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Associated factors of periodontitis and predicted study among young man in China: a population-based cross-sectional study

Periodontitis represents the foremost oral condition in young men, strongly correlated with socioeconomic elements and oral health behaviors. This research aimed to assess the prevalence of periodontitis and a...

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Does “National Civilized City” policy mitigate air pollution in China? A spatial Durbin difference-in-differences analysis

“National Civilized City” (NCC) is regarded as China’s highest honorary title and most valuable city brand. To win and maintain the “golden city” title, municipal governments must pay close attention to variou...

The longitudinal associations between ambient air pollution exposure and dementia in the UK: results from the cognitive function and ageing study II and Wales

Air pollution has been recognised as a potential risk factor for dementia. Yet recent epidemiological research shows mixed evidence. The aim of this study is to investigate the longitudinal associations betwee...

Evaluation of an online arts-based platform to support the health and well-being of older adults during the COVID-19 pandemic: a cross-sectional survey

The objective of this study was to conduct a formative evaluation of the Art Your Service (AYS) arts-based program to determine the program’s potential for improving the social and physical well-being of older ad...

Type 2 diabetes in the employed population: do rates and trends differ among nine occupational sectors? An analysis using German health insurance claims data

Socioeconomic inequalities in type 2 diabetes (T2D) are well established in the literature. However, within the background of changing work contexts associated with digitalization and its effect on lifestyle a...

Women are lean and men are also lean: nutrition titles in women’s and men’s health magazines

Whether nutrition messages in popular health magazines differ by country or season has seldom been studied. We assessed the nutrition topics featured in the headlines of Men’s Health® (MH) and Women’s Health® ...

Impact of capitation on physicians’ behavior among patients with hypertension: an interrupted time series study in rural China

The purpose of this study is to explore the change in physicians’ hypertension treatment behavior before and after the reform of the capitation in county medical community.

Being both a grandmother and a health worker: experiences of community-based health workers in addressing adolescents’ sexual and reproductive health needs in rural Zambia

Community-based health workers (CBHWs) possess great potential to be the missing link between the community and the formal health system for improving adolescents’ access to sexual and reproductive health and ...

The effect of outdoor activities on the medical expenditure of older people: multiple chain mediating effects of health benefits

With the global aging population, attention to the health and medical issues of older adults is increasing. By analyzing the relationship between older people's participation in outdoor activities and medical ...

Public libraries to promote public health and wellbeing: a cross-sectional study of community-dwelling adults

Libraries in the UK have evolved from traditional book-lending institutions into dynamic community hubs, This study aims to explore the potential of libraries to act as community hubs to promote mental and phy...

Exclusive breastfeeding among Indonesian working mothers: does early initiation of breastfeeding matter?

Early initiation of breastfeeding (EIBF) is a starting point that lays the foundation for breastfeeding and bonding between mother and baby. Meanwhile, working mothers are one of the vulnerable groups for the ...

Association between vitamin B2 intake and prostate-specific antigen in American men: 2003–2010 National Health and Nutrition Examination Survey

Accumulating evidence suggests a pivotal role of vitamin B2 in the pathogenesis and progression of prostate cancer (PCa). Vitamin B2 intake has been postulated to modulate the screening rate for PCa by alterin...

Self-reported sexual coercion among in-school young people with disabilities in Ghana

Sexual coercion is one of the major public health concerns globally. This is even more worrying among young people with disabilities (YPWDs). This study assessed the prevalence and factors associated with sexu...

Public health and economic benefits of seasonal influenza vaccination in risk groups in France, Italy, Spain and the UK: state of play and perspectives

Seasonal influenza epidemics have a substantial public health and economic burden, which can be alleviated through vaccination. The World Health Organization (WHO) recommends a 75% vaccination coverage rate (V...

Public health framing of firearm violence on local television news in Philadelphia, PA, USA: a quantitative content analysis

Firearm violence is an intensifying public health problem in the United States. News reports shape the way the public and policy makers understand and respond to health threats, including firearm violence. To ...

Food security status and cardiometabolic health by sex/gender and race/ethnicity among adults in the United States

Minoritized racial/ethnic groups and women in the United States (US) are disproportionately burdened by food insecurity, which likely contributes to disparities in cardiovascular health (CVH). Disparities are ...

The facilitators of and barriers to antimicrobial use and misuse in Lalitpur, Nepal: a qualitative study

Antimicrobial resistance (AMR) is a pressing global health concern driven by inappropriate antibiotic use, which is in turn influenced by various social, systemic, and individual factors. This study, nested wi...

Prevalence of Parkinson’s disease among adults aged 45 years and older in China: a cross-sectional study based on the China health and retirement longitudinal study

In recent decades, China has experienced a rapid increase in the number of elderly individuals and life expectancy, as well as industrialization, which is associated with an increased prevalence of Parkinson's...

Help-seeking processes related to targeted school-based mental health services: systematic review

One in seven adolescents globally are affected by mental health conditions, yet only a minority receive professional help. School-based mental health services have been endorsed as an effective way to increase...

Evaluation of TikTok videos on acute pancreatitis: content quality and reliability analysis

Acute pancreatitis (AP) is a common acute digestive system disorder, with patients often turning to TikTok for AP-related information. However, the platform’s video quality on AP has not been thoroughly invest...

Proton pump inhibitors use is associated with a higher prevalence of kidney stones: NHANES 2007–2018

Proton pump inhibitors (PPIs) are widely used throughout the world as an effective gastrointestinal drug. Nevertheless, according to the existing literature, PPIs can reduce the excretion of magnesium, calcium...

Publisher Correction: Evaluating knowledge, attitude, and physical activity levels related to cardiovascular disease in Egyptian adults with and without cardiovascular disease: a community-based cross-sectional study

The original article was published in BMC Public Health 2024 24 :1107

Effect of maternal vaccination on infant morbidity in Bangladesh

Risk factors of infant mortality in Africa and south Asian countries have been broadly discussed. However, infant morbidity is largely underestimated. We analyzed the data from a randomized vaccine trial in Ba...

Diet quality as assessed by the healthy eating index-2020 among different smoking status: an analysis of national health and nutrition examination survey (NHANES) data from 2005 to 2018

Combining smoking with poor eating habits significantly elevates the risk of chronic illnesses and early death. Understanding of how dietary quality shifts post-smoking cessation remains limited. The objective...

Relationship between socioeconomic status and hypertension incidence among adults in southwest China: a population-based cohort study

To investigate the correlation between socioeconomic status (SES) and the incidence of hypertension among adults aged 18 or above in southwest China.

Fourteen-year trends in overweight, general obesity, and abdominal obesity in Amazonian indigenous peoples

Available data show that the epidemiological profile of most indigenous Brazilian populations is characterized by the coexistence of long-standing health problems (high prevalence of infectious and parasitic d...

“R” you getting this? Factors contributing to the public’s understanding, evaluation, and use of basic reproduction numbers for infectious diseases

We (1) examined the effects of evaluative labels and visual aids on people’s understanding, evaluation, and use of the COVID-19 reproduction number (or “r-number”), (2) examined whether people’s perceived susc...

Perceptions of TB-HIV comorbidity among the Nomads in Adamawa State, Nigeria

The recalcitrance of Mycobacterium tuberculosis (MTB) to eradication was related to achieving a nonreplicating (dormant) state and the increasing global burden of HIV coinfection. Consequently, understanding t...

Addressing loneliness and social isolation in 52 countries: a scoping review of National policies

Even prior to the advent of the COVID-19 pandemic, there was ample evidence that loneliness and social isolation negatively impacted physical and mental health, employability, and are a financial burden on the...

Community screening for dementia among older adults in China: a machine learning-based strategy

Dementia is a leading cause of disability in people older than 65 years worldwide. However, diagnosing dementia in its earliest symptomatic stages remains challenging. This study combined specific questions fr...

Exploring pre-pandemic patterns of vaccine decision-making with the 5C model: results from representative surveys in 2016 and 2018

The 5C psychological antecedents of vaccination (Confidence, Complacency, Constraints, Calculation, and Collective Responsibility) facilitate understanding vaccination decisions in specific target groups as we...

School-aged children’s movement behaviours and subjective health complaints in Japan: a cross-sectional study during COVID-19 pandemic-related school closures and after school reopenings

Social restrictions associated with the COVID-19 pandemic have altered children’s movement behaviours and impacted their mental health. However, the influence of social restrictions on subjective health compla...

Medication adherence and costs of medical care among patients with Parkinson’s disease: an observational study using electronic medical records

Adherence to antiparkinsonian drugs (APDs) is critical for patients with Parkinson’s disease (PD), for which medication is the main therapeutic strategy. Previous studies have focused on specific disorders in ...

Patterns of sedentary behavior among older women with urinary incontinence and urinary symptoms: a scoping review

Independent of physical activity, sedentary behavior has emerged as a significant risk factor for health. Particularly, older adults spent as high as 13 h daily on sedentary activities, which account for 98% o...

Definition and characteristics of climate-adaptive cities: a systematic review

Cities, as frontline responders to climate change, necessitate a precise understanding of climate-adaptive features. This systematic review aims to define and outline the characteristics of climate-adaptive ci...

Long-lasting effects of the COVID-19 pandemic on lifestyle and body weight: results of representative cross-sectional surveys in adults in Germany

The COVID-19 pandemic severely affected people’s daily lives and health. Few studies have looked into the persistence of these changes. In the current study, we investigated to what extent changes in lifestyle...

Effects of perceived stress on turnover intention of female healthcare staff: a serial multiple mediation model

Healthcare staff in China, especially females, work in a high-pressure, high-load, and high-risk environment, which affects the physical and mental health, the efficiency and quality of work, and increases tur...

A qualitative study of the barriers to commissioning social and therapeutic horticulture in mental health care

Social and Therapeutic Horticulture (STH) is a process where trained practitioners work with plants and people to improve an individual’s physical and psychological health, communication and thinking skills. E...

Residential mobility and liver cancer risk: findings from a prospective cohort study in Chinese women

Residential mobility is believed to influence the occurrence and development of cancer; however, the results are inconclusive. Furthermore, limited studies have been conducted on Asian populations. This study ...

Secondary analyses of sex differences in attention improvements across three clinical trials of a digital therapeutic in children, adolescents, and adults with ADHD

Attention-deficit/hyperactivity disorder (ADHD) remains underdiagnosed and undertreated in girls. Inattentive symptoms, often predominant in girls with ADHD, represent a key driver of impairment and often pers...

Myopia information on TikTok: analysis factors that impact video quality and audience engagement

TikTok is emerging as a vital platform for health information dissemination. Despite myopia being a global public health issue, the high-quality myopia information shared by health educators often fails to go ...

Social media heterogeneity and preventive behaviours during the COVID-19 outbreak: a survey on online shopping

Residents’ adoption of preventive behaviours proved beneficial in preventing the large-scale transmission of the virus during the early stages of the COVID-19 outbreak. It is critical to investigate how social...

Association between multiple-heavy-metal exposures and systemic immune inflammation in a middle-aged and elderly Chinese general population

Exposure to heavy metals alone or in combination can promote systemic inflammation. The aim of this study was to investigate potential associations between multiple plasma heavy metals and markers of systemic ...

Understanding facilitators and barriers to COVID-19 vaccination in the Zimbabwean population: a qualitative analysis

Vaccines are effective biological interventions that reduce health burdens. However, during the COVID-19 pandemic, there were concerns about varying levels of COVID-19 vaccination coverage in the Zimbabwean po...

Covid-19 hotlines, helplines and call centers: a systematic review of characteristics, challenges and lessons learned

During the Covid-19 pandemic, a number of hotlines/helplines/call centers was implemented to provide remote services and support public health. The objective of this study was to investigate the characteristic...

Vitamin A supplementation coverage and associated factors for children aged 6 to 59 months in integrated and campaign-based delivery systems in four sub-Saharan African countries

Vitamin A deficiency (VAD) is a leading contributor to the poor health and nutrition of young children in sub-Saharan Africa. Funding constraints are compelling many countries to shift from longstanding campai...

Mortality burden of cardiovascular disease attributable to ambient PM 2.5 exposure in Portugal, 2011 to 2021

Exposure to high levels of environmental air pollution causes several health outcomes and has been associated with increased mortality, premature mortality, and morbidity. Ambient exposure to PM 2.5 is currently c...

Relative and absolute inequalities in cerebrovascular disease mortality rates: exploring the influence of socioeconomic status and urbanization levels in Taiwan

Limited evidence exists regarding the socioeconomic inequalities in cerebrovascular disease (CBD) mortality at different urbanization levels. Therefore, this study was conducted to assess the socioeconomic ine...

Randomised pilot and feasibility trial of a group intervention for men who perpetrate intimate partner violence against women

There is a need for robust evidence on the effectiveness and cost-effectiveness of domestic abuse perpetrator programmes in reducing abusive behaviour and improving wellbeing for victim/survivors. While any ra...

Does health literacy mediate the relationship between socioeconomic status and health related outcomes in the Belgian adult population?

Health literacy (HL) has been put forward as a potential mediator through which socioeconomic status (SES) affects health. This study explores whether HL mediates the relation between SES and a selection of he...

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2022 Citation Impact 4.5 - 2-year Impact Factor 4.7 - 5-year Impact Factor 1.661 - SNIP (Source Normalized Impact per Paper) 1.307 - SJR (SCImago Journal Rank)

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Indexing services, peer-review policy, collections and special issues, editorial policies, appeals and complaints, citing articles in bmc health services research, benefits of publishing with bmc, aims and scope.

BMC Health Services Research  is an open access, peer-reviewed journal that considers articles on all aspects of health services research. The journal has a special focus on digital health, governance, health policy, health system quality and safety, healthcare delivery and access to healthcare, healthcare financing and economics, implementing reform, and the health workforce.  

BMC Health Services Research does not make editorial decisions on the basis of the interest of a study or its likely impact. Studies must be scientifically valid; for research articles this includes a scientifically sound research question, the use of suitable methods and analysis, and following community-agreed standards relevant to the research field.

Health services research is a unique and multidisciplinary field of research that examines how different factors, behaviors, and technologies impact population’s access to healthcare, and the quality and cost of the care they receive.

BMC Health Services Research welcomes submissions covering the following broad areas of research. 

Designing and implementing health system reform

We consider implementation science research examining the methods, trialing, and uptake of research into routine healthcare settings for the benefit of patient health. We also consider research promoting healthcare reforms and the de-implementation of low-value care. Submissions that include public and patient involvement (PPI) or co-production in the research process are particularly encouraged. 

eHealth, mHealth and informatics

We consider all aspects of research relating to the development, trialing, adoption, and implementation of digital health and information technologies, artificial intelligence, machine learning, and mobile health-based innovations in health service management, planning, and delivery of care.

Health policy, politics and power

We consider all aspects of research concerning the decisions, plans, and actions that are undertaken to achieve specific healthcare goals in society. We also consider studies on pharmaceutical policy, legislation, guidelines, and regulations that impact health systems, services, and movements towards universal health coverage.

Health system quality and safety

We consider all aspects of research concerning the review, monitoring, evaluation, communication, and achievement of high-level health system goals based on health system strategies. We also encourage submissions evidencing improvement and innovation to advance the quality and safety of patient care at the health system and service level. Studies examining the perspectives of health systems, health care providers, service users, and caregivers are also considered. 

Please note that studies concerning clinical knowledge, practice, clinical decision-making, and measurement of clinical outcomes, should be directed to the relevant BMC Series medical journal . 

Healthcare delivery and access to healthcare

We consider all aspects of research relating to the organization of people, institutions, and resources to deliver health care services to meet the healthcare needs of the population.   We particularly encourage submissions reporting studies supporting universal health coverage and healthcare equity. Geospatial and epidemiological studies related to healthcare delivery and access to healthcare are also considered.

Healthcare financing and economics

We consider all aspects of research relating to the mobilization, accumulation, and allocation of money to finance the healthcare needs of people, individually and as a population. We also consider studies looking at the various models for financing healthcare, such as private insurance, out-of-pocket expenses, social health insurance schemes, and taxation. We also consider economic evaluations of health policies, interventions, pharmaceuticals, and services. 

Please note that the journal does not consider research focused on increasing for-profit healthcare revenue. For example, monetizing healthcare or personal health data, or marketing for-profit healthcare, including health and insurance products. 

Healthcare governance and management

We consider all aspects of research aiming to inform best practice and continuous improvement for commissioners, decision-makers, and managers, for the benefit of service users and their carers. We also consider studies focused on risk assessments, upholding healthcare standards, incident management and reporting, and auditing.

The health workforce

We consider all aspects of health workforce research including planning, resourcing, and staffing, assessment of healthcare staff attitudes and behaviors, and occupational wellbeing of healthcare staff.  We also consider studies examining demographics and diversity, the health professional job market, methods to improve wellbeing, motivation, and productivity, and health workforce migration studies. 

Please note that studies concerning the clinical knowledge, practice, and decision-making of health professionals, should be directed to the relevant BMC Series medical journal . 

Not sure if your article fits the scope of the journal? Why not explore some of our related journals in the  BMC Series : 

• BMC Infectious Diseases for healthcare-associated infection control practices, hygiene, and PPE 
• BMC Medical Education   for the education and continuing professional development of healthcare professionals
• BMC Nursing   for nursing research, training, education, nurse-led interventions, and nursing practice 
• BMC Pharmacology & Toxicology   for clinical pharmacology and clinical practice
• BMC Primary Care   for primary health care research and general practice, including clinical practice 
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Availability of datasets Where a widely established research community expectation for data archiving in public repositories exists, submission to a community-endorsed, public repository is mandatory. A list of data where deposition is required, can be found on the Editorial Policies Page . 

BMC Health Services Research strongly encourages that all datasets on which the conclusions of the paper rely should be available to readers. We encourage authors to ensure that their datasets are either deposited in publicly available repositories (where available and appropriate) or presented in the main manuscript or additional supporting files whenever possible. If a dataset is not able to be deposited in any of the above repositories due to legal guidelines or ethical reasons, this must be clearly stated in the “Availability of Data and Materials” section.

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Authors are required to formally cite any datasets stored in external repositories that are mentioned within their manuscript, including the main datasets that are the focus of the submission, as well as any other datasets that have been used in the work. For previously published datasets, we ask authors to cite both the related research articles and the datasets themselves. All methods, software, and code developed for the manuscript should include a citation on the reference list. 

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• Zhang, Q-L., Chen, J-Y., Lin, L-B., Wang, F., Guo, J., Deng, X-Y. Characterization of ladybird Henosepilachna vigintioctopunctata transcriptomes across various life stages. figshare https://doi.org/10.6084/m9.figshare.c.4064768.v3 (2018).
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A statement describing how software or custom code can be accessed must be included in the Declaration section “Availability of Data and Materials". License information for the software or method should also be stated clearly in the “Availability of Data and Materials section” and on the repository site.

This section should include a link to the most recent version of your software or code (e.g. GitHub or Sourceforge or Code Ocean) as well as a link to the archived version referenced in the manuscript. The software or code should be archived in an appropriate repository with a DOI or other unique identifier. For software in GitHub, we recommend using Zenodo . 

Code with an assigned DOI must be formally cited and listed in the References section of the manuscript.

Availability of research materials BMC Health Services Research follows the BMC editorial policies for the sharing of research materials. 

Submission of a manuscript to a BMC journal implies that materials described in the manuscript, including all relevant raw data, will be freely available to any scientist wishing to use them for non-commercial purposes. It is acceptable to request reasonable payment to cover costs of distribution and reagents may be made available via commercial or non-commercial third party providers. Any restrictions on materials availability, including if materials are to be distributed by a for-profit company, must be clearly stated in the paper. As per our policy on authorship responsibilities, it is expected that the corresponding author (or relevant designated authors) will be responsible for materials availability unless otherwise stated. 

Study pre-registration BMC Health Services Research encourages study pre-registration and pre-registration of analysis plans in public repositories; details of pre-registration should be provided in the manuscript.

Replication studies BMC Health Services Research ​​​​​​​ welcomes submission of replication studies that provide new insights into previously published results and will evaluate these submissions with the same editorial standards we apply to other submissions.

Standards of reporting BMC Health Services Research ​​​​​​​  advocates complete and transparent reporting of research and follows the BMC editorial policies on standards of reporting. Additional information is available through the journal’s submission guidelines .

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Authors who publish open access in BMC Health Services Research are required to pay an article processing charge (APC). The APC price will be determined from the date on which the article is accepted for publication.

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Peer-review is the system used to assess the quality of a manuscript before it is published. Independent researchers in the relevant research area assess submitted manuscripts for originality, validity and significance to help editors determine whether the manuscript should be published in their journal. You can read more about the peer-review process here .

In cases where the journal is unable to find sufficient peer reviewers, the services of a publishing partner, Research Square, may be used to identify suitable reviewers and provide reports to avoid further delays for authors. Reviewers recruited by Research Square are paid a small honorarium for completing the review within a specified timeframe. Honoraria are paid regardless of the reviewer recommendation. With Research Square, a double-anonymous peer review system is in operation.

In cases where reports have been obtained by Research Square, the peer review reports will be unsigned unless the reviewer opts in to sign the report.

BMC Health Services Research operates a transparent peer-review system, where, if the article is published, the reviewer reports are published online alongside the article under a Creative Commons Attribution License 4.0 but the reviewer is not named.

The benefit of transparent peer review is that it increases transparency. In addition, published reports can serve an educational purpose in helping facilitate training and research into peer review.

Manuscripts submitted to BMC Health Services Research are assessed by our Editors and/or peer reviewers. Editor(s) are expected to obtain a minimum of two peer reviewers for manuscripts reporting primary research or secondary analysis of primary research. It is recognized that in some exceptional circumstances, particularly in niche and emerging fields, it may not be possible to obtain two independent peer reviewers. In such cases, Editor(s) may wish to make a decision to publish based on one peer review report. When making a decision based on one report, Editor(s) are expected to only do so if the peer review report meets the standards set out in the Springer Nature Code of Conduct (section Peer-Review). Overall editorial responsibility for the journal is with the Editor, with Editorial Board Members acting as handling editors. 

BMC Health Services Research is part of the BMC series which publishes subject-specific journals focused on the needs of individual research communities across all areas of biology and medicine. We do not make editorial decisions on the basis of the interest of a study or its likely impact. Studies must be scientifically valid; for research articles this includes a scientifically sound research question, the use of suitable methods and analysis, and following community-agreed standards relevant to the research field. 

Specific criteria for other article types can be found in the submission guidelines.

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All articles submitted to Collections and Special issues are peer reviewed in line with the journal’s standard peer review policy and are subject to all of the journal’s standard editorial and publishing policies. This includes the journal’s policy on competing interests. The Editors declare no competing interests with the submissions which they have handled through the peer review process. The peer review of any submissions for which the Editors have competing interests is handled by another Editor who has no competing interests.

All manuscripts submitted to BMC Health Services Research should adhere to BMC's editorial policies .

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Authors who wish to appeal a rejection or make a complaint should follow the procedure outlined in  BMC's Editorial Policies.

Articles in BMC Health Services Research should be cited in the same way as articles in a traditional journal. Because articles are not printed, they do not have page numbers; instead, they are given a unique article number.

Article citations follow this format:

Authors: Title. BMC Health Serv Res [year], [volume number]:[article number].

e.g. Roberts LD, Hassall DG, Winegar DA, Haselden JN, Nicholls AW, Griffin JL: Increased hepatic oxidative metabolism distinguishes the action of Peroxisome Proliferator-Activated Receptor delta from Peroxisome Proliferator-Activated Receptor gamma in the Ob/Ob mouse. BMC Health Serv Res 2009, 1 :115.

refers to article 115 from Volume 1 of the journal.

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BMC Health Services Research 's open access policy allows maximum visibility of articles published in the journal as they are available to a wide, global audience. 

