In this episode, we are joined by Dr. Jordan Albritton, a Research Public Health Analyst at RTI International to explain the benefits and issues associated with video teleconferencing as a substitute for in-person healthcare.
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Learn how to listen to The Hospital Finance Podcast® on your mobile device.Highlights of this episode include:
- Research overview
- Primary Findings
- Provider in-person vs. video teleconferencing
- Healthcare providers going forward
Mike Passanante: Hi, this is Mike Passanante and welcome back to the award-winning Hospital Finance podcast. Recently, a group of researchers looked at the benefits and issues associated with video teleconferencing as a substitute or adjunct for in-person healthcare. To explain the study’s findings, I’m joined by Jordan Albritton. Dr. Albritton is a research public health analyst in the Healthcare Quality and Outcomes group at RTI International. Jordan, welcome to the show.
Dr. Jordan Albritton: Hey, thanks for having me.
Mike: So Jordan, why don’t you start out by telling us what you were looking at with this research specifically?
Jordan: Yeah. That’s a good question. So essentially, we reviewed all of the published studies of randomized controlled trials that were flagged as involving video teleconferencing in healthcare. So that’s pretty broad. We did have some additional inclusion and exclusion criteria. But we wanted to cast a really broad net and just see what was out there. That said, we did limit the studies to randomized controlled trials because we wanted to start with identifying, what’s the best evidence that’s available? So just off the bat, it’s probably worth noting that, obviously, a lot of evidence is coming from other types of studies, and that’s really important. But this study, the one that we had published, is summarizing what’s available in those RCTs. So we wanted to know, what’s the gold standard evidence for the past several years? What does it say about the use of video teleconferencing in healthcare?
Mike: Yeah. And certainly, with the onset of the pandemic, telemedicine has become a much broader and more used tool in healthcare. So you were looking specifically at the efficacy of that and whether or not that actually changes the quality of the outcomes. Right?
Jordan: That’s right. Yeah.
Mike: So basically, why don’t you just talk us through your primary findings, and then we’ll talk about some of the takeaways from that.
Jordan: Yeah. So if I can, I’ll tell you a bit about the methodology first and how we approached this. So this is technically a rapid review, which if listeners aren’t familiar with that term it’s sort of a newer idea in the systematic literature review world. If you’ve ever looked at a systematic literature review, I mean, they take a year and a half or so to run those to get that done sometimes. And so by the time you have this evidence in your hands, it’s maybe already outdated. So PCORI, who funded our project, they’ve started to recognize that we need to have this evidence synthesis done, but we need it in a timely manner, which I think that’s really great. And so they’ve started promoting and funding these rapid reviews in a number of different areas. It’s still systematic. It follows the process. So it reviews all of the evidence and all of the literature that’s out there. But they find a way to limit the scope and to reduce some of those time-consuming elements so that you really can get it done and out from start to finish in approximately six months, and that’s the goal.
So we reviewed all the published literature going back to 2013, and we synthesize the evidence, and we loaded it to randomized trials. As far as the primary findings and outcomes, we had 38 studies that met our inclusion and exclusion criteria. About 18 of those studies were rated high risk of bias, which means that they did something or they failed to report something. And so that would lead somebody that was reviewing that study to question the validity of those findings. So ultimately, that left us with 20 studies that met the criteria for what we were looking for, mostly diabetes, heart failure, some neurological disorders, respiratory disorders, and then several pain-related disorders, and a few other conditions here and there. So we looked at process outcomes, at patient outcomes. We looked at experience of care. We were interested in both the provider and the patient in that regard. And overwhelmingly, the evidence shows that for those studied conditions and the purposes, that the use of video teleconferencing in healthcare is just as good as and sometimes it resulted in better outcomes than the usual care alternative, which is typically in-person care.
Mike: So when you think about that kind of finding, what would you say are some of the takeaways from this research if you’re a healthcare provider and you’re looking at your in-person versus video teleconferencing balance? What would you say?
Jordan: Yeah. So for me, I think that the results should give healthcare providers confidence providing care virtually. Or if there’s a system that’s thinking about making some changes, there is evidence that shows that– especially for chronic disease, ongoing chronic disease management was a pretty common theme, that providing that care virtually, there’s evidence that that is safe, it’s effective, and that’s something that should be done or could be done. We should, of course, say that there are definitely going to be areas where virtual care is not preferred and maybe it’s not effective. Unfortunately, those aren’t– well, maybe fortunately because if we know it’s not going to be effective, that’s not something that’s going to show up in a randomized controlled trial, for sure. But I think that that kind of even gets to the point that providers, policymakers, planners, people out there are probably aware of a lot of those areas where telehealth is not going to be appropriate. But it’s these ones, the kinds of conditions and purposes where it was studied in the studies that we found that there is a lot of evidence, it seems like, that people should be confident to use video telehealth.
