JMIR Publications

ABSTRACT

Background:

Telehealth interventions, i.e. healthcare provided over a distance using information and communication technology, are suggested as a solution to rising healthcare costs by reducing hospital services use. However, the extent to which this is possible is unclear.

Objective:

To evaluate the effect of telehealth on hospital services use, i.e. (duration of) hospitalizations, and to compare effects between telehealth types and health conditions.

Methods:

We searched PubMed, Scopus, and the Cochrane Library from inception until April 2019. Peer-reviewed randomized controlled trials (RCTs) reporting the effect of telehealth interventions compared to usual care on hospital services use were included. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool, and quality of evidence according to GRADE guidelines.

Results:

We included 129 RCTs in the meta-analyses. Of these RCTs 78.5% had a low risk of bias or some concerns overall. High quality evidence shows that telehealth reduces the risk of an all-cause or a condition-related hospitalization by 18 (95%CI 0 to 30) and 37 (95%CI 20 to 60) per 1000 patients, respectively. We found high quality of evidence that telehealth leads to reductions in mean all-cause and condition-related hospitalizations, with 50 and 110 fewer hospitalizations per 1000 patients, respectively. Overall, all-cause hospital days decreased by 1.07 (95%CI −1.76 to −0.39) hospital days per patient. For hospitalized patients, mean stay for condition-related hospitalizations decreased by 0.89 days (95%CI −1.42 to −0.36). Effects were similar between telehealth types and health conditions. A trend was observed for studies with longer follow-up yielding larger effects.

Conclusions:

Small to moderate reductions in hospital services use can be achieved using telehealth. It should be noted that, despite the large number of included studies, uncertainties around the magnitude of effects remain and not all effects were statistically significant.