Speed of publication

BMC Health Services Research offers a fast publication schedule whilst maintaining rigorous peer review; all articles must be submitted online, and peer review is managed fully electronically (articles are distributed in PDF form, which is automatically generated from the submitted files). Articles will be published with their final citation after acceptance, in both fully browsable web form, and as a formatted PDF.

Flexibility

Online publication in BMC Health Services Research gives you the opportunity to publish large datasets, large numbers of color illustrations and moving pictures, to display data in a form that can be read directly by other software packages so as to allow readers to manipulate the data for themselves, and to create all relevant links (for example, to PubMed , to sequence and other databases, and to other articles).

Promotion and press coverage

Articles published in BMC Health Services Research are included in article alerts and regular email updates. Some may be highlighted on BMC Health Services Research ’s pages and on the BMC homepage.

In addition, articles published in BMC Health Services Research may be promoted by press releases to the general or scientific press. These activities increase the exposure and number of accesses for articles published in BMC Health Services Research . A list of articles recently press-released by journals published by BMC is available here .

As an author of an article published in BMC Health Services Research you retain the copyright of your article and you are free to reproduce and disseminate your work (for further details, see the BMC license agreement ).

For further information about the advantages of publishing in a journal from BMC, please click here .

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Assessing the impact of healthcare research: A systematic review of methodological frameworks

Roles Conceptualization, Data curation, Formal analysis, Funding acquisition, Investigation, Methodology, Validation, Writing – original draft, Writing – review & editing

Affiliation Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom

Roles Conceptualization, Formal analysis, Funding acquisition, Methodology, Project administration, Supervision, Validation, Writing – review & editing

* E-mail: [email protected]

Roles Data curation, Formal analysis, Methodology, Validation, Writing – review & editing

Roles Formal analysis, Methodology, Supervision, Validation, Writing – review & editing

• Samantha Cruz Rivera, 
• Derek G. Kyte, 
• Olalekan Lee Aiyegbusi, 
• Thomas J. Keeley, 
• Melanie J. Calvert

• Published: August 9, 2017
• https://doi.org/10.1371/journal.pmed.1002370
• Reader Comments

Increasingly, researchers need to demonstrate the impact of their research to their sponsors, funders, and fellow academics. However, the most appropriate way of measuring the impact of healthcare research is subject to debate. We aimed to identify the existing methodological frameworks used to measure healthcare research impact and to summarise the common themes and metrics in an impact matrix.

Methods and findings

Two independent investigators systematically searched the Medical Literature Analysis and Retrieval System Online (MEDLINE), the Excerpta Medica Database (EMBASE), the Cumulative Index to Nursing and Allied Health Literature (CINAHL+), the Health Management Information Consortium, and the Journal of Research Evaluation from inception until May 2017 for publications that presented a methodological framework for research impact. We then summarised the common concepts and themes across methodological frameworks and identified the metrics used to evaluate differing forms of impact. Twenty-four unique methodological frameworks were identified, addressing 5 broad categories of impact: (1) ‘primary research-related impact’, (2) ‘influence on policy making’, (3) ‘health and health systems impact’, (4) ‘health-related and societal impact’, and (5) ‘broader economic impact’. These categories were subdivided into 16 common impact subgroups. Authors of the included publications proposed 80 different metrics aimed at measuring impact in these areas. The main limitation of the study was the potential exclusion of relevant articles, as a consequence of the poor indexing of the databases searched.

Conclusions

The measurement of research impact is an essential exercise to help direct the allocation of limited research resources, to maximise research benefit, and to help minimise research waste. This review provides a collective summary of existing methodological frameworks for research impact, which funders may use to inform the measurement of research impact and researchers may use to inform study design decisions aimed at maximising the short-, medium-, and long-term impact of their research.

Author summary

Why was this study done.

• There is a growing interest in demonstrating the impact of research in order to minimise research waste, allocate resources efficiently, and maximise the benefit of research. However, there is no consensus on which is the most appropriate tool to measure the impact of research.
• To our knowledge, this review is the first to synthesise existing methodological frameworks for healthcare research impact, and the associated impact metrics by which various authors have proposed impact should be measured, into a unified matrix.

What did the researchers do and find?

• We conducted a systematic review identifying 24 existing methodological research impact frameworks.
• We scrutinised the sample, identifying and summarising 5 proposed impact categories, 16 impact subcategories, and over 80 metrics into an impact matrix and methodological framework.

What do these findings mean?

• This simplified consolidated methodological framework will help researchers to understand how a research study may give rise to differing forms of impact, as well as in what ways and at which time points these potential impacts might be measured.
• Incorporating these insights into the design of a study could enhance impact, optimizing the use of research resources.

Citation: Cruz Rivera S, Kyte DG, Aiyegbusi OL, Keeley TJ, Calvert MJ (2017) Assessing the impact of healthcare research: A systematic review of methodological frameworks. PLoS Med 14(8): e1002370. https://doi.org/10.1371/journal.pmed.1002370

Academic Editor: Mike Clarke, Queens University Belfast, UNITED KINGDOM

Received: February 28, 2017; Accepted: July 7, 2017; Published: August 9, 2017

Copyright: © 2017 Cruz Rivera et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are within the paper and supporting files.

Funding: Funding was received from Consejo Nacional de Ciencia y Tecnología (CONACYT). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript ( http://www.conacyt.mx/ ).

Competing interests: I have read the journal's policy and the authors of this manuscript have the following competing interests: MJC has received consultancy fees from Astellas and Ferring pharma and travel fees from the European Society of Cardiology outside the submitted work. TJK is in full-time paid employment for PAREXEL International.

Abbreviations: AIHS, Alberta Innovates—Health Solutions; CAHS, Canadian Academy of Health Sciences; CIHR, Canadian Institutes of Health Research; CINAHL+, Cumulative Index to Nursing and Allied Health Literature; EMBASE, Excerpta Medica Database; ERA, Excellence in Research for Australia; HEFCE, Higher Education Funding Council for England; HMIC, Health Management Information Consortium; HTA, Health Technology Assessment; IOM, Impact Oriented Monitoring; MDG, Millennium Development Goal; NHS, National Health Service; MEDLINE, Medical Literature Analysis and Retrieval System Online; PHC RIS, Primary Health Care Research & Information Service; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses; PROM, patient-reported outcome measures; QALY, quality-adjusted life year; R&D, research and development; RAE, Research Assessment Exercise; REF, Research Excellence Framework; RIF, Research Impact Framework; RQF, Research Quality Framework; SDG, Sustainable Development Goal; SIAMPI, Social Impact Assessment Methods for research and funding instruments through the study of Productive Interactions between science and society

Introduction

In 2010, approximately US$240 billion was invested in healthcare research worldwide [ 1 ]. Such research is utilised by policy makers, healthcare providers, and clinicians to make important evidence-based decisions aimed at maximising patient benefit, whilst ensuring that limited healthcare resources are used as efficiently as possible to facilitate effective and sustainable service delivery. It is therefore essential that this research is of high quality and that it is impactful—i.e., it delivers demonstrable benefits to society and the wider economy whilst minimising research waste [ 1 , 2 ]. Research impact can be defined as ‘any identifiable ‘benefit to, or positive influence on the economy, society, public policy or services, health, the environment, quality of life or academia’ (p. 26) [ 3 ].

There are many purported benefits associated with the measurement of research impact, including the ability to (1) assess the quality of the research and its subsequent benefits to society; (2) inform and influence optimal policy and funding allocation; (3) demonstrate accountability, the value of research in terms of efficiency and effectiveness to the government, stakeholders, and society; and (4) maximise impact through better understanding the concept and pathways to impact [ 4 – 7 ].

Measuring and monitoring the impact of healthcare research has become increasingly common in the United Kingdom [ 5 ], Australia [ 5 ], and Canada [ 8 ], as governments, organisations, and higher education institutions seek a framework to allocate funds to projects that are more likely to bring the most benefit to society and the economy [ 5 ]. For example, in the UK, the 2014 Research Excellence Framework (REF) has recently been used to assess the quality and impact of research in higher education institutions, through the assessment of impact cases studies and selected qualitative impact metrics [ 9 ]. This is the first initiative to allocate research funding based on the economic, societal, and cultural impact of research, although it should be noted that research impact only drives a proportion of this allocation (approximately 20%) [ 9 ].

In the UK REF, the measurement of research impact is seen as increasingly important. However, the impact element of the REF has been criticised in some quarters [ 10 , 11 ]. Critics deride the fact that REF impact is determined in a relatively simplistic way, utilising researcher-generated case studies, which commonly attempt to link a particular research outcome to an associated policy or health improvement despite the fact that the wider literature highlights great diversity in the way research impact may be demonstrated [ 12 , 13 ]. This led to the current debate about the optimal method of measuring impact in the future REF [ 10 , 14 ]. The Stern review suggested that research impact should not only focus on socioeconomic impact but should also include impact on government policy, public engagement, academic impacts outside the field, and teaching to showcase interdisciplinary collaborative impact [ 10 , 11 ]. The Higher Education Funding Council for England (HEFCE) has recently set out the proposals for the REF 2021 exercise, confirming that the measurement of such impact will continue to form an important part of the process [ 15 ].

With increasing pressure for healthcare research to lead to demonstrable health, economic, and societal impact, there is a need for researchers to understand existing methodological impact frameworks and the means by which impact may be quantified (i.e., impact metrics; see Box 1 , 'Definitions’) to better inform research activities and funding decisions. From a researcher’s perspective, understanding the optimal pathways to impact can help inform study design aimed at maximising the impact of the project. At the same time, funders need to understand which aspects of impact they should focus on when allocating awards so they can make the most of their investment and bring the greatest benefit to patients and society [ 2 , 4 , 5 , 16 , 17 ].

Box 1. Definitions

• Research impact: ‘any identifiable benefit to, or positive influence on, the economy, society, public policy or services, health, the environment, quality of life, or academia’ (p. 26) [ 3 ].
• Methodological framework: ‘a body of methods, rules and postulates employed by a particular procedure or set of procedures (i.e., framework characteristics and development)’ [ 18 ].
• Pathway: ‘a way of achieving a specified result; a course of action’ [ 19 ].
• Quantitative metrics: ‘a system or standard of [quantitative] measurement’ [ 20 ].
• Narrative metrics: ‘a spoken or written account of connected events; a story’ [ 21 ].

Whilst previous researchers have summarised existing methodological frameworks and impact case studies [ 4 , 22 – 27 ], they have not summarised the metrics for use by researchers, funders, and policy makers. The aim of this review was therefore to (1) identify the methodological frameworks used to measure healthcare research impact using systematic methods, (2) summarise common impact themes and metrics in an impact matrix, and (3) provide a simplified consolidated resource for use by funders, researchers, and policy makers.

Search strategy and selection criteria

Initially, a search strategy was developed to identify the available literature regarding the different methods to measure research impact. The following keywords: ‘Impact’, ‘Framework’, and ‘Research’, and their synonyms, were used during the search of the Medical Literature Analysis and Retrieval System Online (MEDLINE; Ovid) database, the Excerpta Medica Database (EMBASE), the Health Management Information Consortium (HMIC) database, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL+) database (inception to May 2017; see S1 Appendix for the full search strategy). Additionally, the nonindexed Journal of Research Evaluation was hand searched during the same timeframe using the keyword ‘Impact’. Other relevant articles were identified through 3 Internet search engines (Google, Google Scholar, and Google Images) using the keywords ‘Impact’, ‘Framework’, and ‘Research’, with the first 50 results screened. Google Images was searched because different methodological frameworks are summarised in a single image and can easily be identified through this search engine. Finally, additional publications were sought through communication with experts.

Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (see S1 PRISMA Checklist ), 2 independent investigators systematically screened for publications describing, evaluating, or utilising a methodological research impact framework within the context of healthcare research [ 28 ]. Papers were eligible if they included full or partial methodological frameworks or pathways to research impact; both primary research and systematic reviews fitting these criteria were included. We included any methodological framework identified (original or modified versions) at the point of first occurrence. In addition, methodological frameworks were included if they were applicable to the healthcare discipline with no need of modification within their structure. We defined ‘methodological framework’ as ‘a body of methods, rules and postulates employed by a particular procedure or set of procedures (i.e., framework characteristics and development)’ [ 18 ], whereas we defined ‘pathway’ as ‘a way of achieving a specified result; a course of action’ [ 19 ]. Studies were excluded if they presented an existing (unmodified) methodological framework previously available elsewhere, did not explicitly describe a methodological framework but rather focused on a single metric (e.g., bibliometric analysis), focused on the impact or effectiveness of interventions rather than that of the research, or presented case study data only. There were no language restrictions.

Data screening

Records were downloaded into Endnote (version X7.3.1), and duplicates were removed. Two independent investigators (SCR and OLA) conducted all screening following a pilot aimed at refining the process. The records were screened by title and abstract before full-text articles of potentially eligible publications were retrieved for evaluation. A full-text screening identified the publications included for data extraction. Discrepancies were resolved through discussion, with the involvement of a third reviewer (MJC, DGK, and TJK) when necessary.

Data extraction and analysis

Data extraction occurred after the final selection of included articles. SCR and OLA independently extracted details of impact methodological frameworks, the country of origin, and the year of publication, as well as the source, the framework description, and the methodology used to develop the framework. Information regarding the methodology used to develop each methodological framework was also extracted from framework webpages where available. Investigators also extracted details regarding each framework’s impact categories and subgroups, along with their proposed time to impact (‘short-term’, ‘mid-term’, or ‘long-term’) and the details of any metrics that had been proposed to measure impact, which are depicted in an impact matrix. The structure of the matrix was informed by the work of M. Buxton and S. Hanney [ 2 ], P. Buykx et al. [ 5 ], S. Kuruvila et al. [ 29 ], and A. Weiss [ 30 ], with the intention of mapping metrics presented in previous methodological frameworks in a concise way. A consensus meeting with MJC, DGK, and TJK was held to solve disagreements and finalise the data extraction process.

Included studies

Our original search strategy identified 359 citations from MEDLINE (Ovid), EMBASE, CINAHL+, HMIC, and the Journal of Research Evaluation, and 101 citations were returned using other sources (Google, Google Images, Google Scholar, and expert communication) (see Fig 1 ) [ 28 ]. In total, we retrieved 54 full-text articles for review. At this stage, 39 articles were excluded, as they did not propose new or modified methodological frameworks. An additional 15 articles were included following the backward and forward citation method. A total of 31 relevant articles were included in the final analysis, of which 24 were articles presenting unique frameworks and the remaining 7 were systematic reviews [ 4 , 22 – 27 ]. The search strategy was rerun on 15 May 2017. A further 19 publications were screened, and 2 were taken forward to full-text screening but were ineligible for inclusion.

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https://doi.org/10.1371/journal.pmed.1002370.g001

Methodological framework characteristics

The characteristics of the 24 included methodological frameworks are summarised in Table 1 , 'Methodological framework characteristics’. Fourteen publications proposed academic-orientated frameworks, which focused on measuring academic, societal, economic, and cultural impact using narrative and quantitative metrics [ 2 , 3 , 5 , 8 , 29 , 31 – 39 ]. Five publications focused on assessing the impact of research by focusing on the interaction process between stakeholders and researchers (‘productive interactions’), which is a requirement to achieve research impact. This approach tries to address the issue of attributing research impact to metrics [ 7 , 40 – 43 ]. Two frameworks focused on the importance of partnerships between researchers and policy makers, as a core element to accomplish research impact [ 44 , 45 ]. An additional 2 frameworks focused on evaluating the pathways to impact, i.e., linking processes between research and impact [ 30 , 46 ]. One framework assessed the ability of health technology to influence efficiency of healthcare systems [ 47 ]. Eight frameworks were developed in the UK [ 2 , 3 , 29 , 37 , 39 , 42 , 43 , 45 ], 6 in Canada [ 8 , 33 , 34 , 44 , 46 , 47 ], 4 in Australia [ 5 , 31 , 35 , 38 ], 3 in the Netherlands [ 7 , 40 , 41 ], and 2 in the United States [ 30 , 36 ], with 1 model developed with input from various countries [ 32 ].

https://doi.org/10.1371/journal.pmed.1002370.t001

Methodological framework development

The included methodological frameworks varied in their development process, but there were some common approaches employed. Most included a literature review [ 2 , 5 , 7 , 8 , 31 , 33 , 36 , 37 , 40 – 46 ], although none of them used a recognised systematic method. Most also consulted with various stakeholders [ 3 , 8 , 29 , 31 , 33 , 35 – 38 , 43 , 44 , 46 , 47 ] but used differing methods to incorporate their views, including quantitative surveys [ 32 , 35 , 43 , 46 ], face-to-face interviews [ 7 , 29 , 33 , 35 , 37 , 42 , 43 ], telephone interviews [ 31 , 46 ], consultation [ 3 , 7 , 36 ], and focus groups [ 39 , 43 ]. A range of stakeholder groups were approached across the sample, including principal investigators [ 7 , 29 , 43 ], research end users [ 7 , 42 , 43 ], academics [ 3 , 8 , 39 , 40 , 43 , 46 ], award holders [ 43 ], experts [ 33 , 38 , 39 ], sponsors [ 33 , 39 ], project coordinators [ 32 , 42 ], and chief investigators [ 31 , 35 ]. However, some authors failed to identify the stakeholders involved in the development of their frameworks [ 2 , 5 , 34 , 41 , 45 ], making it difficult to assess their appropriateness. In addition, only 4 of the included papers reported using formal analytic methods to interpret stakeholder responses. These included the Canadian Academy of Health Sciences framework, which used conceptual cluster analysis [ 33 ]. The Research Contribution [ 42 ], Research Impact [ 29 ], and Primary Health Care & Information Service [ 31 ] used a thematic analysis approach. Finally, some authors went on to pilot their framework, which shaped refinements on the methodological frameworks until approval. Methods used to pilot the frameworks included a case study approach [ 2 , 3 , 30 , 32 , 33 , 36 , 40 , 42 , 44 , 45 ], contrasting results against available literature [ 29 ], the use of stakeholders’ feedback [ 7 ], and assessment tools [ 35 , 46 ].

Major impact categories

1. primary research-related impact..

A number of methodological frameworks advocated the evaluation of ‘research-related impact’. This encompassed content related to the generation of new knowledge, knowledge dissemination, capacity building, training, leadership, and the development of research networks. These outcomes were considered the direct or primary impacts of a research project, as these are often the first evidenced returns [ 30 , 62 ].

A number of subgroups were identified within this category, with frameworks supporting the collection of impact data across the following constructs: ‘research and innovation outcomes’; ‘dissemination and knowledge transfer’; ‘capacity building, training, and leadership’; and ‘academic collaborations, research networks, and data sharing’.

1 . 1 . Research and innovation outcomes . Twenty of the 24 frameworks advocated the evaluation of ‘research and innovation outcomes’ [ 2 , 3 , 5 , 7 , 8 , 29 – 39 , 41 , 43 , 44 , 46 ]. This subgroup included the following metrics: number of publications; number of peer-reviewed articles (including journal impact factor); citation rates; requests for reprints, number of reviews, and meta-analysis; and new or changes in existing products (interventions or technology), patents, and research. Additionally, some frameworks also sought to gather information regarding ‘methods/methodological contributions’. These advocated the collection of systematic reviews and appraisals in order to identify gaps in knowledge and determine whether the knowledge generated had been assessed before being put into practice [ 29 ].

1 . 2 . Dissemination and knowledge transfer . Nineteen of the 24 frameworks advocated the assessment of ‘dissemination and knowledge transfer’ [ 2 , 3 , 5 , 7 , 29 – 32 , 34 – 43 , 46 ]. This comprised collection of the following information: number of conferences, seminars, workshops, and presentations; teaching output (i.e., number of lectures given to disseminate the research findings); number of reads for published articles; article download rate and number of journal webpage visits; and citations rates in nonjournal media such as newspapers and mass and social media (i.e., Twitter and blogs). Furthermore, this impact subgroup considered the measurement of research uptake and translatability and the adoption of research findings in technological and clinical applications and by different fields. These can be measured through patents, clinical trials, and partnerships between industry and business, government and nongovernmental organisations, and university research units and researchers [ 29 ].

1 . 3 . Capacity building , training , and leadership . Fourteen of 24 frameworks suggested the evaluation of ‘capacity building, training, and leadership’ [ 2 , 3 , 5 , 8 , 29 , 31 – 35 , 39 – 41 , 43 ]. This involved collecting information regarding the number of doctoral and postdoctoral studentships (including those generated as a result of the research findings and those appointed to conduct the research), as well as the number of researchers and research-related staff involved in the research projects. In addition, authors advocated the collection of ‘leadership’ metrics, including the number of research projects managed and coordinated and the membership of boards and funding bodies, journal editorial boards, and advisory committees [ 29 ]. Additional metrics in this category included public recognition (number of fellowships and awards for significant research achievements), academic career advancement, and subsequent grants received. Lastly, the impact metric ‘research system management’ comprised the collection of information that can lead to preserving the health of the population, such as modifying research priorities, resource allocation strategies, and linking health research to other disciplines to maximise benefits [ 29 ].

1 . 4 . Academic collaborations , research networks , and data sharing . Lastly, 10 of the 24 frameworks advocated the collection of impact data regarding ‘academic collaborations (internal and external collaborations to complete a research project), research networks, and data sharing’ [ 2 , 3 , 5 , 7 , 29 , 34 , 37 , 39 , 41 , 43 ].

2. Influence on policy making.

Methodological frameworks addressing this major impact category focused on measurable improvements within a given knowledge base and on interactions between academics and policy makers, which may influence policy-making development and implementation. The returns generated in this impact category are generally considered as intermediate or midterm (1 to 3 years). These represent an important interim stage in the process towards the final expected impacts, such as quantifiable health improvements and economic benefits, without which policy change may not occur [ 30 , 62 ]. The following impact subgroups were identified within this category: ‘type and nature of policy impact’, ‘level of policy making’, and ‘policy networks’.

2 . 1 . Type and nature of policy impact . The most common impact subgroup, mentioned in 18 of the 24 frameworks, was ‘type and nature of policy impact’ [ 2 , 7 , 29 – 38 , 41 – 43 , 45 – 47 ]. Methodological frameworks addressing this subgroup stressed the importance of collecting information regarding the influence of research on policy (i.e., changes in practice or terminology). For instance, a project looking at trafficked adolescents and women (2003) influenced the WHO guidelines (2003) on ethics regarding this particular group [ 17 , 21 , 63 ].

2 . 2 . Level of policy impact . Thirteen of 24 frameworks addressed aspects surrounding the need to record the ‘level of policy impact’ (international, national, or local) and the organisations within a level that were influenced (local policy makers, clinical commissioning groups, and health and wellbeing trusts) [ 2 , 5 , 8 , 29 , 31 , 34 , 38 , 41 , 43 – 47 ]. Authors considered it important to measure the ‘level of policy impact’ to provide evidence of collaboration, coordination, and efficiency within health organisations and between researchers and health organisations [ 29 , 31 ].

2 . 3 . Policy networks . Five methodological frameworks highlighted the need to collect information regarding collaborative research with industry and staff movement between academia and industry [ 5 , 7 , 29 , 41 , 43 ]. A policy network emphasises the relationship between policy communities, researchers, and policy makers. This relationship can influence and lead to incremental changes in policy processes [ 62 ].

3. Health and health systems impact.

A number of methodological frameworks advocated the measurement of impacts on health and healthcare systems across the following impact subgroups: ‘quality of care and service delivering’, ‘evidence-based practice’, ‘improved information and health information management’, ‘cost containment and effectiveness’, ‘resource allocation’, and ‘health workforce’.

