Gilman, Marcia M. Ward, Jonathan Ladinsky, Jacqueline Crowley, Cannon Warren, and Craig Caplan

Background. To enhance the quality of emergency department (ED) care, some rural hospitals have adopted the use of telemedicine (tele-ED). Without a common set of metrics, it is difficult to quantify the impact of this technology.

Introduction. To address this limitation, the Health Resources and Services Administration funded the identification and testing of a core set of measures that could be used to build a business case for the value of tele-ED care.

Methods. A comprehensive environmental scan was conducted to identify existing measures relevant to assessing ED care and the use of telemedicine. Identified measures were assessed against a set of criteria and pilot tested in rural hospitals.

Results. The environmental scan identified numerous ED-specific measures and a limited set of telehealth-specific measures, but no clearly defined measures specific to tele-ED. Applying evaluation criteria to the measures revealed that few have a well-established evidence base, and fewer have undergone the rigorous testing needed to establish statistical reliability and validity. Nevertheless, a parsimonious set of measures was identified that met many of the evaluation criteria. Pilot testing indicated that collecting data using these measures was feasible.

Discussion. For tele-ED benefits to be widely acknowledged, more research is required to demonstrate that care delivered using tele-ED care is as high quality, if not more so, than in-person care. This requires researchers to consistently use a set of clearly defined measures.

Conclusion. The use of clearly defined and standardized measures will aid interpretation and permit replication in multiple studies, furthering acceptance of study findings.