JMIR Publications

ABSTRACT

Background:

Virtual care is here to stay but there remains no comprehensive measurement framework to guide evaluation of its impacts to inform policy decisions and optimization of practice. 

Objective:

The aim of our study was to conduct a systematic review of reviews to synthesize measures related to virtual care evaluation across clinical conditions and contexts to identify gaps in current evaluation metrics, and to inform the development of recommendations for future work.

Methods:

Citations published from 2015-2023 were retrieved from Medline, Cochrane Database of Systematic Reviews, Embase, Emcare, Scopus, CINAHL and Web of Science, utilizing search terms grouped by key concept. The study was reported according to PRISMA guidelines for systematic reviews.  Measures from retained articles (1,233) were thematically grouped against the Proctor Implementation Research Outcomes framework.

Results:

There has been substantial growth in the virtual care literature, particularly since the start of the COVID-19 pandemic.  The majority of articles (73.0%; 900/1233) evaluated client outcomes, including satisfaction with virtual care, usability or functionality of platforms, and/or clinical outcomes. Relative to the other domains of the Proctor framework, implementation measures were poorly defined, and many of the measures were proxy rather than direct measures.  Despite the potential impacts of virtual care on health equity, most studies were purely qualitative.  Measures of safety, privacy and security of virtual care were sparse and poorly defined. Despite the role of caregivers in facilitating virtual visits and providing technical support, few studies examined implementation or satisfaction with virtual care from the prospective of caregivers.  Additionally, provider experience and acceptance of virtual care has implications for availability and adoption; however, relative to patients, few articles examined the provider perspective.

Conclusions:

Our study highlights gaps in current evaluations of virtual care. Future work is needed to standardize measure definitions as they relate to virtual care, particularly in the implementation domain.  Future studies should include both the caregiver and providers as unique perspectives in evaluations, and should embed systematic evaluations of the impact of social determinants of health on virtual care access, adoption, and perspectives of care.