3 . 1 . Quality of care and service delivery . Twelve of the 24 frameworks highlighted the importance of evaluating ‘quality of care and service delivery’ [ 2 , 5 , 8 , 29 – 31 , 33 – 36 , 41 , 47 ]. There were a number of suggested metrics that could be potentially used for this purpose, including health outcomes such as quality-adjusted life years (QALYs), patient-reported outcome measures (PROMs), patient satisfaction and experience surveys, and qualitative data on waiting times and service accessibility.

3 . 2 . Evidence-based practice . ‘Evidence-based practice’, mentioned in 5 of the 24 frameworks, refers to making changes in clinical diagnosis, clinical practice, treatment decisions, or decision making based on research evidence [ 5 , 8 , 29 , 31 , 33 ]. The suggested metrics to demonstrate evidence-based practice were adoption of health technologies and research outcomes to improve the healthcare systems and inform policies and guidelines [ 29 ].

3 . 3 . Improved information and health information management . This impact subcategory, mentioned in 5 of the 24 frameworks, refers to the influence of research on the provision of health services and management of the health system to prevent additional costs [ 5 , 29 , 33 , 34 , 38 ]. Methodological frameworks advocated the collection of health system financial, nonfinancial (i.e., transport and sociopolitical implications), and insurance information in order to determine constraints within a health system.

3 . 4 . Cost containment and cost-effectiveness . Six of the 24 frameworks advocated the subcategory ‘cost containment and cost-effectiveness’ [ 2 , 5 , 8 , 17 , 33 , 36 ]. ‘Cost containment’ comprised the collection of information regarding how research has influenced the provision and management of health services and its implication in healthcare resource allocation and use [ 29 ]. ‘Cost-effectiveness’ refers to information concerning economic evaluations to assess improvements in effectiveness and health outcomes—for instance, the cost-effectiveness (cost and health outcome benefits) assessment of introducing a new health technology to replace an older one [ 29 , 31 , 64 ].

3 . 5 . Resource allocation . ‘Resource allocation’, mentioned in 6frameworks, can be measured through 2 impact metrics: new funding attributed to the intervention in question and equity while allocating resources, such as improved allocation of resources at an area level; better targeting, accessibility, and utilisation; and coverage of health services [ 2 , 5 , 29 , 31 , 45 , 47 ]. The allocation of resources and targeting can be measured through health services research reports, with the utilisation of health services measured by the probability of providing an intervention when needed, the probability of requiring it again in the future, and the probability of receiving an intervention based on previous experience [ 29 , 31 ].

3 . 6 . Health workforce . Lastly, ‘health workforce’, present in 3 methodological frameworks, refers to the reduction in the days of work lost because of a particular illness [ 2 , 5 , 31 ].

4. Health-related and societal impact.

Three subgroups were included in this category: ‘health literacy’; ‘health knowledge, attitudes, and behaviours’; and ‘improved social equity, inclusion, or cohesion’.

4 . 1 . Health knowledge , attitudes , and behaviours . Eight of the 24 frameworks suggested the assessment of ‘health knowledge, attitudes, behaviours, and outcomes’, which could be measured through the evaluation of levels of public engagement with science and research (e.g., National Health Service (NHS) Choices end-user visit rate) or by using focus groups to analyse changes in knowledge, attitudes, and behaviour among society [ 2 , 5 , 29 , 33 – 35 , 38 , 43 ].

4 . 2 . Improved equity , inclusion , or cohesion and human rights . Other methodological frameworks, 4 of the 24, suggested capturing improvements in equity, inclusion, or cohesion and human rights. Authors suggested these could be using a resource like the United Nations Millennium Development Goals (MDGs) (superseded by Sustainable Development Goals [SDGs] in 2015) and human rights [ 29 , 33 , 34 , 38 ]. For instance, a cluster-randomised controlled trial in Nepal, which had female participants, has demonstrated the reduction of neonatal mortality through the introduction of maternity health care, distribution of delivery kits, and home visits. This illustrates how research can target vulnerable and disadvantaged groups. Additionally, this research has been introduced by the World Health Organisation to achieve the MDG ‘improve maternal health’ [ 16 , 29 , 65 ].

4 . 3 . Health literacy . Some methodological frameworks, 3 of the 24, focused on tracking changes in the ability of patients to make informed healthcare decisions, reduce health risks, and improve quality of life, which were demonstrably linked to a particular programme of research [ 5 , 29 , 43 ]. For example, a systematic review showed that when HIV health literacy/knowledge is spread among people living with the condition, antiretroviral adherence and quality of life improve [ 66 ].

5. Broader economic impacts.

Some methodological frameworks, 9 of 24, included aspects related to the broader economic impacts of health research—for example, the economic benefits emerging from the commercialisation of research outputs [ 2 , 5 , 29 , 31 , 33 , 35 , 36 , 38 , 67 ]. Suggested metrics included the amount of funding for research and development (R&D) that was competitively awarded by the NHS, medical charities, and overseas companies. Additional metrics were income from intellectual property, spillover effects (any secondary benefit gained as a repercussion of investing directly in a primary activity, i.e., the social and economic returns of investing on R&D) [ 33 ], patents granted, licences awarded and brought to the market, the development and sales of spinout companies, research contracts, and income from industry.

The benefits contained within the categories ‘health and health systems impact’, ‘health-related and societal impact’, and ‘broader economic impacts’ are considered the expected and final returns of the resources allocated in healthcare research [ 30 , 62 ]. These benefits commonly arise in the long term, beyond 5 years according to some authors, but there was a recognition that this could differ depending on the project and its associated research area [ 4 ].

Data synthesis

Five major impact categories were identified across the 24 included methodological frameworks: (1) ‘primary research-related impact’, (2) ‘influence on policy making’, (3) ‘health and health systems impact’, (4) ‘health-related and societal impact’, and (5) ‘broader economic impact’. These major impact categories were further subdivided into 16 impact subgroups. The included publications proposed 80 different metrics to measure research impact. This impact typology synthesis is depicted in ‘the impact matrix’ ( Fig 2 and Fig 3 ).

CIHR, Canadian Institutes of Health Research; HTA, Health Technology Assessment; PHC RIS, Primary Health Care Research & Information Service; RAE, Research Assessment Exercise; RQF, Research Quality Framework.

https://doi.org/10.1371/journal.pmed.1002370.g002

AIHS, Alberta Innovates—Health Solutions; CAHS, Canadian Institutes of Health Research; IOM, Impact Oriented Monitoring; REF, Research Excellence Framework; SIAMPI, Social Impact Assessment Methods for research and funding instruments through the study of Productive Interactions between science and society.

https://doi.org/10.1371/journal.pmed.1002370.g003

Commonality and differences across frameworks

The ‘Research Impact Framework’ and the ‘Health Services Research Impact Framework’ were the models that encompassed the largest number of the metrics extracted. The most dominant methodological framework was the Payback Framework; 7 other methodological framework models used the Payback Framework as a starting point for development [ 8 , 29 , 31 – 35 ]. Additional methodological frameworks that were commonly incorporated into other tools included the CIHR framework, the CAHS model, the AIHS framework, and the Exchange model [ 8 , 33 , 34 , 44 ]. The capture of ‘research-related impact’ was the most widely advocated concept across methodological frameworks, illustrating the importance with which primary short-term impact outcomes were viewed by the included papers. Thus, measurement of impact via number of publications, citations, and peer-reviewed articles was the most common. ‘Influence on policy making’ was the predominant midterm impact category, specifically the subgroup ‘type and nature of policy impact’, in which frameworks advocated the measurement of (i) changes to legislation, regulations, and government policy; (ii) influence and involvement in decision-making processes; and (iii) changes to clinical or healthcare training, practice, or guidelines. Within more long-term impact measurement, the evaluations of changes in the ‘quality of care and service delivery’ were commonly advocated.

In light of the commonalities and differences among the methodological frameworks, the ‘pathways to research impact’ diagram ( Fig 4 ) was developed to provide researchers, funders, and policy makers a more comprehensive and exhaustive way to measure healthcare research impact. The diagram has the advantage of assorting all the impact metrics proposed by previous frameworks and grouping them into different impact subgroups and categories. Prospectively, this global picture will help researchers, funders, and policy makers plan strategies to achieve multiple pathways to impact before carrying the research out. The analysis of the data extraction and construction of the impact matrix led to the development of the ‘pathways to research impact’ diagram ( Fig 4 ). The diagram aims to provide an exhaustive and comprehensive way of tracing research impact by combining all the impact metrics presented by the different 24 frameworks, grouping those metrics into different impact subgroups, and grouping these into broader impact categories.

NHS, National Health Service; PROM, patient-reported outcome measure; QALY, quality-adjusted life year; R&D, research and development.

https://doi.org/10.1371/journal.pmed.1002370.g004

This review has summarised existing methodological impact frameworks together for the first time using systematic methods ( Fig 4 ). It allows researchers and funders to consider pathways to impact at the design stage of a study and to understand the elements and metrics that need to be considered to facilitate prospective assessment of impact. Users do not necessarily need to cover all the aspects of the methodological framework, as every research project can impact on different categories and subgroups. This review provides information that can assist researchers to better demonstrate impact, potentially increasing the likelihood of conducting impactful research and reducing research waste. Existing reviews have not presented a methodological framework that includes different pathways to impact, health impact categories, subgroups, and metrics in a single methodological framework.

Academic-orientated frameworks included in this review advocated the measurement of impact predominantly using so-called ‘quantitative’ metrics—for example, the number of peer-reviewed articles, journal impact factor, and citation rates. This may be because they are well-established measures, relatively easy to capture and objective, and are supported by research funding systems. However, these metrics primarily measure the dissemination of research finding rather than its impact [ 30 , 68 ]. Whilst it is true that wider dissemination, especially when delivered via world-leading international journals, may well lead eventually to changes in healthcare, this is by no means certain. For instance, case studies evaluated by Flinders University of Australia demonstrated that some research projects with non-peer-reviewed publications led to significant changes in health policy, whilst the studies with peer-reviewed publications did not result in any type of impact [ 68 ]. As a result, contemporary literature has tended to advocate the collection of information regarding a variety of different potential forms of impact alongside publication/citations metrics [ 2 , 3 , 5 , 7 , 8 , 29 – 47 ], as outlined in this review.

The 2014 REF exercise adjusted UK university research funding allocation based on evidence of the wider impact of research (through case narrative studies and quantitative metrics), rather than simply according to the quality of research [ 12 ]. The intention was to ensure funds were directed to high-quality research that could demonstrate actual realised benefit. The inclusion of a mixed-method approach to the measurement of impact in the REF (narrative and quantitative metrics) reflects a widespread belief—expressed by the majority of authors of the included methodological frameworks in the review—that individual quantitative impact metrics (e.g., number of citations and publications) do not necessary capture the complexity of the relationships involved in a research project and may exclude measurement of specific aspects of the research pathway [ 10 , 12 ].

Many of the frameworks included in this review advocated the collection of a range of academic, societal, economic, and cultural impact metrics; this is consistent with recent recommendations from the Stern review [ 10 ]. However, a number of these metrics encounter research ‘lag’: i.e., the time between the point at which the research is conducted and when the actual benefits arise [ 69 ]. For instance, some cardiovascular research has taken up to 25 years to generate impact [ 70 ]. Likewise, the impact may not arise exclusively from a single piece of research. Different processes (such as networking interactions and knowledge and research translation) and multiple individuals and organisations are often involved [ 4 , 71 ]. Therefore, attributing the contribution made by each of the different actors involved in the process can be a challenge [ 4 ]. An additional problem associated to attribution is the lack of evidence to link research and impact. The outcomes of research may emerge slowly and be absorbed gradually. Consequently, it is difficult to determine the influence of research in the development of a new policy, practice, or guidelines [ 4 , 23 ].

A further problem is that impact evaluation is conducted ‘ex post’, after the research has concluded. Collecting information retrospectively can be an issue, as the data required might not be available. ‘ex ante’ assessment is vital for funding allocation, as it is necessary to determine the potential forthcoming impact before research is carried out [ 69 ]. Additionally, ex ante evaluation of potential benefit can overcome the issues regarding identifying and capturing evidence, which can be used in the future [ 4 ]. In order to conduct ex ante evaluation of potential benefit, some authors suggest the early involvement of policy makers in a research project coupled with a well-designed strategy of dissemination [ 40 , 69 ].

Providing an alternate view, the authors of methodological frameworks such as the SIAMPI, Contribution Mapping, Research Contribution, and the Exchange model suggest that the problems of attribution are a consequence of assigning the impact of research to a particular impact metric [ 7 , 40 , 42 , 44 ]. To address these issues, these authors propose focusing on the contribution of research through assessing the processes and interactions between stakeholders and researchers, which arguably take into consideration all the processes and actors involved in a research project [ 7 , 40 , 42 , 43 ]. Additionally, contributions highlight the importance of the interactions between stakeholders and researchers from an early stage in the research process, leading to a successful ex ante and ex post evaluation by setting expected impacts and determining how the research outcomes have been utilised, respectively [ 7 , 40 , 42 , 43 ]. However, contribution metrics are generally harder to measure in comparison to academic-orientated indicators [ 72 ].

Currently, there is a debate surrounding the optimal methodological impact framework, and no tool has proven superior to another. The most appropriate methodological framework for a given study will likely depend on stakeholder needs, as each employs different methodologies to assess research impact [ 4 , 37 , 41 ]. This review allows researchers to select individual existing methodological framework components to create a bespoke tool with which to facilitate optimal study design and maximise the potential for impact depending on the characteristic of their study ( Fig 2 and Fig 3 ). For instance, if researchers are interested in assessing how influential their research is on policy making, perhaps considering a suite of the appropriate metrics drawn from multiple methodological frameworks may provide a more comprehensive method than adopting a single methodological framework. In addition, research teams may wish to use a multidimensional approach to methodological framework development, adopting existing narratives and quantitative metrics, as well as elements from contribution frameworks. This approach would arguably present a more comprehensive method of impact assessment; however, further research is warranted to determine its effectiveness [ 4 , 69 , 72 , 73 ].

Finally, it became clear during this review that the included methodological frameworks had been constructed using varied methodological processes. At present, there are no guidelines or consensus around the optimal pathway that should be followed to develop a robust methodological framework. The authors believe this is an area that should be addressed by the research community, to ensure future frameworks are developed using best-practice methodology.

For instance, the Payback Framework drew upon a literature review and was refined through a case study approach. Arguably, this approach could be considered inferior to other methods that involved extensive stakeholder involvement, such as the CIHR framework [ 8 ]. Nonetheless, 7 methodological frameworks were developed based upon the Payback Framework [ 8 , 29 , 31 – 35 ].

Limitations

The present review is the first to summarise systematically existing impact methodological frameworks and metrics. The main limitation is that 50% of the included publications were found through methods other than bibliographic databases searching, indicating poor indexing. Therefore, some relevant articles may not have been included in this review if they failed to indicate the inclusion of a methodological impact framework in their title/abstract. We did, however, make every effort to try to find these potentially hard-to-reach publications, e.g., through forwards/backwards citation searching, hand searching reference lists, and expert communication. Additionally, this review only extracted information regarding the methodology followed to develop each framework from the main publication source or framework webpage. Therefore, further evaluations may not have been included, as they are beyond the scope of the current paper. A further limitation was that although our search strategy did not include language restrictions, we did not specifically search non-English language databases. Thus, we may have failed to identify potentially relevant methodological frameworks that were developed in a non-English language setting.

In conclusion, the measurement of research impact is an essential exercise to help direct the allocation of limited research resources, to maximise benefit, and to help minimise research waste. This review provides a collective summary of existing methodological impact frameworks and metrics, which funders may use to inform the measurement of research impact and researchers may use to inform study design decisions aimed at maximising the short-, medium-, and long-term impact of their research.

Supporting information

S1 appendix. search strategy..

https://doi.org/10.1371/journal.pmed.1002370.s001

S1 PRISMA Checklist. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist.

https://doi.org/10.1371/journal.pmed.1002370.s002

Acknowledgments

We would also like to thank Mrs Susan Bayliss, Information Specialist, University of Birmingham, and Mrs Karen Biddle, Research Secretary, University of Birmingham.

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Health Services and Outcomes Research Methodology

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• Amy M J O'Shea, Mikayla Gibson, James Merchant, Kelby Rewerts, Kelly Miell, Peter J Kaboli, Stephanie L Shimada

A Community-Based Pre-Exposure Prophylaxis Telehealth Program Focused on Latinx Sexual Minority Men

This research describes the development and implementation of a community-based organization pre-exposure prophylaxis (CBO-PrEP) telehealth program to address barriers faced by Latinx sexual minority men. The program established protocols for referrals, insurance coverage, and appointments. The results indicate that CBO-PrEP successfully engaged the target population, with a high percentage undergoing laboratory testing and receiving PrEP prescriptions, showcasing the potential impact of collaborative approaches.

• Elí A Andrade, Gabriela Betancourt, Gustavo Morales, Omar Zapata, Lissette Marrero, Sage Rivera, Eric Nieves, Carolina Miranda, Chanelle Diaz, Robert Beil, Viraj V Patel, Jonathan Ross

Socioeconomic Determinants of Remote Patient Monitoring Implementation Among Rural and Urban Hospitals

This study investigated the relationship between social determinants of health and the adoption of remote patient monitoring (RPM) for chronic disease management. The study found that both rural and urban hospitals near households with lower middle socioeconomic status are less likely to have adopted RPM when compared with their counterparts near households with the highest socioeconomic status. The findings underscore the importance of addressing disparities in access to RPM services.

• Matthew Najarian, Anthony Goudie, Jonathan P Bona, Mandana Rezaeiahari, Sean G Young, Cari A Bogulski, Corey J Hayes

Completion of Recommended Tests and Referrals in Telehealth vs In-Person Visits

This retrospective cohort study conducted at a large urban hospital-based primary care practice and an affiliated community health center aimed to assess the association of diagnostic loop closure (completion of recommended tests and specialty referrals) for telehealth visits compared to in-person visits. The findings revealed that rates of diagnostic loop closure were low across all visit modalities with patients with telehealth visits less likely to close the loop compared to those with in-person visits.

• Anthony Zhong, Maelys J Amat, Timothy S Anderson, Umber Shafiq, Scot B Sternberg, Talya Salant, Leonor Fernandez, Gordon D Schiff, Mark D Aronson, James C Benneyan, Sara J Singer, Russell S Phillips

Association of Remote Patient Monitoring with Mortality and Healthcare Utilization in Hypertensive Patients: a Medicare Claims-Based Study

This study evaluated the association between remote patient monitoring (RPM) use and patient outcomes among Medicare beneficiaries aged 65 years and older with hypertension. RPM use was associated with reduced hazards of mortality and hospitalizations. However, there was an increase in cardiovascular-related outpatient visits, suggesting potential benefits and trade-offs of RPM implementation in managing hypertension in older adults.

• Mahip Acharya, Mir M Ali, Cari A Bogulski, Ambrish A Pandit, Ruchira V Mahashabde, Hari Eswaran, Corey J Hayes

Adapting Connect for Health pediatric weight management program for telehealth in response to the COVID-19 pandemic

This study focused on telehealth experiences for a primary care, pediatric weight management intervention. The results highlight the importance of a combination of in-person and virtual visits to align with patient and provider preferences, with specific considerations for those with limited English proficiency.

• Meg Simione, Kelly Aschbrenner, Haley Farrar-Muir, Man Luo, Jazmin Granadeno, Ariadne Caballero-Gonzalez, Sarah N Price, Carlos Torres, Alexy Arauz Boudreau, Lauren Fiechtner, Simon J Hambidge, Kerry Sease, Elsie M Taveras

Telehealth utilization in gynecologic oncology clinical trials

This study assesses the safety and feasibility of implementing telehealth and remote clinical trial operations in gynecologic oncology during the COVID-19 pandemic. The study found virtual provider visits and off-site laboratory testing increased during the telehealth period. While minor protocol deviations increased, major deviations and adverse events remained of low incidence and did not differ.

• Leslie Andriani, Jinhee Oh, Erin McMinn, Emily Gleason, Nathanael C Koelper, Jesse Chittams, Fiona Simpkins, Emily M Ko
• October 2023

Use of Telemedicine and Quality of Care Among Medicare Enrollees With Serious Mental Illness

This cohort study investigates the impact of telemedicine use during the COVID-19 pandemic on mental health care for Medicare beneficiaries with serious mental illnesses. The study categorizes practices based on telemedicine use and compares changes in care patterns and quality metrics. The findings indicate that practices with higher telemedicine use saw an increase in mental health visits per year compared with prepandemic levels, with no significant changes observed in other quality metrics.

• Andrew D Wilcock, Haiden A Huskamp, Alisa B Busch, Sharon-Lise T Normand, Lori Uscher-Pines, Pushpa V Raja, Jose R Zubizarreta, Michael L Barnett, Ateev Mehrotra

Evaluating the association between expanded coverage of direct-to-consumer telemedicine and downstream utilization and quality of care for urinary tract infections and sinusitis

This study compares direct-to-consumer (DTC) telemedicine and in-person visits for urinary tract infections (UTIs) and sinusitis, analyzing rates of testing, follow-up care, and quality. The study finds that DTC telemedicine coverage is associated with reductions in antibiotics for sinusitis and laboratory tests for UTI, without changes in overall office and outpatient visits or emergency department visits.

• Jiani Yu, Peter J Huckfeldt, Pamela J Mink, Ateev Mehrotra, Jean M Abraham

Persistence of Telemedicine Usage for Breast and Prostate Cancer after the Peak of the COVID-19 Pandemic

This study investigates utilization of telemedicine for breast and prostate cancer patients. The findings underscore specific contexts where providers and patients use telehealth.

• Susan Chimonas, Allison Lipitz-Snyderman, Zoe Spiegelhoff, Nirjhar Chakraborty, Kenneth Seier, Charlie White, Gilad Kuperman

Telemedicine Buprenorphine Initiation and Retention in Opioid Use Disorder Treatment for Medicaid Enrollees

This retrospective cohort study examined the outcomes of telemedicine versus in-person care for initiating transmucosal buprenorphine treatment of opioid use disorder (OUD) during the COVID-19 pandemic. The study found that telemedicine initiation was associated with better 90-day retention in buprenorphine treatment and was not associated with an increased risk of opioid-related nonfatal overdose.

• Lindsey R Hammerslag, PhD Aimee Mack, MPH Redonna K Chandler, PhD Laura C Fanucchi, MD, MPH Daniel J Feaster, PhD Marc R LaRochelle, MD, MPH Michelle R Lofwall, MD Michael Nau, PhD Jennifer Villani, PhD, MPH Sharon L Walsh, PhD Philip M Westgate, PhD Svetla Slavova, PhD Jeffery C Talbert, PhD

Remote Monitoring Compared With In-Office Surveillance of Blood Pressure in Patients With Pregnancy-Related Hypertension: A Randomized Controlled Trial

This study looked at individuals with hypertensive disorders or pregnancy and compared blood pressure ascertainment within 10 days of postpartum discharge using in-office blood pressure assessment versus remote patient monitoring. The study found that those using remote monitoring showed significantly higher rates of blood pressure ascertainment compared to the in-office group. Remote monitoring had no significant differences in readmission rates or initiation of antihypertensive medications post-discharge, suggesting that remote monitoring has the potential to enhance postpartum care.

• Brittany J Arkerson, Matthew M Finneran, Solita R Harris, Jessica Schnorr, Eliza R McElwee, Lauren Demosthenes, Renata Sawyer

Financial performance of rural hospitals persistently lacking or having telehealth technology

This study analyzed the adoption of telehealth by rural hospitals and its impact on their financial performance from 2009 to 2019. Findings suggest that telehealth adoption was influenced by hospital and community characteristics, with factors such as hospital ownership, patient demographics, and insurance status playing significant roles. The study found that rural hospitals adopting telehealth exhibited better financial performance over the 11-year period compared to non-adopters, indicating potential benefits for sustainability and service provision in rural health care settings.