So we found several studies, again, with key outcomes that actually favored the telehealth group. There weren’t any clear patterns that we could draw from that as far as where the telehealth and video conferencing group would be favored. But I think it’s an important thing, and I think there’s growing recognition that virtual care can actually be used to produce better outcomes than usual care or in-person care in some instances. Again, not for every condition, but there are a number of benefits, timeliness, convenience, completeness. You can have sort of integration that maybe is superior than if somebody just comes into the office.
Mike: Jordan, were there anything about these findings that surprised you?
Jordan: Yeah. I can think of two things that surprised me. First one is that, actually, I think I expected there to be a little more literature out there than what we found, especially given that we were casting a pretty broad net. But again, we were limiting only to randomized controlled trials. So that was sort of our limiting factor. The other issue with that is that, again, 18 of the 38 studies that otherwise met our criteria had one or two things or more that led us to question the validity of the findings and just that there might be some bias there. So some of it has to do with the quality of the studies and really that there were only a handful of conditions that were actually well covered, as I mentioned before. So that’s definitely part of it.
The second thing that surprised me, perhaps, is that the vast majority of the studies included what we’re calling multiple component or multi-component interventions, and none of those studies conducted component analyses. So what I mean by that is that they didn’t just do video teleconferencing, but they did video teleconferencing and something else, whether that’s remote patient monitoring like getting a blood pressure cuff or some virtual education or there was some messaging platform. And I think that, in some sense, that really makes sense. That’s kind of how the world works. Other than things perhaps like Teledoc and MDLIVE, most telehealth solutions, I think, tend to be implemented with other components to support patient care and improve outcomes. But again, 16 out of the 20 studies that we ultimately reviewed in the article that we had published were these multi-component interventions. So they were teasing out the differences of the impact of video. Ultimately, it was a little bit more challenging.
Mike: Based on what you found, what do you think this means for healthcare providers moving forward?
Jordan: Yeah. Well, I’d say that I think that it’s pretty clear that telehealth and, in particular, video teleconferencing in healthcare, it’s not going anywhere. As we mentioned, definitely the pandemic was driving a lot of this. 2020 saw a huge shift in the way that we’re delivering healthcare. I think the other thing is that it’s important to note that, again, most of these studies were set up with these multi-component interventions, and that’s how telehealth is used in the real world. So I think providers should be prepared for additional tools to become available that are going to make the use of video teleconferencing in healthcare even more effective. And if I was a healthcare provider or working with a practice, I’d be thinking about the potential disruption that might come from that.
And again, this is really beyond this study now, what I’m talking about, but think about if patients had artificial intelligence guided diagnostic tools like autoscopes and stethoscopes at home that would maybe allow them to have more effective video visits where they actually have some of the evidence and the tools that are needed in the office. You probably have people who are less likely to come in for things like the common cold or ear infections. So that could negatively impact some healthcare practices and systems. But maybe it makes time for more effective chronic disease management, which again, will probably move towards this hybrid model where it includes virtual care and in-person care. And I think that’s really the next question that these RCTs won’t answer is, how should virtual care be integrated into the existing system so that we can really drive improvement and reduce costs? It’s not a matter of if or really when, but it’s how, and people are doing that. It’s really exciting to see. And I think that’s where telehealth really will become transformative is when we know the best way to do this and we can drive people towards value. And if you’re not ready for that, then you might have a challenge in the sort of environment as potential disruption kind of takes place.
Mike: Jordan, where can someone learn more about you or get a copy of the study?
Jordan: Yeah. Well, yeah, for sure, the study is published in the Annals of Internal Medicine last month, so December 2021. So that would be a good place to look for the study. And I also should say that we do have a full report that’s published and publicly available on PCORI‘s website, and so that would be another great place to look. I think that the collaboration that we’ve had with PCORI for this study, for this work is really great, and they’re doing other work like this as well. And then if anybody wants to reach out to me or has any other questions, certainly can send me an email, and then my email is jalbritton@rti.org. So happy to have discussions with anybody that’s interested.
Mike: Jordan Albritton, thanks for coming by the Hospital Finance podcast today.
Jordan: All right. Thanks so much.
Mike: If you have a topic that you’d like us to discuss on the Hospital Finance podcast or if you’d like to be a guest, drop us a line at update@besler.com.