• Saleema A Karim, J Mick Tilford, Cari A Bogulski, Maysam Rabbani, Corey J Hayes, Hari Eswaran
• September 2023

Sociodemographic disparities in the use of cardiovascular ambulatory care and telemedicine during the COVID-19 pandemic

This research study investigated the association of patient and visit characteristics with telehealth modality in cardiology clinics during the COVID-19 pandemic. The study found disparities in video-based telehealth for older patients, Black patients, those with limited English proficiency, and Medicaid recipients. Further research is needed to understand barriers and outcomes related to telehealth among diverse populations.

• Agency for Healthcare Research and Quality; National Institutes of Health
• Esli Osmanlliu, Neil M Kalwani, Vijaya Parameswaran, Lubna Qureshi, Rajesh Dash, David Scheinker, Fatima Rodriguez

Mobile Health Intervention in Patients With Type 2 Diabetes: A Randomized Clinical Trial

The study investigated the impact of clinical pharmacists and health coaches utilizing telehealth on hemoglobin A1c (HbA1c) levels for African American and Latinx patients with type 2 diabetes. The study found that, among participating patients, HbA1c levels improved, suggesting that this telehealth intervention can improve blood glucose levels in the studied populations.

• Ben S Gerber, Alana Biggers, Jessica J Tilton, Daphne E Smith Marsh, Rachel Lane, Dan Mihailescu, JungAe Lee, Lisa K Sharp

Older Veterans' Experiences of a Multicomponent Telehealth Program: Qualitative Program Evaluation Study

This study focuses on addressing the multifaceted needs of older veterans with multiple health conditions through a telehealth program. Qualitative interviews with program participants identified areas for improvement and adaptation.

• Michelle R Rauzi, Meredith L Mealer, Lauren M Abbate, Jennifer E Stevens-Lapsley, Kathryn A Nearing

Researcher Experience and Comfort With Telemedicine and Remote Patient Monitoring in Cancer Treatment Trials

This research focused on the integration of telemedicine and remote patient monitoring (RPM) in oncology practices since the onset of COVID-19, particularly in treatment trials. A survey was conducted to assess experience and comfort levels with telemedicine and RPM. The findings suggest that while telemedicine and RPM has been increasingly used in cancer treatment trials, there is a higher level of researcher comfort compared to real-world experience.

• Morgan R L Lichtenstein, Laura A Levit, Caroline Schenkel, Kelsey Kirkwood, Lola A Fashoyin-Aje, Suanna S Bruinooge, Michael J Kelley, Josh A Mailman, Allison Magnuson, Daniel P Mirda, Divya Natesan, Dawn L Hershman

Telemedicine Critical Care-Mediated Mortality Reductions in Lower-Performing Patient Diagnosis Groups: A Prospective, Before and After Study

This study evaluated the impact of implementing telemedicine critical care on risk-adjusted mortality in adult intensive care units at academic medical centers. The study found that, overall, there was a slight decrease in risk-adjusted mortality after telemedicine critical care implementation, although not statistically significant. However, a subgroup of patients with a history of lower performance in ICU care experienced a significant reduction in standardized mortality ratio and risk-adjusted mortality, while the higher-performing patient group showed no significant changes.

• Walter A Boyle, Christopher M Palmer, Lisa Konzen, Bradley A Fritz, Jason White, Michelle Simkins, Brian Dieffenderfer, Ayesha Iqbal, Jill Bertrand, Shelley Meyer, Paul Kerby, Sara Buckman, Vladimir Despotovic, Jim Kozlowski, Patricia Crimmins Reda, Igor Zwir, C Charles Gu, Uchenna R Ofoma

Telemedicine Visits in US Skilled Nursing Facilities

This cohort study investigated the telehealth use in skilled nursing facilities (SNFs) during the COVID-19 pandemic. The study revealed that telehealth adoption in SNFs significantly increased in early 2020 and gradually stabilized at a higher rate than before the pandemic. Importantly, higher telemedicine use in SNFs was linked to improved access to psychiatry visits.

• Agne Ulyte, Ateev Mehrotra, Andrew D Wilcock, Gillian K SteelFisher, David C Grabowski, Michael L Barnett
• August 2023

Telehealth and In-Person Mental Health Service Utilization and Spending, 2019 to 2022

This study examines trends in mental health service utilization and spending before and during the COVID-19 pandemic. During the acute phase of the pandemic, in-person visits decreased and telehealth visits increased. In the post-acute phase, telehealth visits stabilized and in-person visits increased, resulting in overall mental health service utilization being higher than before the pandemic by August 2022.

• Jonathan H Cantor, Ryan K McBain, Pen-Che Ho, Dena M Bravata, Christopher Whaley

Telehealth use and perceptions among prostate cancer survivors

This study investigated telehealth disparities among prostate cancer survivors. One-third of survivors had used telehealth, with 10% considering it comparable to in-person visits. Those with lower education were less likely to use telehealth and less likely to feel inclined to use it, highlighting the importance of addressing these disparities.

• Luke W Chen, Deborah S Usinger, Aaron J Katz

Comparing the Discussion of Telehealth in Two Social Media Platforms: Social Listening Analysis

This study compared telehealth-related discussions on social media before and during the COVID-19 pandemic. Both of the platforms reviewed exhibited a surge in discussions related to telehealth during the pandemic, with one focusing more on news and services and one involving more user discussions and inquiries about using telehealth for therapy or counseling. The findings highlight the evolving discourse on telehealth in social media and suggest platform-specific differences in how telehealth is perceived and discussed by users.

• Catherine C Shoults, Leah Dawson, Corey Hayes, Hari Eswaran

Telemedicine in Primary Care: Lessons Learned About Implementing Health Care Innovations During the COVID-19 Pandemic

This research study examines the experiences of primary care clinicians with telemedicine during the first two years of the COVID-19 pandemic. Respondents noted initial telehealth implementation challenges due to infrastructure and reimbursement issues. Over time, clinicians' attitudes toward telemedicine improved, with many considering it an important tool alongside in-person care.

• Rebecca S Etz, Craig A Solid, Martha M Gonzalez, Erin Britton, Kurt C Stange, Sarah R Reves

Why U.S. Patients Declined Hospital-at-Home during the COVID-19 Public Health Emergency: An Exploratory Mixed Methods Study

This study aimed to understand patient refusals of hospital-at-home during the COVID-19 Public Health Emergency. The study highlights the need to improve education about hospital-at-home and to address domestic barriers and diagnostic challenges.

• Nels Paulson, Margaret P Paulson, Michael J Maniaci, Rachel A Rutledge, Shealeigh Inselman, Stephanie J Zawada

Use of Medication for Opioid Use Disorder Among Adults With Past-Year Opioid Use Disorder in the US, 2021

This study examines the prevalence of medication for opioid use disorder (MOUD) receipt among US adults with past-year opioid use disorder (OUD). The study found that despite guidelines recommending MOUD, around 1 in 5 adults with past-year OUD received any form of MOUD. Disparities were identified, particularly among Black adults, women, the unemployed, and those in nonmetropolitan areas, who were less likely to receive MOUD. Those who used telehealth for substance use treatment were more likely to have received MOUD.

• National Institutes of Health; Centers for Disease Control and Prevention
• Christopher M Jones, Beth Han, Grant T Baldwin, Emily B Einstein, Wilson M Compton

Towards a conceptual framework for addressing state-level barriers to decentralized clinical trials in the U.S.

This article proposes a framework to identify barriers to decentralized clinical trials, including those related to policies and regulations governing virtual care.

• Stephanie J Zawada, Kevin C Ruff, Tara Sklar, Bart M Demaerschalk
• Telehealth policy

Telehealth Lifestyle Redesign Occupational Therapy for Diabetes: Preliminary Effectiveness, Satisfaction, and Engagement

This research evaluates telehealth delivery in an occupational therapy intervention for young adults with diabetes. Preliminary results suggest that telehealth clients experienced significant improvements in occupational performance, satisfaction, and health management, with high levels of satisfaction.

• Seth Mitchell, John Sideris, Jeanine Blanchard, Gabrielle Granados, Jesús Díaz, Elizabeth Pyatak

State Medicaid Telehealth Coverage Policy Decisions Since the COVID-19 Public Health Emergency

This report analyzes state Medicaid telehealth policy changes during the COVID-19 pandemic through May 2022. The study reviews both temporary and permanent state Medicaid telehealth policies to provide insight into the evolving landscape of telehealth regulation.

• Office of the Assistant Secretary for Planning and Evaluation
• Peggy G Chen, Sara E Heins, Stephanie Dellva

Changes in Telehealth Experienced by Advanced Practice RNs During COVID-19

This research study investigates advanced practice RNs' experiences with telehealth before and during the COVID-19 pandemic. A survey found that while a majority of respondents did not use telehealth before the pandemic, half of them began using it daily during the pandemic. The study highlights the challenges and benefits of telehealth adoption and suggests that telehealth is likely to remain an integral part of health care, emphasizing the need for recommendations for advanced practice RN.

• Mavis N Schorn, Carole R Myers, Julie Barroso, Karen Hande, Tamika Hudson, Jennifer Kim, and Ruth Kleinpell
• Workforce development

Factors Associated with Remote Patient Monitoring Services Provision by Hospitals and Health Care Systems in the United States

This research study investigates factors influencing the provision of remote patient monitoring (RPM), finding that 40% of hospitals reviewed offered RPM. Positive associations were observed with hospital participation in clinically integrated networks and private, non-profit ownership, while negative associations were noted with critical access hospital designation, for-profit ownership, and location in the South.

• Ambrish A Pandit, Hari Eswaran, Cari A Bogulski, Maysam Rabbani, Mary 'Katy' Allison, Leah Dawson, Corey J Hayes

Variations in Physician Telemedicine Provision

This research study examines the variation in telemedicine adoption among primary care physicians. While overall telemedicine use declined over time, about 32.5% of physicians continued to provide relatively high rates of telemedicine services. Physician preferences had an impact on telemedicine adoption, with individual physicians explaining 7.7% of the variation in telemedicine use, highlighting the role of physician behavior in patient access to telehealth services.

• Nate C Apathy, Ram A Dixit, Christian L Boxley, Katharine T Adams, Ethan Booker, Raj M Ratwani

Assessment Fidelity of Parents Implementing a Standardized Telehealth Infant Autism Screener

The research demonstrates that telehealth is effective for pediatric occupational therapy and that remote parent coaching provides benefits for parents and infants. The study evaluated telehealth-delivered observational autism screening tool for infants, with parents achieving an 82% adherence rate to the fidelity checklist. This study suggests that a parent coaching telehealth approach may be valid for pediatric telehealth assessments.

• Allison Q Phillips, Emily Campi, Meagan R Talbott, Grace T Baranek

Federal telehealth policy changes during the COVID-19 public health emergency: Associations with telemental health use among rural and urban Medicare beneficiaries

Medicare beneficiaries faced increased mental health concerns with limited access to mental health services during the COVID-19 pandemic. This study compared rural and urban Medicare fee-for-service beneficiary use of telemental health from 2019 to 2020. The analysis found a significant rise in telemental health use for both groups, with urban residents benefiting disproportionately. Among rural beneficiaries, older age was linked to lower telemental health use, indicating a need to address barriers.

• Health Resources and Services Administration's Telehealth Research Center; Health Resources and Services Administration
• Jean A Talbot PhD,MPH, Amanda R Burgess MPH,MPPM, Yvonne C Jonk PhD, Heidi O'Connor MS

Rural-Urban Disparities in Video Telehealth Use During Rapid Mental Health Care Virtualization Among American Indian/Alaska Native Veterans

This research focuses on the differences in utilization of video telehealth for mental health care among American Indian/Alaska Native veterans and non-American Indian/Alaska Native veterans. The study reveals increased telehealth use across all veteran groups but noted a significant difference in telehealth use among rural and urban populations, especially among American Indian/Alaska Native veterans.

• Isabelle S Kusters, Amber B Amspoker, Kristen Frosio, Stephanie C Day, Giselle Day, Anthony Ecker, Julianna Hogan, Jan A Lindsay, Jay Shore

Telehealth Utilization Among Occupational Therapists in Oncology: Results From a National Survey

This study aimed to explore the prevalence and perceptions of telehealth services among occupational therapy practitioners (OTPs) in oncology. The findings indicate that despite limited access prior to the COVID-19 pandemic, a majority of OTPs in oncology settings support telehealth use, with the highest endorsement relating to accessibility. Telehealth-delivered occupational therapy treatments in oncology were considered well-suited for areas such as education, quality of life, and psychosocial interventions.

• Alix G Sleight, Caroline M Klein, Alexandra E Feldman, Leah I Stein Duker

Prevalence and appropriateness of in-person versus not-in-person ambulatory antibiotic prescribing in an integrated academic health system: A cohort study

This study examines ambulatory antibiotic prescribing in an integrated health delivery system from 2016 to 2019. The study reveals the need for ambulatory stewardship interventions focused on all antibiotic prescribing.

• Tiffany Brown, Ji Young Lee, Adriana Guzman, Michael A Fischer, Mark W Friedberg, Kao-Ping Chua, Jeffrey A Linder

Changes in Telehealth Experienced by Advanced Practice RNs During COVID-19: US Survey Results

The article examines the impact of the COVID-19 pandemic on advanced practice registered nurses (APRNs) and their use of telehealth. While a majority of APRNs did not utilize telehealth before the pandemic, its use significantly increased during the pandemic, with half of the respondents incorporating telehealth into their daily practice. The findings highlight both the barriers faced, such as limited access to technology for certain populations, and the benefits observed, including improved patient access to care. The study emphasizes the need for enhanced APRN education, policy, and practice to ensure expanded health care access.

• Mavis N Schorn, Carole R Myers, Julie Barroso, Karen Hande, Tamika Hudson, Jennifer Kim, Ruth Kleinpell

Telehealth Services for Primary Care and Urgent Care to Support Rural Schools and Students

This study looked at students receiving primary care or urgent care services from school-based telehealth programs. Of the students seeking primary care telehealth services, 67.7% did not have a primary care provider outside of the school. The availability of both primary care and urgent care telehealth services in the school allowed most students to return to the classroom without the need for further follow-up.

• Marcia M Ward, Kimberly A S Merchant, Fred Ullrich, Divya Bhagianadh, Knute D Carter, Kristin Smith, Theresa L Gillette, Sheila Freed, Luke J Mack
• School-based health

Updated Medicare FFS Telehealth Trends by Beneficiary Characteristics, Visit Specialty, and State, 2019-2021

This research examines Medicare fee-for-service (FFS) use of telehealth from 2019 to 2021 by beneficiary characteristic, visit specialty, and geography. This report found telehealth use among Medicare FFS beneficiaries in 2021 continued to be far above pre-pandemic levels, but lower than at the peak of 2020. Telehealth use in 2021 remained highest for behavioral health compared to non-behavioral health among Medicare FFS beneficiaries. The analysis found audio-only eligible telehealth comprised about one quarter of Medicare FFS telehealth in both 2020 and 2021. This report notes a wide variation across states in use of telehealth for Medicare FFS beneficiaries.

• Lok Wong Samson, Sara J Couture, Tim B Creedon, Laura Jacobus-Kantor, Steven Sheingold

Expansion of Telehealth Availability for Mental Health Care After State-Level Policy Changes From 2019 to 2022

This study aimed to investigate the associations between state policies and the availability of telehealth services at outpatient mental health treatment facilities. The state policies studied, payment parity, reimbursement for audio-only, participation in the Interstate Medical Licensure Compact, and participation in the Psychology Interjurisdictional Compact, were associated with expansion of telehealth availability for mental health care at mental health treatment facilities.

• Ryan K McBain, Megan S Schuler, Nabeel Qureshi, Samantha Matthews, Aaron Kofner, Joshua Breslau, Jonathan H Cantor

Postpartum Care up to 1 Year After Pregnancy: A Systematic Review and Meta-analysis

This systematic review evaluates postpartum care within the first year after pregnancy, focusing on alternative health care delivery strategies and extension of health insurance coverage. Findings suggest that certain factors, such as where health care was provided (by telephone or in clinic), may not impact depression or anxiety symptoms. More research is needed to improve postpartum care, especially for individuals at higher risk of complications.

• Ian J Saldanha, Gaelen P Adam, Ghid Kanaan, Michael L Zahradnik, Dale W Steele, Valery A Danilack, Alex Friedman Peahl, Kenneth K Chen, Alison M Stuebe, Ethan M Balk

The use of telehealth-supported stewardship activities in acute-care and long-term care settings: An implementation effectiveness trial

This study assessed the implementation of telehealth-supported stewardship activities in Veterans' Administration medical centers acute-care and long-term care units. The program resulted in reductions in antibiotic use in long-term care units but not in smaller acute-care units.

• Daniel J Livorsi, Stacey Hockett Sherlock, Cassie Cunningham Goedken, Sandra Pratt, David A Goodman, Kim C Clarke, Hyunkeun Cho, Heather Schacht Reisinger, Eli N Perencevich

Telepsychiatry Use Before and During the COVID-19 Pandemic Among Children Enrolled in Medicaid

This study investigated the utilization of telepsychiatry among children enrolled in Medicaid before and during the COVID-19 pandemic. Findings revealed a significant increase in telehealth usage, while overall mental health service utilization declined.

• Mir M Ali, Kristina D West, Erin Bagalman, Tisamarie B Sherry

Management of Postpartum Hypertensive Disorders of Pregnancy

This research study examines management strategies for postpartum hypertensive disorders of pregnancy, emphasizing home blood pressure (BP) monitoring, pharmacological treatment, and magnesium sulfate regimens. Results show that home blood pressure monitoring likely improves BP measurement adherence and decreases disparities between non-Black and Black patients in adherence to recommended BP surveillance.

• Dale W Steele, Gaelen P Adam, Ian J Saldanha, Ghid Kanaan, Michael L Zahradnik, Valery A Danilack-Fekete, Alison M Stuebe, Alex F Peahl, Kenneth K Chen, Ethan M Balk

Primary Care Telemedicine Use among Assisted Living Residents with Dementia during COVID-19: Race and Dual Enrollment Status

Telehealth services expanded to help primary care providers connect to assisted living facility residents with dementia during the COVID-19 pandemic. This study found that while Black and Hispanic assisted living facility residents and those in assisted living facilities with a higher proportion of duals were less likely to use telehealth early in the pandemic these racial and ethnic or socioeconomic differences did not persist.

• National Institutes of Health; Agency for Healthcare Research and Quality
• Yechu Hua, MA, Helena Temkin-Greener, PhD, Shubing Cai, PhD

Postdischarge Noninvasive Telemonitoring and Nurse Telephone Coaching Improve Outcomes in Heart Failure Patients With High Burden of Comorbidity

The purpose of this research is to investigate the effectiveness of noninvasive telemonitoring and nurse telephone coaching as a post-discharge strategy for heart failure patients, with a focus on how comorbidity burden influences its impact. The study reveals that noninvasive telemonitoring and nurse telephone coaching improved survival among heart failure patients with a high comorbidity burden.

• Asher Kimchi, Harriet U Aronow, Yu-Ming Ni, Michael K Ong, James Mirocha, Jeanne T Black, Andrew D Auerbach, Theodore G Ganiats, Sheldon Greenfield, Patrick S Romano, Ilan Kedan; BEAT-HF Research Group

Telehealth Use to Address Cardiovascular Disease and Hypertension in the United States: A Systematic Review and Meta-Analysis, 2011-2021

This review explored the utilization of telehealth for hypertension and cardiovascular disease management, with a specific emphasis on social determinants of health and health disparities. The findings suggest that telehealth is comparable to in-person care for blood pressure and cardiovascular disease management.

• Centers for Disease Control and Prevention
• Tiara N Jackson, Meera Sreedhara, Myles Bostic, Michelle Spafford, Shena Popat, Kincaid Lowe Beasley, Julia Jordan, Roy Ahn

Digital health and telehealth in cancer care: a scoping review of reviews

This research conducted a scoping review of reviews on digital health and telehealth interventions in cancer care. The results showed that while many reviews summarized interventions for cancer patients, there were notable gaps in addressing older adults, bereavement, and sustainability, as well as limited comparisons between telehealth and in-person care.

• Kelly M Shaffer, Kea L Turner, Chelsea Siwik, Brian D Gonzalez, Rujula Upasani, Jillian V Glazer, Robert J Ferguson, Catherine Joshua, Carissa A Low

Effect of Chronic Disease Home Telehealth Monitoring in the Veterans Health Administration on Healthcare Utilization and Mortality

This study investigates the impact of home telehealth monitoring on hospitalizations, emergency department (ED) visits, and mortality in veterans aged 65 and older with congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), or diabetes mellitus (DM). The results show that the initiation of home telehealth monitoring was associated with increased ED visits but no change in hospitalizations. Those with CHF or DM had lower all-cause mortality while those with COPD had higher health care utilization and all-cause mortality.

• Nicholas M Mohr, J Priyanka Vakkalanka, Andrea Holcombe, Knute D Carter, Kimberly D McCoy, Heidi M Clark, Jeydith Gutierrez, Kimberly A S Merchant, George J Bailey, Marcia M Ward

Care coordination between rural primary care and telemedicine to expand medication treatment for opioid use disorder: Results from a single-arm, multisite feasibility study

This study focuses on the feasibility of implementing a care coordination model involving telemedicine for medication treatment of opioid use disorder (MOUD) in rural settings. The intervention involved establishing referral and coordination between rural clinics and a telemedicine provider. Results indicated that implementing the care coordination model led to an increase in patient-days on MOUD, particularly in clinics with limited MOUD capacity. This suggests that the model is most effective in expanding access to MOUD in rural areas where resources for MOUD are limited.

• Yih-Ing Hser PhD, Larissa J Mooney MD, Laura-Mae Baldwin MD, MPH, Allison Ober MSW, PhD, Lisa A Marsch PhD, Seth Sherman PhD, Abigail Matthews PhD, Sarah Clingan PhD, Zhe Fei PhD, Yuhui Zhu PhD, Alex Dopp PhD, Megan E Curtis PhD, Katie P Osterhage MMS, Emily G Hichborn BS, Chunqing Lin PhD, Megan Black MPH, Stacy Calhoun PhD, Caleb C Holtzer MD, MPH, Noah Nesin MD, Denise Bouchard DNP-C, Maja Ledgerwood DSW, LCSW, Margaret A. Gehring FNP, DNP, Yanping Liu MD, PhD, Neul Ah Ha BS, Sean M Murphy PhD, Maria Hanano BA, Andrew J Saxon MD

Telehealth Use, Care Continuity, and Quality: Diabetes and Hypertension Care in Community Health Centers Before and During the COVID-19 Pandemic

This research study explores the relationship between care continuity and the quality of diabetes and hypertension care in community health centers (CHCs) both before and during the COVID-19 pandemic, with a focus on the mediating effect of telehealth. The study found that higher care continuity is associated with telehealth use and A1c testing.

• Aaron A Tierney, Denise D Payán, Timothy T Brown, Adrian Aguilera, Stephen M Shortell, Hector P Rodriguez

Updated National Survey Trends in Telehealth Utilization and Modality (2021-2022)

This report includes trends in national telehealth utilization from 2021 to 2022. Results show that while overall telehealth use remains steady, disparities in video telehealth use exist among different populations and insurance types.

• Euny C Lee, Violanda Grigorescu, Idia Enogieru, Scott R Smith, Lok Wong Samson, Ann B Conmy, and Nancy De Lew

Telemental health in emergency care settings: A qualitative analysis of considerations for sustainability and spread

The study examines the barriers and facilitators for the sustainability and expansion of a model of telehealth care, telemental health video. The findings showed overall satisfaction, with increased comfort for patients in discussing difficult topics, and benefits for clinicians in terms of cross-coverage and safety. Adequate infrastructure and workforce capacity are crucial to ensure successful uptake of this model.

• McKenzie K Roddy, Patricia Chen, Alvin D Jeffery, Jeydith Gutierrez, Melissa Rubenstein, Corey Campbell, Eric Blake, Michael J Ward

Telehealth for management of chronic non-cancer pain and opioid use disorder in safety net primary care

This study qualitatively assesses the benefits and challenges of telehealth for managing chronic non-cancer pain, opioid use disorder, and multi-morbidity in urban safety net primary care patients. Factors such as patient burden, communication and technology challenges, pain control, opioid misuse, and medical complexity should be considered when making decisions about continuing or expanding telehealth services.

• Alexis Cooke, Stacy Castellanos, Celeste Enriquez, Pamela Olsen, Christine Miaskowski, Margot Kushel, Kelly Ray Knight

Trends in Telehealth Visits During Pregnancy, 2018 to 2021

This study analyzed trends in prenatal telehealth visits during pregnancy and identified patient characteristics associated with the number of prenatal telehealth visits. The findings showed prenatal telehealth utilization increased significantly during the COVID-19 pandemic.

• Mahip Acharya, Mir M Ali, Corey J Hayes, Cari A Bogulski, Everett F Magann, Hari Eswaran

Association between broadband capacity and telehealth utilization among Medicare Fee-for-service beneficiaries during the COVID-19 pandemic

This study used county-level data to assess the association between broadband access and telehealth utilization in the United States during the COVID-19 pandemic. The findings show decreased telehealth utilization in rural areas and indicates the importance of broadband access for health care access.

• Ambrish A Pandit, Ruchira V Mahashabde, Clare C Brown, Mahip Acharya, Catherine C Shoults, Hari Eswaran, Corey J Hayes

Comparison of Telehealth and In-person Behavioral Health Services and Payment in a Large Rural Multisite Usual Care Study

This study compared behavioral health services for in-person and telehealth cohorts and examined relative value units (RVU) and payment. Behavioral health services provided by telehealth used services with lower RVUs than behavioral health services provided in-person, on average, even after adjusting for patient demographics and diagnosis.

• Marcia M Ward, Knute D Carter, Divya Bhagianadh, Fred Ullrich, Kimberly A S Merchant, James P Marcin, Kari Beth Law, Carly McCord, Jonathan Neufeld, Eve-Lynn Nelson, Dan M Shane

Remote Cardiovascular Hypertension Program Enhanced Blood Pressure Control During the COVID-19 Pandemic

The study assessed the impact of the COVID-19 pandemic on a remote hypertension management program. The study found that the remote clinical management program delivered significant improvements in blood pressure control and increased home blood pressure monitoring despite disruptions in traditional care.

• Simin Gharib Lee, Alexander J Blood, Christopher P Cannon, William J Gordon, Hunter Nichols, David Zelle, Benjamin M Scirica, Naomi D L Fisher

Telehealth and In-Person Behavioral Health Services in Rural Communities Before and During the COVID-19 Pandemic: Multisite Prospective Cohort Study

This research study examines the changes in patient and treatment characteristics in telehealth and in-person behavioral health services. The study found health care providers adjusted both telehealth and in-person service delivery during the COVID-19 pandemic.

• Marcia M Ward, Fred Ullrich, Divya Bhagianadh, Eve-Lynn Nelson, James P Marcin, Knute D Carter, Kari Beth Law, Carly McCord, Jonathan Neufeld, Kimberly A S Merchant

Whole Health coaching to rural Veterans through telehealth: Advantages, gaps, and opportunities

This study examines how Whole Health coaches adapted to using telehealth to engage rural Veterans during the COVID-19 pandemic, identifying advantages and gaps. Findings emphasize the need for a blended approach that integrates virtual, in-person, and lower-tech options.

• Kelsea LeBeau, Deepthi S Varma, Consuelo M Kreider, Gail Castañeda, Cheri Knecht, Diane Cowper Ripley, Huanguang Jia, and J Hale-Gallardo

Utilization of Remote Patient Monitoring Within the United States Health Care System: A Scoping Review

This scoping review examines remote patient monitoring (RPM) studies and reimbursement policies in the United States. Findings show a significant increase in RPM-related literature from 2015 to 2021, with cardiovascular diseases among the most studied. Future research on RPM should focus on outcomes and trends in reimbursement policies.

• Corey J Hayes, Leah Dawson, Hannah McCoy, Michelle Hernandez, Jennifer Andersen, Mir M Ali, Cari A Bogulski, Hari Eswaran

Implementation of a women's reproductive behavioral health telemedicine program: a qualitative study of barriers and facilitators in obstetric and pediatric clinics

This study focuses on the implementation of a telemedicine program for perinatal mood and anxiety disorders and substance use disorders in community obstetric and pediatric clinics. Barriers to implementation included practical challenges such as staffing, space, and technology support, while facilitators included the high demand for mental health and substance use disorder services and the commitment of clinics to address these health concerns. The study highlights the importance of addressing resource and technology needs, while leveraging clinics' commitment to women's health, to ensure successful implementation of telemedicine programs.

• Katherine R Sterba, Emily E Johnson, Edie Douglas, Rubin Aujla, Lisa Boyars, Ryan Kruis, Rebecca Verdin, Rachel Grater, Kathryn King, Dee Ford, Constance Guille

Association of Receipt of Opioid Use Disorder-Related Telehealth Services and Medications for Opioid Use Disorder With Fatal Drug Overdoses Among Medicare Beneficiaries Before and During the COVID-19 Pandemic

This study examined the association between receipt of telehealth services and medications for opioid use disorder (OUD) and fatal drug overdoses before and during the COVID-19 pandemic among Medicare beneficiaries. The study found that the receipt of OUD-related telehealth services, receipt of medications for OUD from opioid treatment programs, and receipt of buprenorphine in office-base settings were all associated with reduced risk for fatal drug overdose.

• Centers for Disease Control and Prevention; National Institutes of Health; Centers for Medicare & Medicaid Services
• Christopher M Jones, Carla Shoff, Carlos Blanco, Jan L Losby, Shari M Ling, Wilson M Compton

Patient Characteristics Associated With Being Offered or Choosing Telephone vs Video Virtual Visits Among Medicare Beneficiaries

This goal of this study was to understand the characteristics of Medicare beneficiaries who received telephone-only telehealth visits when both telephone and video options were available. Results show Medicare beneficiaries often reported being offered or choosing telephone-only visits even when video visits were available.

• Ishani Ganguli, E John Orav, Ruth Hailu, Joyce Lii, Meredith B Rosenthal, Christine S Ritchie, Ateev Mehrotra

Use of Telemedicine among Office-Based Physicians, 2021

Telemedicine adoption gradually rose prior to the COVID-19 pandemic, but the field saw a significant increase during the pandemic as a way for physicians to provide health services while limiting patient exposure to the virus. The widespread use of telemedicine could impact the quality, cost, and accessibility of health care, so it's important to understand its usage. This data brief documents rates of telemedicine use by office-based physicians, the types of tools used, physician characteristics, satisfaction levels, and plans to continue using telemedicine beyond the pandemic.

• Yuriy Pylypchuk, Wesley Barker 

Parent-Reported Use of Pediatric Primary Care Telemedicine: Survey Study

The COVID-19 pandemic resulted in the widespread availability of telemedicine services for children from primary care practices. This study is specifically focused on children who typically receive medical services in person while identifying factors that are linked to the usage of telemedicine services provided by primary care providers. Research outcomes reveal that promoting access to primary care, ensuring payment for primary care telemedicine, and removing obstacles in non-metropolitan areas can all contribute to the equitable use of primary telemedicine care for children.

• Kristin N Ray, Samuel R Wittman, Sarah Burns, Tran T Doan, Kelsey A Schweiberger, Jonathan G Yabes, Janel Hanmer, Tamar Krishnamurti
• February 2023

Racial and Ethnic Disparity in 4Ms among Older Adults Among Telehealth Users as Primary Care

This study investigates the quality of primary care delivered via telehealth in relation to equity among older adults across race and ethnicity in provider-shortage urban areas. The study examines the documentation of 4M (what matters, mobility, medication, and mentation) and self-reported racial and ethnic backgrounds in Southern Nevada. The findings indicate disparities, such as reduced documentation for what matters among Asian/Hawaiian/Pacific Islanders and mobility among Black individuals.

• Ji Won Yoo, Hee-Taik Kang, Ian Choe, Laurie Kim, Dong-Hun Han, Jay J Shen, Yonsu Kim, Peter S Reed, Iulia Ioanitoaia-Chaudhry, Maria Teresa Chong, Mingon Kang, Jerry Reeves, Maryam Tabrizi
• January 2023

Inequitable access to general and behavioral healthcare in the US during the COVID-19 pandemic: A role for telehealth?

The COVID-19 pandemic had extensive consequences, including increased psychological distress and alcohol consumption, which created heightened challenges particularly for disadvantaged communities. To mitigate the impact of lockdowns, medical office closures, and fear of transmission, telehealth services were expanded early in the pandemic to provide continued access to health care. This study investigates the accessibility of general and behavioral health care services and disparities during the first year of the pandemic.

• Nina Mulia, Yu Ye, Thomas K Greenfield, Priscilla Martinez, Deidre Patterson, William C Kerr, Katherine J Karriker-Jaffe

Telemedicine along the cascade of care for substance use disorders during the COVID-19 pandemic in the United States

The way healthcare services are provided has transformed because of the COVID-19 pandemic, which created an opportunity to advance telemedicine by formalizing clinical guidance. In this study, researchers aim to outline the delivery of substance use disorder (SUD) treatments and services through telemedicine along the continuum of care in the United States since the onset of the COVID-19 pandemic. This review summarizes telemedicine-based delivery, including screening/assessment, prescription, monitoring, recovery support and other related services.

• National Institutes of Health; United States Department of Veterans Affairs
• Chunqing Lin, Huyen Pham, Yuhui Zhu, Sarah E Clingan, Lewei Allison Lin, Sean M Murphy, Cynthia I Campbell, Tanya R Sorrell, Yanping Liu, Larissa J Mooney, Yih-Ing Hser

Telemedicine Use and Quality of Opioid Use Disorder Treatment in the US During the COVID-19 Pandemic

There is limited understanding and knowledge about the potential consequences of the rapid shift to telehealth for opioid use disorder (OUD) treatment during the COVID-19 pandemic. The purpose of this study is to investigate the correlation between telemedicine utilization during the COVID-19 pandemic and indicators of OUD treatment quality. The results of this study indicate that patients who were treated by clinicians with both high and low levels of telemedicine usage had comparable clinical outcomes during the COVID-19 pandemic, which suggests that telemedicine is a viable substitute for in-person OUD care.

• Ruth Hailu, Ateev Mehrotra, Haiden A Huskamp, Alisa B Busch, Michael L Barnett

Use of Telehealth During the COVID-19 Era

This study focuses on the use of telehealth during the peak of the COVID-19 pandemic, highlighting the clinical outcomes and characteristics of patients who utilized digital health services. Patients utilizing telehealth and telemedicine services are more likely to be young to middle-aged, female, White, of higher socioeconomic status, and living in urban settings.

• Elham Hatef, Renee F Wilson, Susan M Hannum, Allen Zhang, Hadi Kharrazi, Jonathan P Weiner, Stacey A Davis, Karen A Robinson

Federally Qualified Health Centers Use of Telehealth to Deliver Integrated Behavioral Health Care During COVID-19

During the COVID-19 pandemic, Federally Qualified Health Centers (FQHCs) providing integrated behavioral health (IBH) services shifted to deliver care via telehealth. FQHC administrators reported that telehealth was essential and addressed workforce issues but noted concerns around payment parity and reimbursement and the impact on core components of IBH.

• Brianna M Lombardi, Lisa de Saxe Zerden, Catherine Greeno
• December 2022

A mixed-methods analysis of telehealth implementation in nursing homes amidst the COVID-19 pandemic

Nursing homes implemented telehealth services to adapt to the COVID-19 pandemic. This study found an increase in telehealth adoption. Training, integrated equipment, and staff presence during visits was identified as telehealth facilitators. Barriers included smartphone usage, billing issues, interoperability, and staffing challenges.

• Kimberly R Powell, Amy E Winkler, Jianfang Liu, Gregory L Alexander

Comparison of in-person vs. telebehavioral health outcomes from rural populations across America

The goal of this research is to examine the outcomes in patient symptoms of anxiety and depression. Results show no clinical or statistical difference in depression or anxiety symptoms between patients treated via telehealth and in-person.

• Carly McCord, Fred Ullrich, Kimberly A S Merchant, Divya Bhagianadh, Knute D Carter, EveLynn Nelson, James P Marcin, Kari Beth Law, Jonathan Neufeld, Annaleis Giovanetti, Marcia M Ward

Evaluation of Telehealth Visit Attendance After Implementation of a Patient Navigator Program

With the expansion and increase of telehealth during the COVID-19 pandemic, clinicians and patients faced the challenge of acclimating to virtual care through video visits. The study investigates the visit attendance for patients, comparing outcomes of those who received navigator outreach to those who did not. The results show visit attendance improvement for video visits after telehealth navigator outreach.

• Oren J Mechanic, Emma M Lee, Heidi M Sheehan, Tenzin Dechen, Ashley L O'Donoghue, Timothy S Anderson, Catherine Annas, Leanne B Harvey, Allison A Perkins, Michael A Severo, Jennifer P Stevens, Alexa B Kimball

Telehealth-guided provider-to-provider communication to improve rural health: A systematic review

Rural health care is an ongoing research focal point as remote care, remote patient monitoring, and telehealth services continue to expand nationwide. This study assesses health care disparities, benefits, and the utilization of telehealth-supported provider-to-provider communication in rural populations through a systemic review of observational studies. Researchers assessed trials and observational studies from several medical databases to determine barriers for rural provider-to-provider collaboration, evidence gaps, and the key takeaways from their findings.

• Annette M Totten, Dana M Womack, Jessica C Griffin, Marian S McDonagh, Cynthia Davis-O'Reilly, Ian Blazina, Sara Grusing, Nancy Elder

State Medicaid Telehealth Policies Before and During the COVID-19 Public Health Emergency: 2022 Update

This research highlights that state Medicaid programs have significant discretion in services delivered via telehealth. During the COVID-19 pandemic, all states and the District of Columbia utilized telehealth flexibilities provided by the Centers for Medicare & Medicaid Services. Some states made telehealth flexibilities permanent, while others let them expire. Additional research is needed to assess the impact of increased telehealth utilization in Medicaid on access to care, utilization rates, and quality of care.

• Jacquelyn Rudich, Ann B Conmy, Rose C Chu, Christie Peters, Nancy De Lew, Benjamin D Sommers
• November 2022

Racial/Ethnic Differences in Children’s Mental Health Services Use Before and During the COVID-19 Pandemic Issue Brief

This research brief provides a comprehensive analysis of the disparities in children's mental health services utilization across racial and ethnic groups. The report finds an increase in telehealth for mental health care during the COVID-19 pandemic. This increase was not large enough to combat the overall decrease in mental health care, which disproportionately affected minority children.

• Mir M Ali, Kristina D West, Timothy B Creedon

Digital Health Technologies in Pediatric Trials

This research study explores the potential of using miniaturized sensors and other technologies to collect physiological and functional data directly from pediatric patients participating in clinical trials. The review discusses the advantages and disadvantages of these technologies in various pediatric diseases, highlighting the need for more reports on their use in this population. While the objective and frequent measurements provided by digital health technology offer opportunities to enhance drug evaluation in infants and young children, challenges remain in selecting the appropriate design, metrics, and sensors for each disease.  

• Leonard Sacks, Elizabeth Kunkoski, Marianne Noone

Low-Volume Emergency Departments are More Likely to Use Telehealth for Sepsis Care in a National Rural Telehealth Network

Low-volume emergency departments (EDs) have higher rates of mortality as compared to higher volume EDs. This multicenter, retrospective study evaluated the prevalence of tele-ED use for sepsis care to understand variations across rural EDs and identify factors that predict the need for sepsis consultation using telemedicine.

• Nicholas M Mohr, Tracy Young, Allison R Schuette, Fred Ullrich, Luke J Mack, Katie DeJong, Amanda Bell, Mark Pals, Carlos A Camargo Jr, Kori S Zachrison, Krislyn M Boggs, Adam Skibbe, Dan M Shane, Knute D Carter, Kimberly A.S. Merchant, Marcia M Ward

Pre-Pandemic Telehealth Use among Children in Medicaid Managed Care and Fee-for-Service Programs

This study assessed the use of telehealth by Medicaid MCOs to provide pediatric care. The researchers analyzed variations in telehealth use based on geography, race, and ethnicity and identified the health conditions and services that accounted for the greatest percentage of telehealth visits for children enrolled in Medicaid MCOs.

• Yvonne Jonk, Heidi O’Connor, Jean A Talbot

Telehealth and Public Health Practice in the United States- Before, During and After the COVID-19 Pandemic

In 2020, the Centers for Disease Control and Prevention (CDC) established a telehealth unit as part of its COVID-19 emergency response and a CDC telehealth workgroup. The workgroups identified ways that telehealth can benefit public health including increasing access to reduce health disparities, enhancing disease management and preventative care, and triaging care to ensure appropriate use of health services.

• Antonio J Neri, Geoffrey P Whitfield, Erica T Umeakunne, Jeffrey E Hall, Carol J DeFrances, Ami B Shah, Paramjit K Sandhu, Hanna B Demeke, Amy R Board, Naureen J Iqbal, Katia Martinez, Aaron M Harris, Frank V Strona

Association Between In-Person vs Telehealth Follow-up and Rates of Repeated Hospital Visits Among Patients Seen in the Emergency Department

Improved patient mortality is associated with the promptness of follow-up visits from the emergency department (ED). Although in-person follow up visits after ED discharges are known to be effective, the success of telehealth as a follow-up option is unspecified. This cohort study examines the difference in the rates of patients who were discharged from the ED and have an in-person follow-up in comparison to those patients who have telehealth follow-up appointments.

• Vivek V Shah, Chad W Villaflores, Linh H Chuong, Richard K Leuchter, Austin S Kilaru, Sitaram Vangala, Catherine A Sarkisian
• October 2022

Association of Adequacy of Broadband Internet Service with Access to Primary Care in the Veterans Health Administration Before and During the COVID-19 Pandemic

While the Veterans Health Administration (VHA) offered several telehealth services before the pandemic, the use of telehealth by veterans significantly increased during the COVID-19 pandemic. An analysis of data from VHA found that veterans who lived in communities with limited or no access to broadband were less likely to access primary care via telehealth during the pandemic. Reduced access to broadband was associated with neighborhood-level social disadvantage, worsening access disparities.

• Amy MJ O’Shea, Aaron Baum, Bjarni Haraldsson, Ariana Shahnazi, Matthew R Augustine, Kailey Mulligan, Peter J Kaboli

Quality of Telehealth-Delivered Inpatient Palliative Care During the Early COVID-19 Pandemic

This study focused on the use of palliative primary care using telehealth and hybrid models during the pandemic. The research findings suggest that the use of telehealth may expand the availability of palliative care for individuals and their families who are not conveniently located near a health center that offers this important service. The authors note that telehealth may be more appropriate for some palliative care services than for others.

• Ann A Soliman, Kathleen M Akgun, Jane Coffee, Jennifer Kapo, Laura J Morrison, Elizabeth Hopkinson, Dena Schulman-Green, Shelli L Feder

Receipt of Telehealth Services, Receipt and Retention of Medications for Opioid Use Disorder, and Medically Treated Overdose Among Medicare Beneficiaries Before and During the COVID-19 Pandemic

To ensure access to substance use disorder services during the pandemic, the government authorized the use of telehealth to prescribe and manage medications for opioid use disorder (MOUD). This study looked at over 150,000 Medicare beneficiaries living with OUD during the pandemic and found that MOUD prescribing via telehealth improved retention in an OUD-treatment program using prescribed medication and reduced the likelihood of medically treated overdose.

• Centers for Disease Control and Prevention; Centers for Medicare & Medicaid Services; National Institutes of Health
• Christopher M Jones, Carla Shoff, Kevin Hodges, Carlos Blanco, Jan L Losby, Shari M Ling, Wilson M Compton

Targeted Telehealth Education Increases Interest in Using Telehealth among a Diverse Group of Low-Income Older Adults

Telehealth has the potential to empower older adults to have more autonomy over their health, but they are less likely to use telehealth. This research study focuses on an education program targeting vulnerable, low-income, minority older adults. Results show that the program increased their confidence in accessing and using telehealth, resulting in improved health promotion and achieving the aim of promoting telehealth use among this population.  

• Emily Jezewski, Abigale Miller, MaryAnn Eusebio, Jane Potter

Transitioning to telehealth? A guide to evaluating outcomes

This research study addresses the need for comprehensive evaluation of telehealth outcomes and performance, considering access to care, cost, experience, and effectiveness. The study emphasizes the understudied aspects of telehealth accessibility and accommodations and highlights the importance of establishing an evaluation system for telehealth outcomes.

• Melinda M Li, Kristin L Rising, Elizabeth M Goldberg
• September 2022

Certain Medicare Beneficiaries, Such as Urban and Hispanic Beneficiaries, Were More Likely Than Others to Use Telehealth During the First Year of the COVID-19 Pandemic

This data brief examines the characteristics of Medicare beneficiaries who used telehealth during the first year of the pandemic. This report discusses how the temporary expansion of telehealth impacted various beneficiary groups. In addition, the learnings can help to inform future work in increasing beneficiary access to telehealth.

• HHS Office of Inspector General (OIG)

Effect of a Comprehensive Telehealth Intervention vs Telemonitoring and Care Coordination in Patients With Persistently Poor Type 2 Diabetes Control

This study addresses poorly controlled type 2 diabetes by comparing simple and comprehensive telehealth interventions. The trial shows that comprehensive telehealth is more effective than telemonitoring and care coordination, improving outcomes for patients at a reasonable cost. These findings suggest that implementing comprehensive telehealth could enhance diabetes care.

• Matthew J Crowley, Phillip E Tarkington, Hayden B Bosworth, Amy S Jeffreys, Cynthia J Coffman, Matthew L Maciejewski, Karen Steinhauser, Valerie A Smith, Moahad S Dar, Sonja K Fredrickson, Amy C Mundy, Elizabeth M Strawbridge, Teresa J Marcano, Donna L Overby, Nadya T Majette Elliott, Susanne Danus, David Edelman

Transgender Individuals and Digital Health

The use of digital health technologies including telehealth and mhealth expands access to health care as well as education and the ability to access resources to improve overall health such as housing and employment. This study discusses how digital health technologies can reduce disparities in quality of care for transgender individuals.

• Asa E. Radix, Keosha Bond, Pedro B. Carneiro, Arjee Restar

Age and Racial Disparities in Telehealth Use Among People with HIV During the COVID-19 Pandemic

This research study analyzed HIV care appointments at an urban tertiary hospital to assess the uptake of telehealth and sociodemographic variations in utilization among people with HIV. The findings indicated age and racial differences in terms of in-person versus telehealth appointments.

• Eleanor E Friedman, Samantha A Devlin, Sarah F Gilson, Jessica P Ridgway
• August 2022

Adoption of telemedicine in a rural United States cancer center amidst the COVID-19 pandemic: A qualitative study

Oncology, the branch of medicine that deals with the diagnosis and treatment of cancer, has been slower than other fields of medicine to utilize telemedicine. This study aims to better understand the different factors that affect provider and patient hesitancy for telemedicine uptake and sustained use in oncology. Overall, providers favored telemedicine utilization for lower-acuity cancer care visits that were less dependent on physical exams, and more focused on patient education. The results give researchers important data that can aid in the improvement of virtual cancer care, giving the opportunity for increased access to rural and underserved communities.

• Matthew Brian Mackwood, Rebecca L Butcher, Danielle Vaclavik, Jennifer A Alford-Teaster, Kevin M Curtis, Mary L Lowry, Tor D Tosteson, Wenyan Zhao, Anna N A Tosteson

Assessing Technical Feasibility and Acceptability of Telehealth Palliative Care in Nursing Homes

The goal of this study is to assess the technical feasibility and acceptability of using telehealth for palliative care consultations in nursing homes. The findings demonstrated that palliative care video visits were well-received, with participants expressing comfort, improved communication, and potential future use, highlighting the value of telehealth as a cost-effective means to enhance access to palliative care services in nursing homes.

• Caroline E Stephens, Theresa A Allison, Lynn A Flint, Daniel David, Victoria Wertz, Elizabeth Halifax, Pamela Barrientos, Christine S Ritchie

Mindfulness-Based Smoking Cessation Delivered Through Telehealth and Text Messaging for Low-Income Smokers: Protocol for a Randomized Controlled Trial

Telehealth has the potential to widely expand patient access to the intervention and treatment for tobacco usage. Low-income minority groups often struggle with quitting due to a lack of healthcare infrastructure around smoking cessation interventions, and therefore experience tobacco-related health problems at a greater rate. This study uses telehealth sessions and SMS text messaging to deliver mindfulness-based smoking cessation treatment, with the hope of reaching population groups that normally do not have access to in-person treatment centers. Data will continue to be collected until the spring of 2024.

• Claire A Spears, Josephine Mhende, China Hawkins, Vuong Van Do, Matthew J Hayat, Michael P Eriksen, Donald Hedeker, Lorien C Abroms, David W Wetter

Telehealth for the Longitudinal Management of Chronic Conditions: Systematic Review

This systematic review looked for studies that compare use and outcomes of in-person and telehealth care for chronic care management of congestive heart failure, chronic obstructive pulmonary disease, and type 2 diabetes mellitus.

• Allison A Lewinski, Conor Walsh, Sharron Rushton, Diana Soliman, Scott M Carlson, Matthew W Luedke, David J Halpern, Matthew J Crowley, Ryan J Shaw, Jason A Sharpe, Anastasia-Stefania Alexopoulos, Amir Alishahi Tabriz, Jessica R Dietch, Diya M Uthappa, Soohyun Hwang, Katharine A Ball Ricks, Sarah Cantrell, Andrzej S Kosinski, Belinda Ear, Adelaide M Gordon, Jennifer M Gierisch, John W Williams Jr, Karen M Goldstein

The future of telehealth in type 1 diabetes

Telehealth services have been utilized in type 1 diabetes (T1D) clinical care for years, but the COVID-19 pandemic accelerated adoption and sparked interest in long-term integration into routine care. This review examines the existing literature on telemedicine in T1D care, highlighting its benefits and barriers. The findings indicate that telehealth can effectively contribute to improved glycemic control and long-term outcomes in T1D and it is anticipated that future care models will adopt a hybrid approach combining both in-person and telehealth visits.

• Erin C Cobry, R Paul Wadwa

"I was Unsure at First": A Qualitative Evaluation of Patient Perceptions of VA Clinical Video Telehealth Visits in the V-IMPACT Program

Many veterans have skepticism about telehealth. This study examines how veteran’s opinions of telehealth change once they experience a virtual appointment. Findings show a wide variety of patient responses to telehealth appointments, and these experiences offer an opportunity for future telehealth providers to better understand the needs of their patients to make virtual care as effective and supportive as possible.

• Ashley C Mog, Megan Moldestad, Rachael Kenney, Lauren Stevenson, Marcie Lee, P Michael Ho, George G Sayre

Adapting PCIT-Health for Telehealth Delivery: A Case Study

Parent-Child Interaction Therapy-Health (PCIT-Health) is a form of behavior parent training that focuses on helping parents learn skills for better managing a child’s behavior, including obesity-related behaviors. This study examines the experience of one family using telehealth to receive PCIT. The results show that the family had a positive experience with telehealth-delivered PCIT, and that the parent’s skillset of positive parenting practices increased. This study gave researchers more information on patient experience with telehealth-delivered PCIT so that in the future there can be a wider implementation of this practice for improving child behavioral problems.

• Sarah E Domoff, Mikaela M Overton, Aubrey L Borgen, Larissa N Niec

Association between state payment parity policies and telehealth usage at community health centers during COVID-19

Parity policies are the combined amount of reimbursement that a health benefit plan allows for the compensation to the distant site and the originating site which are required to not be less than the total amount allowed for healthcare services provided in-person. This study highlights the association between payment parity policies and the use of telehealth at community health centers, particularly during COVID-19.

• Clese Erikson, Jordan Herring, Yoon Hong Park, Qian Luo, Guenevere Burke

Broadband access and telemedicine adoption for opioid use disorder treatment in the United States

Buprenorphine is a medication used for patients who struggle with opioid use disorder, but only about 1 in 5 patients receive treatment. The COVID-19 pandemic increased telehealth utilization for addiction treatment with studies supporting telemedicine as an effective way to deliver treatment for opioid use disorder. This study aims to identify the percentage of the US population that experience challenges with treatment accessibility. Barriers to treatment that are examined in this study include limited internet access and the number of buprenorphine-waivered providers near a patient’s residence.

• Mir M Ali, Robin Ghertner

COVID-19 Telemedicine and Vaccination at an Urban Safety Net HIV Medicine Clinic

The Owen Clinic at UC San Diego Health developed a telemedicine clinic in response to the COVID-19 pandemic to ensure the continuity of care for patients with human immunodeficiency virus (HIV), and other high-risk populations. This study gives an in-depth review of the Owen Clinic and various virtual-medical services it provided throughout the pandemic that ultimately were effective in treating and monitoring high-risk patients.

• Ryan Anson, Aaron Willcott, Will Toperoff, Afsana Karim, Michael Tang, Darcy Wooten, J Tyler Lonergan, Laura Bamford

Expanding access to substance use services and mental health care for people with HIV in Alabama, a technology readiness assessment using a mixed methods approach

Due to Alabama's vast amount of rural area, there are many obstacles that patients can face while trying to receive treatment for HIV. Specifically, HIV patients often experience challenges with access to treatment for mental health and substance use disorders (SUD) due to a lack of public health infrastructure and limited amounts of health care providers near their residence. This study examines if adopting telehealth screenings for mental health and SUDs can improve rural patients access to healthcare services.

• Ellen F Eaton, Kaylee Burgan, Greer McCollum, Sera Levy, James Willig, Michael J Mugavero, Sushanth Reddy, Eric Wallace, Tom Creger, Stefan Baral, Susanne Fogger, Karen Cropsey

Improving heart failure care and guideline-directed medical therapy through proactive remote patient monitoring-home telehealth and pharmacy integration

This study evaluates the use of remote patient monitoring (RPM) home-telehealth and pharmacist consultations on high-risk cardiovascular patients, with the overall goal being a reduction in hospital admissions due to heart failure. A registered nurse, cardiovascular physician, and pharmacist all play a crucial role in care delivery during this study, working together to improve guideline-directed medical therapy (GDMT) prescription. Results from this study show that the number of patients who maximized GDMT care increased, which may have assisted in the reduction of hospital admissions due to heart failure during the study.

• Kimberly A Lynch, David A Ganz, Debra Saliba, Donald S Chang, Shelly S de Peralta

Managing innovation: a qualitative study on the implementation of telehealth services in rural emergency departments

This study focuses on the integration of telehealth services for emergency departments in rural areas and highlights gaps in the implementation and long-term utilization. Researchers administered semi-structured interviews from six U.S. health care systems that provided emergency telehealth services. Results include necessary implementation factors in strategies, capability, relationships, financials, protocols, environment, service characteristics, and accountability.

• Mochamad Muska Nataliansyah, Kimberly AS Merchant, James A Croker, Xi Zhu, Nicholas M Mohr, James P Marcin, Hicham Rahmouni, Marcia M Ward

The impact of the COVID-19 pandemic on people who inject drugs accessing harm reduction services in an rural American state

Harm reduction services, such as syringe service programs (SSPs), shelters, peer support groups, and low barrier buprenorphine treatment are services for people who inject drugs (PWID) and their recovery process. Prior to the COVID-19 pandemic, PWID faced many challenges with access to these services, but the pandemic exacerbated these barriers even further. This study examines the impact that COVID-19 had on access to harm-reduction services, specifically for Maine residents.

• Kinna Thakarar, Michael Kohut, Rebecca Hutchinson, Rebecca Bell, Hannah E Loeb, Debra Burris, Kathleen M Fairfield

Emergency Departments' Uptake of Telehealth for Stroke Versus Pediatric Care: Observational Study

The study aimed to investigate the discrepancy in the adoption of telestroke and pediatric telehealth services in emergency departments. The researchers hypothesized that differences in financial incentives, prehospital routing policy, and certification requirements could have contributed to the uneven adoption. The study shows the most frequently indicated reason for adoption of telehealth services was related to clinical care.

• Kori S Zachrison, Emily M Hayden, Krislyn M Boggs, Tehnaz P Boyle, Jingya Gao, Margaret E Samuels-Kalow, James P Marcin, Carlos A Camargo Jr

Association Between Telemedicine Use in Nonmetropolitan Counties and Quality of Care Received by Medicare Beneficiaries With Serious Mental Illness

For people diagnosed with serious mental illnesses such as schizophrenia, bipolar I disorder, and other related psychotic disorders, accessibility to specialty mental health care services is an ongoing barrier. This cohort study explores the association between greater telemental health service use in a nonmetropolitan county and quality measures including 118,670 patients diagnosed with schizophrenia, bipolar I disorder, and/or related psychotic disorders. This includes the use of specialty mental health care and medical adherence of patients with schizophrenia or related psychotic disorders. Results from the study reveal slight increases in encounters with outpatient specialty mental health professionals and increased possibility of follow-up after being hospitalized.

• Bill Wang, Haiden A Huskamp, Sherri Rose, Alisa B Busch, Lori Uscher-Pines, Pushpa Raja, Ateev Mehrotra

Behavioral healthcare organizations' experiences related to use of telehealth as a result of the COVID-19 pandemic: an exploratory study

The COVID-19 pandemic resulted in many behavioral health services having to transition to deliver care virtually via telehealth. This study analyzes the experiences of behavioral health organizations that used telehealth during the pandemic to determine any common themes. Results show that organizations viewed convenience, increased access to disadvantaged populations, and lack of commute as advantages of telehealth; common disadvantages included limited access to technology and possible ineffective treatments.

• Substance Abuse and Mental Health Services Administration
• Abby Kisicki, Sara Becker, Michael Chaple, David H Gustafson, Bryan J Hartzler, Nora Jacobson, Ann A Murphy, Stephanie Tapscott, Todd Molfenter

Clinical Appropriateness of Telehealth: A Qualitative Study of Endocrinologists' Perspectives

Since the use of telehealth in outpatient endocrinology is likely to remain common after the COVID-19 pandemic, this study examines how endocrinologists determine clinical appropriateness for telehealth and identifies their strategies to navigate barriers to safe and effective use. This research is crucial due to the absence of guidelines on telehealth use in this field, and the findings show the need for expert guidance to anchor future evidence-based guidelines for determining clinical appropriateness of telehealth in endocrinology.

• Kailyn E Sitter, Denise H Wong, Rendelle E Bolton, Varsha G Vimalananda

Evaluation of an experiential clinical learning option during pandemic teaching suspensions

Due to the COVID-19 pandemic, many educational environments had to transition to virtual learning, including teaching hospitals for medical students. This study evaluates one hospital’s transition to using telehealth for a new learning program that allows students to become familiar with clinician and patient perspectives of different care models. The curriculum specifically focuses on using virtual care in the multidisciplinary field of addiction medicine.

• Jules Canfield, Ve Truong, Agata Bereznicka, Karsten Lunze

Factors influencing uptake of telemental health via videoconferencing at high and low adoption sites within the Department of Veterans Affairs during COVID-19: a qualitative study

The purpose of this study is to determine factors that influence site-level uptake of telemental health via videoconferencing (TMH-V) by examining both a low adoption site and a high adoption site within the US Department of Veterans Affairs. Findings show that while there are many positive and negative influencers of TMH-V uptake, the biggest influencer was site complexity. User-friendly sites that are accessible to patients with a limited technology skill set positively affect site uptake. Unfortunately, a majority of the sites examined were not user-friendly, so complexity had an overall negative influence. Understanding the various influencers of site-level uptake allows for improvement on future implementation, overall increasing patient access to virtual mental health care.

• Samantha L Connolly, Jennifer L Sullivan, Jan A Lindsay, Stephanie L Shimada, Leonie Heyworth, Kendra R Weaver, Christopher J Miller

Long-term Effects of Remote Patient Monitoring in Patients Living with Diabetes: A Retrospective Look at Participants of the Mississippi Diabetes Telehealth Network Study

This study examines the effectiveness of long-term remote patient monitoring (RPM) for patients with diabetes in the state of Mississippi. While RPM has been proven to be an effective tool for monitoring patient’s hemoglobin A1C levels, the ability of RPM to support patients in maintaining treatment is unclear. Many participants experienced reductions in hemoglobin levels after 12 months of nurse coaching and diabetes self-management education that were provided via telehealth, indicating that RPM could be an important tool in managing chronic diseases, specifically diabetes.

• Tearsanee Carlisle Davis, Ashley S. Allen, and Yunxi Zhang

Parent satisfaction with the parent-provider partnership and therapy service delivery for children with disabilities during COVID-19: Associations with sociodemographic variables

Parents of children with disabilities played a huge role in facilitating the continuity of care for their children throughout the COVID-19 pandemic, especially through managing and delivering therapies remotely. This study aims to examine the relationship between sociodemographic factors and parent satisfaction with the delivery of therapy services for children with disabilities during the pandemic. Factors impacting parents' satisfaction with therapy services included access to telehealth services, number of household essential workers, number of children, parent education, and more.

• Ashley N Murphy, Ellie Bruckner, Linzy M Pinkerton, Heather J Risser

Perception of Telehealth During the COVID-19 Pandemic Among Survivors of Gynecologic Cancer

This study aimed to understand the preferences of gynecologic cancer survivors for telehealth cancer care. Over half preferred in-person visits. Many noted concerns about missing out on physical examination during telehealth visits. The study highlights the need for careful evaluation of patient concerns and education to develop future care models that include telehealth elements for gynecologic cancer survivors.

• Nicholas Quam, Ashley E Stenzel, Katherine Brown, Patricia Jewett, Helen M Parsons, Jane Hui, Rahel G Ghebre, Anne Blaes, Deanna Teoh, Rachel I Vogel

Perceptions and Use of Telehealth Among Mental Health, Primary, and Specialty Care Clinicians During the COVID-19 Pandemic

The purpose of this study was to capture healthcare providers attitudes towards telehealth utilization during the COVID-19 pandemic, since physician’s attitudes may impact utilization rates of telehealth by patients. Findings show differences in video, phone, and in-person care utilization across specialties, as well as clinicians attitudes towards telehealth having an impact on patient utilization.

• Samantha L Connolly, Christopher J Miller, Allen L Gifford, Michael E Charness

Predictors of telemedicine use during the COVID-19 pandemic in the United States-an analysis of a national electronic medical record database

Although telehealth utilization has rapidly increased within the past years, disadvantaged groups still face barriers to access. This is a retrospective study that analyzes outpatient medical encounters for patients using a national electronic medical record database from March 1 to December 31, 2020. Findings show that older and non-Hispanic Black patients had significantly lower levels of telehealth utilization than other patient groups.

• Sameed Ahmed M Khatana , Lin Yang, Lauren A Eberly, Howard M Julien, Srinath Adusumalli, Peter W Groeneveld

Public health implications of adapting HIV pre-exposure prophylaxis programs for virtual service delivery in the context of the COVID-19 pandemic: a systematic review

Based on a systematic review, the authors suggest a virtual service delivery model for PrEP that can be leveraged for the COVID-19 public health emergency using the internet and social media for demand creation, community-based self-testing, telehealth platforms for risk assessment and follow-up, applications for support groups and adherence/appointment reminders, and applications and internet for monitoring.

• Pragna Patel, Michael Kerzner, Jason B Reed, Patrick Sullivan, Wafaa M El-Sadr

Schedule of Visits and Televisits for Routine Antenatal Care

This is a systematic review that examines the role that telehealth can play in the future of antenatal care. Various factors that could facilitate or create a barrier in the implementation of telehealth for antenatal care were also reviewed. Studies reviewed show that there were no differences in the amount of preterm births or neonatal intensive care unit admissions when comparing telehealth and in-person visits, and that both patients and providers are open to telehealth utilization in this field, but more research is needed.

• Ethan M. Balk, Kristin J. Konnyu, Wangnan Cao, Monika Reddy Bhuma, Valery A. Danilack, Gaelen P. Adam, Kristen A. Matteson, Alex Friedman Peahl

Strategies to Ensure Continuity of Care Using Telemedicine with Older Adults during COVID-19: A Qualitative Study of Physicians in Primary Care and Geriatrics

This study examines the utilization of telehealth by patients aged 65 and older during the COVID-19 pandemic, as well as explore the experiences of primary care physicians and geriatricians by conducting interviews. Examining various strategies used to maintain the care of patients aged 65 and older throughout the pandemic allows for future improvement of telehealth utilization for geriatricians. Findings indicate the importance of evaluating a patient's technological readiness in advance, making accommodations for disabilities, and involving caregivers throughout the telehealth experience.

• Kevin Chen, Natalie M Davoodi, Daniel H Strauss, Melinda Li, Frances N Jimenez, Kate M Guthrie, Elizabeth M Goldberg

Telehealth for Women's Preventative Services

This study evaluated the effectiveness, use, and implementation of telehealth for women's preventative services for reproductive healthcare and interpersonal violence (IPV), and to evaluate patient preferences and engagement for telehealth, particularly in the context of COVID-19. Three of the 16 studies indicated that telehealth utilization increased during COVID-19 public health emergency.

• Cantor A, Nelson HD, Pappas M, Atchison C, Hatch B, Huguet N, Flynn B, McDonagh M.

The Lack of a Physical Exam During New Patient Telehealth Visits Does Not Impact Plans for Office and Operating Room Procedures

This study examines if surgical plans made during a telehealth visit remain unchanged after a pre-operative examination immediately before surgery. Data for this study was gathered during the COVID-19 pandemic on urology patients. Results show that majority of surgical planning made during new patient visits stayed the same after in-person examinations, signaling that telehealth can be a useful tool in the future for virtual surgical planning.

• Nicholas W Eyrich, Juan J Andino, Roberta E Ukavwe, Mark W Farha, Akshar K Patel, Daniel Triner, Chad Ellimoottil

The Role of Telehealth and Clinical Informatics in Data Driven Primary Care Redesign

Due to the COVID-19 pandemic, telehealth has experienced many updates in the past 3 years. These innovations have presented a new opportunity in the health care field for utilization of new ways to remotely monitor medically complex patients This study uses clinical informatics linked to inpatient and emergency department use to evaluate telehealth utilization of various population segments. Results show that there is potential to improve patient outcomes using telehealth in the primary care and acute care settings, as well as decrease emergency department and inpatient utilization.

• Jodie L Brown, Sharon Hewner

Using Implementation Science to Understand Teledermatology Implementation Early in the COVID-19 Pandemic: Cross-sectional Study

Due to the COVID-19 pandemic, the use of telehealth in dermatology practices (teledermatology) has experienced rapid expansion. Implementation science uses evidence-based practices to improve the quality and effectiveness of healthcare services, and this study aims to understand more about how implementation science can be used in dermatologic care, as well as in teledermatology. Results from this study give health care providers insight on how to successfully continue the use teledermatology after the pandemic.

• Shanelle Mariah Briggs, Jules Benjamin Lipoff, Sigrid Marie Collier

Addressing Hypertension Outcomes Using Telehealth and Population Health Managers: Adaptations and Implementation Considerations

This study examines various population health approaches to help with hypertension management. Telehealth is one approach that this study focuses on, with it being a cost-effective strategy that addresses multiple barriers to hypertension utilization and care delivery. Results show that telehealth is an effective strategy for advancing hypertension care within a population health paradigm by addressing multiple drivers of high blood pressure.

• National Institutes of Health; United States Department of Veterans Affairs; Health Resources and Services Administration
• Connor Drake, Allison A. Lewinski, Abigail Rader, Julie Schexnayder, Hayden B. Bosworth, Karen M. Goldstein, Jennifer Gierisch, Courtney White-Clark, Felicia McCant, and Leah L. Zullig

An Economic and Health Outcome Evaluation of Telehealth in Rural Sepsis Care: A Comparative Effectiveness Study

Sepsis is one of the top reasons for hospital mortality and healthcare costs. Telehealth has been shown to improve short-term sepsis care; however, the effect on costs and long-term outcomes is unclear. This study compares costs and outcomes for sepsis treated in rural emergency departments.

• Nicholas M Mohr, Allison R Schuette, Fred Ullrich, Luke J Mack, Katie De Jong, Carlos A Camargo, Kori S Zachrison, Krislyn M Boggs, Adam Skibbe, Amanda Bell, Mark Pals, Dan M Shane, Knute D Carter, Kimberly A S Merchant, Marcia M Ward

Describing Changes in Telebehavioral Health Utilization and Services Delivery in Rural School Settings in Pre- and Early Stages of the COVID-19 Public Health Emergency

Due to significant provider shortages, challenges exist for patients attempting to receive behavioral health services especially in light of the COVID-19 pandemic. In this study, researchers collected data from students in fifteen school-based telehealth programs in rural areas nationwide. Results of the study show increased utilization and implementation of telebehavioral services in school-based programs as a direct response to the effects of the COVID-19 pandemic.

• Marcia M Ward, Fred Ullrich, Kimberly AS Merchant, Knute D Carter, Divya Bhagianadh, Meghan Lacks, Erika Taylor, Jennifer Gordon

Evaluation of Mental Health Mobile Applications

This is a technical brief that examines the potential of mobile application (app) utilization for mental health and wellness services. Although there are many mobile apps available for mental health services, there is little guidance that consumers and patients can use when trying to determine what application to use. This brief also provides a framework to assess apps based on different strengths and limitations.

• Smisha Agarwal, Madhu Jalan, Holly C. Wilcox, Ritu Sharma, Rachel Hill, Emily Pantalone, Johannes Thrul, Jacob C. Rainey, Karen A. Robinson, Ph.D.

Postpartum during a pandemic: Challenges of low-income individuals with healthcare interactions during COVID-19

The COVID-19 pandemic resulted in many changes in women’s healthcare delivery for childbirth and the postpartum period, but these changes particularly affected low-income patients. This study examines various challenges that low-income patients experienced during the pandemic.

• Maria V Gomez-Roas, Ka'Derricka M Davis, Karolina Leziak, Jenise Jackson, Brittney R Williams, Joe M Feinglass, William A Grobman, Lynn M Yee

Telehealth: Current Definitions and Future Trends

This report defines common telehealth terms across a variety of contexts (clinicians, academia, federal stakeholders) and explains why it is important to use terminology that is contextually appropriate. Most patients will not distinguish between the terms “telehealth” and “telemedicine” in their use. Academic researchers may need to distinguish the terms to accurately describe and frame their research. Among federal stakeholders, telehealth is currently the most used term and would have the most recognition.

• Hari Eswaran, Leah Dawson

Telemedicine versus in-Person Primary Care: Impact on Visit Completion Rate in a Rural Appalachian Population

The purpose of this study is to understand the affects that telehealth has on patient access and visit completion rates for primary care in a rural community. While the COVID-19 pandemic increased telehealth utilization and availability, little research has been done to determine if the increased availability of virtual care has actually improved access to healthcare in rural and underserved areas. Findings from this study show that the introduction of telehealth in these rural communities created an increase in appointment completion by 20%, indicating that there was an overall increase in patient access.

• Treah Haggerty, Heather M Stephens, Shaylee A Peckens, Erika Bodkins, Michael Cary, Geri A Dino, Cara L Sedney

The Potential of Telecommunication Technology to Address Racial/Ethnic Disparities in HIV PrEP Awareness, Uptake, Adherence, and Persistence in Care: A Review

The purpose of this review was to understand how studies have used electronic telecommunication technology to increase awareness, uptake, adherence, and persistence in PrEP care among Black and Hispanic/Latino persons and how it can reduce social and structural barriers that contribute to disparities in HIV infection.

• Kimberly N Evans, Rashida Hassan, Ashley Townes, Kate Buchacz, Dawn K Smith

Defining Telehealth for Research, Implementation, and Equity

The COVID-19 pandemic made telehealth an essential service for health care access which led to the development of temporary policies with varying definitions and regulations by state and organization. Currently, more permanent guidelines are being established which has provided an opportunity to re-evaluate how telehealth is integrated into regular health care delivery. By defining a clear understanding of telehealth and its components, the clinical care can improve and more precise control and expectations for researchers, patients and providers can be implemented.

• Joy Roy, Deborah R Levy, Yalini Senathirajah

Primary care telemedicine during the COVID-19 pandemic: patient’s choice of video versus telephone visit

This study investigates how patient characteristics influenced the choice between video and audio-only telehealth appointments. The analysis of almost one million patient-scheduled primary care telehealth visits found that 39% were video visits. Patients who were Black or Hispanic, living in lower socioeconomic status or areas with limited internet access, were less likely to opt for video visits. Patients aged 65 or older, those with previous video visit experience or mobile portal access, or those seeing their own provider were more inclined to choose video visits. The research highlights a digital divide and underscores the importance of maintaining telephone telemedicine options.

• Jie Huang, Ilana Graetz, Andrea Millman, Anjali Gopalan, Catherine Lee, Emilie Muelly, and Mary E Reed

Temporary telehealth policies were developed by various organizations and states during the COVID-19 emergency, with varying definitions, regulations, and coverage. As these policies are being replaced with more permanent guidelines, there is an opportunity to form a consensus in definitions to set a standard of care.  

In the early stages of the COVID-19 pandemic, states and the federal government quickly implemented policy changes to expand access to health care. As a result, the definition of telehealth and the services included varied across entities. The researchers discuss the implications of this variance which will impact policy and research and hinder efforts to address health disparities. As a result, efforts must be made to establish a single definition for telehealth that is consistently used.

Direct and indirect effects of a Project ECHO longitudinal clinical tele-mentoring program on viral suppression for persons with HIV: a population-based analysis

Project ECHO tele-mentoring for community providers was associated with improvement in viral suppression for people with HIV whose providers participate or work in the same clinic system as a provider who participates.

• Health Resources and Services Administration; National Institutes of Health
• Brian R Wood, Karin Bauer, Richard Lechtenberg, Susan E Bushkin, Lea Bush, Jeff Capizzi, Beth Crutsinger-Perry, Steven J Erly, Timothy W Menza, Jennifer R Reuer, Matthew R Golden, James P Hughes

Tele-urgent Care for Low-Acuity Conditions: A Systematic Review

The pandemic increased the use of tele-urgent care to improve timely access to health care while preventing unnecessary, in-person contact. This research study reviewed the literature to determine whether tele-urgent care might be an effective substitute for in-person care for low-acuity conditions in the future. While there was no evidence of costs savings, the research suggests that tele-urgent care may increase access by triaging patients to the right level of care.

• Nathan Boucher, Elizabeth Van Voorhees, Anita Vashi, Olivia Dong, Perri Morgan, Janeen E. Smith, Soheir Adam, Amir Alishahi Tabriz, Michael J. Mulholland, Jessica R. Dietch, John D. Whited, Joel C. Boggan, Jessica J. Fulton, C. Blake Cameron, Adelaide Gordon, Karen M. Goldstein, Belinda Ear, John W. Williams, Sarah Cantrell, Sarah W. Dickerson, Jennifer M. Gierisch

Telemedicine Use in Disasters: A Scoping Review

Disasters of all scales are a recurring issue and challenge for the health care systems, especially for providers and hospitals nationwide. The utilization of telemedicine is a direct response to improve access to health care during disasters, which is referred to as disaster telemedicine. This study focuses on literature that provides insight and response recommendations into the current use of disaster telemedicine for the most common barriers in regional disaster health.

• National Institutes of Health; U.S. Department of Health and Human Services
• Mark Litvak, Katherine Miller, Tehnaz Boyle, Rachel Bedenbaugh, Christina Smith, David Meguerdichian, David Reisman, Paul Biddinger, Adam Licurse, Eric Goralnick

Telestroke Infrastructure, Processes and Support Needs: A Survey of Hospitals in Five States

Telehealth and the use of telehealth for stroke treatment and services is considered be cost-effective, specifically for its use and ability to provide timely treatments. This study reviews multiple telestroke programs to identify how other and existing programs can implement and sustain their telestroke services and programs.

• Christopher M Shea, Kea Turner, Josh Weinstein, Amir Alishahi Tabriz, Nimmy Babu, Jessica Link Reeve, Steve North

Child Health, Vulnerability, and Complexity: Use of Telehealth to Enhance Care for Children and Youth With Special Health Care Needs

Telehealth has the potential to improve the quality of care, particularly deficiencies related to access and patient experience of care for children and youth with special health care needs and reduce disparities related to accessing in-person care.

• Jeanne Van Cleave, Christopher Stille, David E Hall

Deploying a telemedicine collaborative care intervention for posttraumatic stress disorder in the U.S. Department of Veterans Affairs: A stepped wedge evaluation of an adaptive implementation strategy

This study uses two strategies, standard implementation and enhanced implementation, to determine the best way to incorporate telehealth utilization in trauma-focused psychotherapy for veterans with post-traumatic stress disorder (PTSD). Results show that although telehealth is an effective means for engaging veterans in treatment, neither of these strategies were successful at incorporating telehealth into routine care treatment of PTSD.

• John C Fortney, Suparna Rajan, Heather S Reisinger, Jane Moeckli, John P Nolan, Edwin S Wong, Peter Rise, Valentina V Petrova, George G Sayre, Jeffrey M Pyne, Anouk Grubaugh, Fatma Simsek-Duran, Kathleen M Grubbs, Leslie A Morland, Bradford Felker, Paula P Schnurr

mHealth Interventions for Self-management of Hypertension: Framework and Systematic Review on Engagement, Interactivity, and Tailoring

The prevention or management of hypertension is an area of interest for researchers. This systematic review explores user engagement for hypertension-focused mobile health (mHealth) interventions as well as tailoring and interactivity for mHealth users. Digital behavior change interventions require engagement to be effective for users.

• Weidan Cao, M Wesley Milks, Xiaofu Liu, Megan E Gregory, Daniel Addison, Ping Zhang, Lang Li

Telehealth During COVID-19: Suicide Prevention and American Indian Communities in Montana

The risk of suicide among American Indian and Alaskan Native Communities during the COVID-19 pandemic significantly exceeded that of other racial and ethnic groups. Telehealth is an effective way to deliver behavioral health services in these communities. This study assessed Montana-based provider perceptions of the potential for telehealth to reduce suicides and the implications for future research.

• Zachary Pruitt, Kate P Chapin, Haley Eakin, Annie L Glover

Telehealth Use Among Older Adults During COVID-19: Associations with Sociodemographic and Health Characteristics, Technology Device Ownership, and Technology Learning

While the number of older adults using telehealth increased significantly during the COVID-19 pandemic, adoption and use of this care modality lagged that of younger adults. In this study, the authors investigate the factors that contribute to this discrepancy and discuss the implications.

• Namkee G Choi, Diana M DiNitto, C Nathan Marti, Bryan Y Choi

Telemedicine and visit completion among people with HIV during the COVID-19 pandemic compared to pre-pandemic

During the COVID-19 public health emergency, telemedicine visit completion among people with HIV increased significantly, especially among populations with lower pre-pandemic engagement.

• Walid G El-Nahal, Nicola M Shen, Jeanne C Keruly, Joyce L Jones, Anthony T Fojo, Bryan Lau, Yukari C Manabe, Richard D Moore, Kelly A Gebo, Catherine R Lesko, Geetanjali Chander

Empowerment through technology: A systematic evaluation of the content and quality of mobile applications to empower individuals with cancer

Mobile health application availability has increased for cancer patients due to a focus on patient empowerment. This systematic review evaluates and summarizes the evidence of mobile health apps and their characteristics and qualities. The evaluation found that cancer patient apps should be designed for usability and usefulness for a diverse group.

• Teresa Hagan Thomas, Kailey Go, Kelsey Go, Natalie Jane McKinley, Kayla R Dougherty, Kai-Lin You, Young Ji Lee
• February 2022

Evaluation of Online Patient Portal vs Text-Based Blood Pressure Monitoring Among Black Patients With Medicaid and Medicare Insurance Who Have Hypertension and Cardiovascular Disease

There is a considerable issue of unmonitored hypertension and cardiovascular disease among Black patients. Twenty Black patients with Medicaid and Medicare insurance who have hypertension and cardiovascular disease (CVD) or CVD risk factors were enrolled in this randomized pilot clinical trial. Researchers assessed the increased use and acceptability of a text-based model for home blood pressure (BP) monitoring compared with online portal use. When combined with telemonitoring, self measured BP is associated with improved BP control, although disparities in telemedicine access may limit the beneficial outcomes of home BP monitoring for Black patients.

• Lauren A Eberly, Monika Sanghavi, Howard M Julien, Laura Burger, Neel Chokshi, Jennifer Lewey

National Survey Trends in Telehealth Use in 2021: Disparities in Utilization and Audio vs. Video Services

This report analyzes national trends in telehealth utilization and how use of video-enabled vs. audio-only telehealth services differ across patient populations. The study finds notable disparities by race, ethnicity, income, age, and insurance status in access to video-enabled telehealth.

• Madjid Karimi, Euny C. Lee, Sara J. Couture, Aldren Gonzales, Violanda Grigorescu, Scott R. Smith, Nancy De Lew, Benjamin D. Sommers

Telehealth Exercise Intervention in Older Adults With HIV: Protocol of a Multisite Randomized Trial

This study aims to successfully develop a synchronous telehealth exercise intervention program for people with HIV to improve cardiorespiratory fitness.

• Krisann K. Oursler, Vincent C. Marconi, Brandon C. Briggs, John D. Sorkin, Alice S. Ryan

Telehealth Utilization During the COVID-19 Pandemic: A Preliminary Selective Review

During the COVID-19 pandemic, in-person health care visits dramatically decreased, and the utilization of telehealth services increased. The purpose of this study is to examine various patterns in telehealth utilization based off certain factors, including geographical location, type of health care service, and a patient’s age, race, and income.

• Amelia Harju, Jonathan Neufeld

Understanding Caregiver Satisfaction with a Telediagnosis Assessment of Autism Spectrum Disorder

Access to providers who are qualified to diagnose autism-spectrum disorder (ASD) is challenging for parents of children who show signs of ASD. Telehealth has increasingly been used as a resource to decrease the wait time for early diagnosis and increase timely access to services. Overall, caregivers were satisfied with telediagnostic assessment, but the researchers identified variation including experience and accuracy of the diagnosis.

• Maranda K Jones, Matthew A Zellner, Amanda N Hobson, Amy Levin, Megan Y Roberts

A Pilot Study Examining Access to and Satisfaction with Maternal Mental Health and Substance Use Disorder Treatment via Telemedicine

It is common for women to experience mental health problems and substance use disorders (SUDs) while pregnant and during the postpartum year. Unfortunately, many women are not able to receive proper treatment for these problems due to barriers to care, but using telehealth as a tool to increase access is one way to combat this. This study was conducted to evaluate patient satisfaction with their accessibility to proper treatment for these disorders, as well as their experiences with this care being delivered via telehealth. Results show that women receiving mental health and SUD treatment via telemedicine within their obstetrician's office had high levels of satisfaction, and that it significantly increased access to care.

• National Institutes of Health; Health Resources and Services Administration
• Constance Guille, Emily Johnson, Edie Douglas, Rubin Aujla, Lisa Boyars, Ryan Kruis, Rebecca Beeks, Kathryn King, Dee Ford, Katherine Sterba
• January 2022

Evaluation of a telemedicine pilot program for the provision of HIV pre-exposure prophylaxis in the Southeastern United States

In this telePrEP feasibility study, adherence to PrEP remained high and most participants preferred telemedicine or a combination of telemedicine and in-person office visits to only in-person office visits. Without this program, many participants were unlikely to have received PrEP.

• Marty S Player, Nicole A Cooper, Suzanne Perkins, Vanessa A Diaz

Experiences with Telemedicine for HIV Care During the COVID-19 Pandemic: A Mixed-Methods Study

People with HIV and clinical staff perceive telemedicine visits as useful, with benefits including the ability to engage and re-engage patients in care, perceived patient-centeredness and flexibility, the opportunity to engage family and multidisciplinary care team members, and the opportunity to enhance telemedicine use proficiency through practice and support.

• Dini Harsono, Yanhong Deng, Sangyun Chung, Lydia A Barakat, Gerald Friedland, Jaimie P Meyer, Elizabeth Porter, Merceditas Villanueva, Michael S Wolf, Jessica E Yager, E Jennifer Edelman

Patient Experience with In-Person and Telehealth Visits Before and During the COVID-19 Pandemic at a Large Integrated Health System in the United States

The positive experiences with telehealth reported in this study, especially video based telehealth, may be due to patient appreciation of efforts made to maintain access during the COVID-19 public health emergency, the focused nature of telehealth visits, and help by staff for navigation technical issues.

• Ron D Hays, Samuel A Skootsky

Rapid Implementation of a Telemedicine Program in a Ryan White–Funded HIV Clinic During a Global Pandemic

With the introduction of telemedicine in an HIV clinic, the average monthly number of patient encounters increased, the mean no-show rate decreased, and viral suppression increased. Patient satisfaction also increased during this period.

• Peter T Ender, Rebecca H Markson, Ambuj Suri, Katey Ruppert, Nichole Padron, Jill C Stoltzfus, Victoria Berges, Rajika Reed

Tele-Audiology: Current State and Future Directions

Tele-audiology can reduce barriers to hearing care by increasing access to care and reducing barriers such as time and travel. This study reviewed existing literature that found audiology services like hearing screenings, diagnostic tests, and rehabilitation can be safely delivered via telehealth and increase access to individuals who may otherwise have limited access to a hearing specialist.

• Kristin L D’Onofrio, Fan-Gang Zeng

The Changing Nature of Telehealth Use by Primary Care Physicians in the United States

The use of telehealth by primary care providers has evolved over the past several years. Using survey data, this study examined changes in the use of telehealth by primary care physicians. The study delineated physician characteristics associated with primary care providers that plan to continue using telehealth versus those who indicated that they are likely to discontinue the use of telehealth.

• Timothy Callaghan, Carly McCord, David Washburn, Kirby Goidel, Cason Schmit, Tasmiah Nuzhath, Abigail Spiegelman, Julia Scobee

Use of Telehealth Services for Prenatal Care in Mississippi: Comparison of Pre-COVID-19 Pandemic and Pandemic Obstetric Management

There has been little research to examine the use of telehealth during the COVID-19 public health emergency and its impact on the delivery of care during pregnancy and outcomes associated with pregnancy. This study examines prenatal care practices during the height of the first wave of the COVID-19 public health emergency, compared to the immediate pre-pandemic time period, and explores maternal and birth outcomes during these time periods.

• Jennifer C Reneker, Yunxi Zhang, Dorthy K Young, Xiaojian Liu, Elizabeth A Lutz

Brief Report: Supporting Access to HIV Care for Children and Youth During the COVID-19 Pandemic With Telemedicine and Rideshare

Telemedicine has the potential to bridge pediatric health care gaps. Telemedicine combined with rideshare support ensured uninterrupted access to HIV care among pediatric and adolescent patients.

• Wei Li A Koay, Supriya Prabhakar, Anne Neilan, Joanna Meyers, Nara Lee, Natella Rakhmanina
• December 2021

Medicare Beneficiaries’ Use of Telehealth in 2020: Trends by Beneficiary Characteristics and Location

This research report examines changes in Medicare fee-for-service Part B visits and the use of telehealth in 2020 during the COVID-19 public health emergency by beneficiary characteristics, provider specialty, and location.

• Lok Wong Samson, Wafa Tarazi, Gina Turrini, Steven Sheingold

Patient and Provider Perspectives on Pediatric Telemedicine During the COVID-19 Pandemic

The COVID-19 pandemic led to rapid expansion of telemedicine services, and the purpose of this study is to better understand perceptions of telemedicine and compare parent/guardian satisfaction between in-person and telemedicine encounters.

• Sophie E Katz, Preston Spencer, Christine Stroebel, Lora Harnack, Jason Kastner, Ritu Banerjee

Technology Support Challenges and Recommendations for Adapting an Evidence-Based Exercise Program for Remote Delivery to Older Adults: Exploratory Mixed Methods Study

During the pandemic, a growing number of older adults with chronic conditions accessed exercise classes through videoconferencing technology to help meet their clinician’s recommendations for fitness. While users of a tele-exercise program found it helpful, technology barriers such as access to a webcam, experience using videoconferencing, and ability to troubleshoot technology were identified as barriers to participation.

• Nancy Gell, Elise Hoffman , Kushang Patel

Telehealth for HIV Care Services in South Carolina: Utilization, Barriers, and Promotion Strategies During the COVID-19 Pandemic

Telehealth was used to provide a wide array of medical and supportive HIV services, including case management, support groups, housing, food, and transportation services. Staff education, cell phone distribution, client empowerment and technology use guidance, bureaucracy and process adjustments, and reimbursement changes are all strategies that could further facilitate telehealth use to deliver care and treatment to people with HIV.

• Valerie Yelverton, Shan Qiao, Sharon Weissman, Bankole Olatosi, Xiaoming Li

Bringing Iowa TelePrEP to Scale: A Qualitative Evaluation

Regional partnerships between public health organizations and telehealth programs have the potential to expand access to HIV pre-exposure prophylaxis in rural and small urban areas, but the best practices on how to successfully conduct these partnerships are unknown. Iowa TelePrEP is a regional public health‒partnered telehealth model created by the Iowa Department of Public Health and the University of Iowa to assess barriers and facilitators to statewide expansion and the lessons learned in the process. The facilitators of expansion included early public health partner engagement, model acceptability and inclusion of a navigator, and adaptability to local public health partner settings.

• Emily E Chasco, Cody Shafer, Dena M B Dillon, Seth Owens, Michael E Ohl, Angela B Hoth
• November 2021

Development and Preliminary Feasibility of iByte4Health: A Mobile Health (mHealth) Pediatric Obesity Prevention Intervention to Engage Parents with Low-Income of Children 2-9 Years

Pediatric obesity continues to be a major public health concern with minority, low-income youth most at risk. This study assesses the use of mobile health (mHealth) programs such as iByte4Health, a text-messaging based obesity prevention program. The goal of iByte4Health is to deliver patent and child-focused content which encourages conversations towards key health behaviors, goals, and behavioral changes.

• Gina L Tripicchio, Melissa Kay, Sharon Herring, Travis Cos, Carolyn Bresnahan, Danielle Gartner, Laura Stout Sosinsky, Sarah B Bass

Georgia Leverages Telehealth to Expand HIV Care Management in Underserved Areas

In Georgia, HIV telehealth has been successful at bridging gaps in patient care and in training local providers to offer comprehensive HIV care. A total of 60 telemedicine solutions were deployed in Georgia to expand HIV care access in 12 Georgia health districts. Among Ryan White HIV/AIDS Program clients who had a telehealth visit, 99.4% were prescribed antiretroviral therapy and 91.4% were virally suppressed.

• Suleima Salgado, Gregory Felzien, Jared Brumbeloe

Implementation of Telehealth Services in Rural Schools: A Qualitative Assessment

Many rural areas have a shortage of health care professional to meet the needs of the community. Several schools located in rural areas have implemented telehealth solutions to address the unmet health needs of students. This study captures insights from telehealth programs funded through the School-Based Telehealth Network Grant Program to identify facilitators and barriers to inform implementation of telehealth programs in rural schools.

• Kimberly Fox, Amanda Burgess, Martha Elbaum Williamson, John Massey, George Shaler, Karen Pearson, Jennifer MacKenzie, Kimberly Merchant, Xi Zhu, Marcia Ward

Telehealth Competencies for Nursing Education and Practice

Telehealth has seen significant growth as a health care delivery method, specifically among advanced practice nurses. With lack of standardized telehealth training, advanced practice nurses are not equipped to maximize use of telehealth to provide care for patients. In this research, the Four P’s of Telehealth framework (planning, preparing, providing, and performance evaluation) was used to identify, develop, and evaluate telehealth competencies. Effective use of these competencies to guide training development will provide the necessary education and tools needed to assume leadership roles in all phases of telehealth implementation and delivery.

• Carolyn M Rutledge, Jennifer O’Rourke, Anne M Mason, Katherine Chike-Harris, Lyn Behnke, Lolita Melhado, Loureen Downes, Tina Gustin
• October 2021

Trends in Outpatient Telemedicine Utilization Among Rural Medicare Beneficiaries, 2010-2019

In a study of 10.4 million rural Medicare beneficiaries, researchers discovered continuous growth in telemedicine use among Medicare beneficiaries with a disproportionate share of all telemedicine visits for serious mental illness (e.g., bipolar disorder) between 2010 and 2019 – especially for care provided by nurse practitioners and other non-physician clinicians.

• Michael L. Barnett, Haiden A. Huskamp, Alisa B. Busch, Lori Uscher-Pines, Krisda H. Chaiyachati, Ateev Mehrotra

Employing telehealth within HIV care: advantages, challenges, and recommendations

While the COVID-19 pandemic added new challenges within the medical field, it also presented new opportunities, such as catalyzing the implementation of telehealth within spaces that offer care for people living with HIV, substance use disorders, and various behavioral health problems.

• Melissa Grove, L. Lauren Brown, Hannan K. Knudsen, Erika G. Martin, Bryan R. Garner

State Medicaid Telehealth Policies Before and During the COVID-19 Public Health Emergency

The pandemic led to an expansion of telehealth access for individuals receiving Medicaid across the United States. Based on Medicaid claims data, the authors discuss the growth in telehealth use by Medicaid and Children’s Health Insurance Program (CHIP) recipients. The report also analyzes state policies for telehealth reimbursement under Medicaid and discusses how these changes are likely to impact access and health equity.

• Rose C Chu, Christie Peters, Nancy De Lew, Benjamin D Sommers

Keeping Pace With 21st Century Healthcare: A Framework for Telehealth Research, Practice, and Program Evaluation in Occupational Therapy

The use of telehealth in occupational therapy is steadily increasing, but there is little framework around the evaluation of these services. This study introduces the PACE Framework, which aims to support researchers and practitioners in systematically evaluating components of telehealth service delivery in occupational therapy through population and health outcomes, access for all clients, costs and cost-effectiveness, and the experiences of clients and occupational therapy practitioners.

• Lauren M. Little, Kristen A. Pickett, Rachel Proffitt, Jana Cason

This study examines telehealth utilization for HIV services in South Carolina, identifies barriers to telehealth during the COVID-19 public health emergency, and investigates strategies to facilitate remote HIV care delivery.

Telehealth for the Treatment of Serious Mental Illness and Substance Use Disorders

This guide reviews the research on the effectiveness of using telehealth for serious mental illness and substance abuse disorders. It makes recommendations for practice and provides examples of how practitioners use these practices in their programs.

Seeing the Value of Video: A Qualitative Study on Patient Preference for Using Video in a Veteran Affairs Telemental Health Program Evaluation

A web-based treatment program for veterans utilizes video visits with mental health experts to conduct online cognitive behavioral therapy that targets treating clinically significant symptoms of depression and post-traumatic stress disorder. This program evaluated whether or not veterans thought that using video during these sessions is important, and why it may or may not be important. Results show that being able to visually see a provider has distinct benefits for care and the patient-provider relationship, which gives important information for future telehealth use when debating whether to use video or phone for remote care.

• Patricia V Chen, Ashley Helm, Terri Fletcher, Miryam Wassef, Julianna Hogan, Amy Amspoker, Marylene Cloitre, Jan Lindsay

Comparative effects of telephone versus in-office behavioral counseling to improve HIV treatment outcomes among people living with HIV in a rural setting

People with HIV at risk for discontinuing HIV care and treatment failure living in rural areas expressed a preference for telephone-delivered behavioral counseling and those who received telephone counseling completed a greater number of sessions.

• Seth C Kalichman, Harold Katner, Lisa A Eaton, Ellen Banas, Marnie Hill, Moira O Kalichman

Evaluation of an Intrahospital Telemedicine Program for Patients Admitted With COVID-19: Mixed Methods Study

In this study, virtual care was associated with reductions in personal protective equipment use, reductions in COVID-19 exposure risk, and patient and provider satisfaction.

• Sean Legler, Matthew Diehl, Brian Hilliard, Andrew Olson, Rebecca Markowitz, Christopher Tignanelli, Genevieve B Melton, Alain Broccard, Jonathan Kirsch, Michael Usher

Use of Telehealth in Substance Use Disorder Services During and After COVID-19: Online Survey Study

This study investigated the widespread adoption of telephone and video technologies for delivering treatment for substance use disorders (SUDs) during the COVID-19 pandemic. The study looked at the acceptance and intent to use telehealth among service providers beyond the pandemic. Findings revealed high utilization rates of telehealth services across different SUD treatment modalities, with organizations expressing intent to continue using telehealth post-pandemic. The study highlighted the influence of perceived usefulness and ease of use on the acceptance of telehealth, emphasizing their potential for sustained application in SUD care.

• Todd Molfenter, Nancy Roget, Michael Chaple, Stephanie Behlman, Olivia Cody, Bryan Hartzler, Edward Johnson, Maureen Nichols, Patricia Stilen, Sara Becker
• February 2021

Evaluation of Pragmatic Telehealth Physical Therapy Implementation During the COVID-19 Pandemic

The goal of this study is to evaluate the implementation of telehealth physical therapy in response to COVID-19 and identify strategies to maintain and scale up its use in a large urban academic medical center. The results indicate that telehealth physical therapy was utilized and accessible during the COVID-19 pandemic, providing guidance for future initiatives to expand its use and study in physical therapy through health policy, quality improvement, and implementation science efforts.

• Matthew J Miller, Sang S Pak, Daniel R Keller, Deborah E Barnes
• January 2021

HRSA's Evidence-Based Tele-Emergency Network Grant Program: Multi-site Prospective Cohort Analysis Across Six Rural Emergency Department Telemedicine Networks

Six rural hospital systems received grants from HRSA to study how their emergency telehealth departments affect outcomes for patients. Telehealth was often the patient’s first point of contact and usually resulted in a transfer to a distant hospital or local inpatient facility. Findings suggest that emergency telehealth plays an important role in improving access for rural emergency patients.

• Sarah Heppner, Nicholas Mohr, Knute Carter, Fred Ullrich, Kimberly Merchant, Marcia Ward

The Future of Telehealth in School-Based Health Centers: Lessons from COVID-19

A qualitative analysis of nationally-led "Listening and Learning" sessions by the School-Based Health Alliance revealed substantial innovation and expansion of telehealth services due to COVID-10. School-based health programs were shown to reduce barriers to health care access, protect the most vulnerable, and decrease the spread of disease. Telehealth implementations in schools may also help keep youth from emergency departments and provide needed mental health care.

• Anna Goddard, Erin Sullivan, Paula Fields, Suzanne Mackey

The Provision of Counseling to Patients Receiving Medications for Opioid Use Disorder: Telehealth Innovations and Challenges in the Age of COVID-19

Medications for opioid use disorders (MOUD) combined with behavioral health therapy is an effective approach for the treatment of patients with a substance use disorder (SUD). During the COVID-19 pandemic, the government enacted waivers that allowed behavioral health care for SUD, including prescribing and refilling MOUD to be delivered virtually. This article reviews how these changes have impacted access and describes the need to identify models for hybrid care of patients with SUD in the future.

• Jaclyn MW Hughto, Lisa Peterson, Nicholas S Perry, Alex Donoyan, Matthew J Mimiaga, Kimberly M Nelson, David W Pantalone

Patient Characteristics Associated With Telemedicine Access for Primary and Specialty Ambulatory Care During the COVID-19 Pandemic

Telemedicine use has expanded since the onset of the COVID-19 pandemic, and the purpose of this study was to evaluate what inequities may exist in its design. Among patients scheduled for primary care and ambulatory telemedicine visits, differences were seen in rates of telemedicine and video use.

• Lauren A Eberly, Michael J Kallan, Howard M Julien, Norrisa Haynes, Sameed Ahmed M Khatana, Ashwin S Nathan, Christopher Snider, Neel P Chokshi, Nwamaka D Eneanya, Samuel U Takvorian, Rebecca Anastos-Wallen, Krisda Chaiyachati, Marietta Ambrose, Rupal O'Quinn, Matthew Seigerman, Lee R Goldberg, Damien Leri, Katherine Choi, Yevginiy Gitelman, Daniel M Kolansky, Thomas P Cappola, Victor A Ferrari, C William Hanson, Mary Elizabeth Deleener, Srinath Adusumalli
• December 2020

Maternal Telehealth Access Project (MTAP) Report on Community Grant Program

The Maternal Telehealth Access Project (MTAP) was launched to ensure that quality telehealth prenatal and postpartum services are accessible and available in underserved communities during the COVID-19 public health emergency. Increased access to perinatal services and support via telehealth, including clinical care, care coordination, support, and doulas/community health workers leads to improved clinical outcomes for moms and babies.

• Leslie deRosset, Sarah Verbiest, Dorothy Cilenti, Dawn Godbolt, Kelli Sheppard
• November 2020

Telebehavioral Health Use Among Rural Medicaid Beneficiaries: Relationships with Telehealth Policies

This study examines Medicaid telehealth policies and telebehavioral health use among rural fee-for-service (FFS) patients. It finds that rural Medicaid FFS beneficiaries may have better access to telebehavioral health services when they give informed consent in a provider setting.

• Jean Talbot, Yvonne Jonk, Amanda Burgess, Deborah Thayer, Erika Ziller, Nathan Paluso, Andrew Coburn
• October 2020

Telehealth Use in a Rural State: A Mixed Methods Study Using Maine's All-Payer Claims Database

The expansion of telehealth in Maine is partly driven by Medicare patients. This research suggests telehealth is improving access to behavioral health and speech-language pathology. Telehealth is limited, however, by access problems including provider shortages, lack of broadband, and other insurance coverage like Medicare and commercial policies.

• Yvonne Jonk, Martha Williamson, Deborah Thayer, Jennifer MacKenzie, Catherine McGuire, Kimberley Fox, Andrew Coburn

Environmental Scan on Telehealth in the Context of Alternative Payment Models (APMs) and Physician-Focused Payment Models (PFPMs)

This publication explores the integration of telehealth within Medicare's alternative payment models (APMs) and physician-focused payment models (PFPMs). The study examines the evolution of telehealth coverage and reimbursement policies under Medicare and Medicaid, discusses the effectiveness of telehealth interventions across various clinical settings, and identifies key issues and opportunities for optimizing telehealth integration within APMs and PFPMs, including challenges related to billing, interoperability, and patient-centered care.

• September 2020

Leveraging Digital Platforms to Scale Health Care Workforce Development: The Career 911 Massive Open Online Course

A massive open online course (MOOC) called Career 911 was created to encourage students from diverse backgrounds to explore health-related professions.

• Melissa A Simon, Shaneah Taylor, Laura S Tom

Telepsychiatric Consultation as a Training and Workforce Development Strategy for Rural Primary Care

There is a shortage of rural primary care personnel with expertise in team care for patients with common mental disorders. This research investigated the feasibility of regular systematic case reviews through telepsychiatric consultation, within collaborative care for depression, as a continuous training and workforce development strategy in rural clinics.

• Morhaf Al Achkar, Ian M. Bennett, Lydia Chwastiak, Theresa Hoeft, Tre Normoyle, Melinda Vredevoogd, Davis G. Patterson

Averted Transfers in Rural Emergency Departments Using Telemedicine: Rates and Costs Across Six TeleED Networks

Using telemedicine in rural emergency departments saved an average of $2,673 per patient by avoiding transport costs. The majority of the cost savings went to public insurance.

• Marcia Ward, Knute Carter, Fred Ullrich, Kimberly Merchant, Nabil Natafgi, Xi Zhu, Paula Weigel, Sarah Heppner, Nicholas Mohr
• August 2020

Outcomes of a Rapid Adolescent Telehealth Scale-Up During the COVID-19 Pandemic

In response to the COVID-19 public health emergency, health systems needed to quickly transition from in-person visits to telehealth. This study examines the unique challenges within adolescent medicine during this transition, such as patient confidentiality during digital communication and multidisciplinary care teams learning to use video formats.

• Sarah M. Wood, Krishna White, Rebecka Peebles, Julia Pickel, Maryam Alausa, Jamie Mehringer, Nadia Dowshen

A telehealth lifestyle intervention to reduce excess gestational weight gain in pregnant women with overweight or obesity (GLOW): a randomised, parallel-group, controlled trial

Significant weight gain in pregnancy among overweight or obese women increases their already elevated risk of having gestational diabetes, a cesarean delivery, and post-partum weight retention. It also increases the chances of a larger infant and the child's risk of obesity. This research investigated whether a telehealth lifestyle intervention reduced excess weight gain in participants.

• Assiamira Ferrara, Monique M Hedderson, Susan D Brown, Samantha F Ehrlich, Ai-Lin Tsai, Juanran Feng, Maren Galarce, Santica Marcovina, Patrick Catalano, Charles P Quesenberry

Process of Identifying Measures and Data Elements for the HRSA School-Based Telehealth Network Grant Program

An analysis of the School-Based Telehealth Network Grant Program’s initiatives to measure the effect that telehealth has on the quality of healthcare services offered in schools. The project also aimed to identify a common set of measures that could assess school-based telehealth services, utilization, processes, and outcomes.

• Marcia Ward, Kimberley Fox, Kimberly Merchant, Amanda Burgess, Fred Ullrich, Karen Pearson, George Shaler, Christopher Shea, Steve North, Carlos Mena

Project Moxie: Results of a Feasibility Study of a Telehealth Intervention to Increase HIV Testing Among Binary and Nonbinary Transgender Youth

Because transgender youth have low rates of engagement in HIV prevention, Project Moxie tested the feasibility of an intervention that provides home-based HIV self-testing combined with video-chat counseling.

• Rob Stephenson, Kieran Todd, Erin Kahle, Stephen Sullivan, Michael Miller-Perusse, Akshay Sharma, Keith Horvath

Telehealth with remote blood pressure monitoring compared with standard care for postpartum hypertension

Hypertensive disorders of pregnancy (HDP) affect 10% of the pregnancies in the United States and are the most common reason for postpartum hospital readmissions. This study considers whether postpartum home telehealth with remote blood pressure monitoring could reduce the readmission rates during the first 6 weeks postpartum in women with HDP.

• Kara Kjersten Hoppe, Nicole Thomas, Melissa Zernick, Julia B Zella, Thomas Havighurst, KyungMann Kim, Makeba Williams, Brenda Niu, Ali Lohr, Heather M Johnson

Emergency Department Telemedicine Consults are Associated with Faster Time-to-ECG and Time-to-Fibrinolysis for Myocardial Infarction Patients

Heart attack is a common and deadly event that requires treatment as soon as possible. Telemedicine can improve how quickly heart attacks are diagnosed and treated in rural hospitals.

• Aspen Miller, Marcia Ward, Fred Ullrich, Kimberly Merchant, Morgan Swanson, Nicholas Mohr
• February 2020

PrEPTECH: a telehealth-based initiation program for human immunodeficiency virus pre-exposure prophylaxis in young men of color who have sex with men. A pilot study of feasibility.

This pilot study uses a telehealth-based approach to pre-exposure prophylaxis (PrEP) initiation as a solution to barriers such as stigma, cost, adherence concerns, and medical distrust.

• Oliver N. Refugio, Mabel M. Kimble, Cara L. Silva, James E. Lykens, Christian Bannister, Jeffrey D. Klausner
• January 2020

Provider-to-Provider Telemedicine Improves Adherence to Sepsis Bundle Care in Community Emergency Departments

Sepsis occurs when an infection reaches the bloodstream and getting care quickly improves the chances of survival. In this study, telemedicine in the emergency department improved the rates of adhering to the sepsis treatment protocol. The timely replacement of fluids and the administration of antibiotics greatly improved sepsis care at rural community hospitals.

• Nicholas Mohr, Kaylyn Campbell, Morgan Swanson, Fred Ullrich, Kimberly Merchant, Marcia Ward

Treatment of Opioid Use Disorder in Pregnant Women via Telemedicine: A Nonrandomized Controlled Trial

Increased rates of maternal and infant morbidity and mortality are associated with opioid use disorder (OUD). The use of telehealth for maternal care practices for pregnant and postpartum individuals can improve access to care and telehealth services, while reducing the effects of OUD. However, additional evaluation is required before expanding this health care delivery method.

• Constance Guille, Annie N Simpson, Edie Douglas, Lisa Boyars, Kathryn Cristaldi, James McElligott, Donna Johnson, Kathleen Brady

Emergency Department Telemedicine Consults Decrease Time to Interpret Computed Tomography of the Head in a Multi-Network Cohort

A study of emergency telemedicine (tele-ED) for stroke care in four tele-ED networks. Tele-ED was associated with decreased time to diagnostic imaging interpretation and time to thrombolytic medication.

• Morgan Swanson, Aspen Miller, Marcia Ward, Fred Ullrich, Kimberly Merchant, Nicholas Mohr
• November 2019

Tele-Emergency Behavioral Health in Rural and Underserved Areas

Severe shortages of behavioral health specialists in rural and underserved areas make placing patients in appropriate facilities difficult. This paper describes two different emergency departments in the Midwest using telemedicine to address behavioral health access and placement for patients in rural and underserved areas. Findings suggest that transfer to in-patient facilities was much higher in both models when using telemedicine.

• Paula Weigel, Divya Bhagianadh, Kimberly Merchant, Amy Wittrock, Hicham Rahmouni, Amanda Bell, Stephanie Laws, Marcia Ward

A Postpartum Remote Hypertension Monitoring Protocol Implemented at the Hospital Level

This study evaluated using remote blood pressure monitoring on postpartum women with hypertension when they leave the hospital. It found that remote monitoring of this type showed high patient compliance, retention, and satisfaction.

• Alisse Hauspurg, Lara S Lemon, Beth A Quinn, Anna Binstock, Jacob Larkin, Richard H Beigi, Andrew R Watson, Hyagriv N Simhan
• October 2019

The Use of Telehealth in School-Based Health Centers

School-based telehealth programs can expand health care access to rural and underserved youth by eliminating barriers to access, such as transportation. This article describes characteristics of School-Based Telehealth Centers using technology to add to the access of care beyond onsite providers for underserved communities.

• Hayley Love, Nirmita Panchal, John Schlitt, Caroline Behr, Samira Soleimanpour

Development of a tailored, telehealth intervention to address chronic pain and heavy drinking among people with HIV infection: integrating perspectives of patients in HIV care

Chronic pain and heavy drinking commonly co-occur and can influence the course of HIV, but there have been no interventions designed to address both conditions among people living with HIV. This study aims to better understand pain symptoms, patterns of alcohol use, treatment experiences, and technology use in order to tailor a telehealth intervention that will address all these conditions.

• Tibor P. Palfai, Jessica L. Taylor, Richard Saitz, Maya P. L. Kratzer, John D. Otis, Judith A. Bernstein
• August 2019

The Use of and Experiences With Telelactation Among Rural Breastfeeding Mothers: Secondary Analysis of a Randomized Controlled Trial

Telelactation services connecting breastfeeding mothers to lactation consultants increase access to professional breastfeeding support in rural areas. This research shows both high demand for and positive experiences with these telehealth services in an underserved population.

• Kandice Kapinos, Virginia Kotzias, Debra Bogen, Kristin Ray, Jill Demirci, Mary Ann Rigas, Lori Uscher-Pines

Telehealth and texting intervention to improve HIV care engagement, mental health and substance use outcomes in youth living with HIV: a pilot feasibility and acceptability study protocol

This study aims to evaluate the feasibility, acceptability, and preliminary clinical outcomes of a 12-session telehealth counseling series provided to young adults living with HIV that will include education, motivational enhancement and problem-solving around HIV care, mental health, substance use, and other challenges.

• Angie R Wootton, Dominique A Legnitto, Valerie A Gruber, Carol Dawson-Rose, Torsten B Neilands, Mallory O Johnson, Parya Saberi

Cell Phone Counseling Improves Retention of Mothers With HIV Infection in Care and Infant HIV Testing in Kisumu, Kenya: A Randomized Controlled Study

This study shows the effectiveness of cell phone counseling to keep pregnant women with HIV in care in Kisumu, Kenya. Phone counseling helps reach and retain pregnant women with HIV infection and postpartum mothers in care. It also improved infant HIV testing and antenatal and postnatal care services.

• United States Agency for International Development
• Avina Sarna, Lopamudra Ray Saraswati, Jerry Okal, James Matheka, Danmark Owuor, Roopal J Singh, Nancy Reynolds, Sam Kalibala

Randomized Controlled Trial of a Mobile Health Intervention to Promote Retention and Adherence to Preexposure Prophylaxis Among Young People at Risk for Human Immunodeficiency Virus: The EPIC Study

Young people are the least likely to use protection against sexually transmitting HIV. An interactive text-messaging intervention significantly increased the odds of using protection among young individuals at risk for getting HIV.

• Albert Y Liu, Eric Vittinghoff, Patricia von Felten, K Rivet Amico, Peter L Anderson, Richard Lester, Erin Andrew, Ixchell Estes, Pedro Serrano, Jennifer Brothers, Susan Buchbinder, Sybil Hosek, Jonathan D Fuchs

Text Messages Can Encourage Patients to Discuss and Receive HIV Testing in Primary Care

Regular HIV testing does not often happen in primary care visits. Providers want patients to ask for the test, as opposed to suggesting it themselves. This study finds that using a patient-centered text message campaign may prompt patients to discuss HIV testing with their physicians, thereby increasing HIV testing.

• Renata Wettermann, Haley Marek, Thomas P. Giordano, Monisha Arya

Pediatric tele-emergency care: A study of two delivery models

The study evaluates two tele-emergency department programs for pediatric patients with different designs, one general and one specialized. The study shows design choices affect how programs are evaluated and highlights the challenge of creating standard metrics.

• Paula A Weigel, Kimberly A S Merchant, Amy Wittrock, Jamie Kissee, Fred Ullrich, Amanda L Bell, James P Marcin, Marcia M Ward

The Third National Telemedicine & Telehealth Service Provider Showcase Conference: Advancing Telehealth Partnerships

The “Telemedicine & Telehealth Service Provider Showcase” (SPS) Conference, a national conference established in 2014, is a space for discussion on telehealth and relevant components of the telehealth services industry. Key topics shared in the SPS 2017 Conference include the following and more: development of effective partnerships; using telehealth services as a strategic asset; important reimbursement; direct-to-consumer initiatives; legislative and regulatory issues, and overall takeaways.

• Dale C Alverson, Elizabeth A Krupinski, Kristine A Erps, Nancy S Rowe, Ronald S Weinstein

Feasibility and acceptability of an online positive affect intervention for those living with comorbid HIV depression

This article presents pilot data of using an online intervention to improve the outlook of people living with both HIV and depression. The intervention was rated well by patients and was shown to be both acceptable and feasible to use.

• S. M. Bassett, M. Cohn, P. Cotten, I. Kwok, J. T. Moskowitz

Implementation Strategies for Telestroke: A Qualitative Study of Telestroke Networks in North Carolina

This study examines the adoption decision process and strategies employed during telestroke network development, implementation, and sustainability.

• Christopher Shea, Kea Turner, Amir Alishahi Tabriz, Steve North
• September 2018

Telestroke Adoption Among Community Hospitals in North Carolina: A Cross-Sectional Study

Telestroke is the use of telemedicine in stroke care. This study identifies community and hospital characteristics associated with adoption of telestroke among acute care hospitals in North Carolina.

• Christopher Shea, Amir Tabriz, Kea Turner, Steve North, Kristin Reiter

Telemedicine Use Decreases Rural Emergency Department Length of Stay for Transferred North Dakota Trauma Patients

Emergency department telemedicine consults for trauma patients were associated with faster hospital transfers and the increased use of radiography.

• Nicholas M. Mohr, J. Priyanka Vakkalanka, Karisa K. Harland, Amanda Bell, Brian Skow, Dan M. Shane, Marcia M. Ward

This paper is in the following e-collection/theme issue:

Published on 17.4.2024 in Vol 26 (2024)

Mobile Apps to Support Mental Health Response in Natural Disasters: Scoping Review

Authors of this article:

• Nwamaka Alexandra Ezeonu 1 , MBBS, MSc, MBA   ; 
• Attila J Hertelendy 2, 3 , BSc, MHS, MSc, PhD   ; 
• Medard Kofi Adu 4 , BSc, MSc   ; 
• Janice Y Kung 5 , BCom, LMIS   ; 
• Ijeoma Uchenna Itanyi 1, 6, 7 , MBBS, MPH   ; 
• Raquel da Luz Dias 4 , BSc, MSc, PhD   ; 
• Belinda Agyapong 8 , HDip, BSc, MEd   ; 
• Petra Hertelendy 9 , BS   ; 
• Francis Ohanyido 10 , MBBS, MBA, MPH   ; 
• Vincent Israel Opoku Agyapong 4 , BSc, PGD, MBChB, MSc, MD, PhD   ; 
• Ejemai Eboreime 4 , MBBS, MSc, PhD  

1 Center for Translation and Implementation Research, College of Medicine, University of Nigeria, Nsukka, Nigeria

2 Department of Information Systems and Business Analytics, College of Business, Florida International University, Miami, FL, United States

3 Department of Emergency Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States

4 Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada

5 Geoffrey and Robyn Sperber Health Sciences Library, University of Alberta, Edmonton, AB, Canada

6 Department of Community Medicine, University of Nigeria, Enugu, Nigeria

7 Department of Public Health Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada

8 Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada

9 Department of Psychology, Florida State University, Tallahassee, FL, United States

10 West African Institute of Public Health, Abuja, Nigeria

Corresponding Author:

Ejemai Eboreime, MBBS, MSc, PhD

Department of Psychiatry

Faculty of Medicine

Dalhousie University

5909 Veterans' Memorial Lane

8th Floor Abbie J Lane Memorial Building, QEII Health Sciences Centre

Halifax, NS, B3H 2E2

Phone: 1 9024732479

Email: [email protected]

Background: Disasters are becoming more frequent due to the impact of extreme weather events attributed to climate change, causing loss of lives, property, and psychological trauma. Mental health response to disasters emphasizes prevention and mitigation, and mobile health (mHealth) apps have been used for mental health promotion and treatment. However, little is known about their use in the mental health components of disaster management.

Objective: This scoping review was conducted to explore the use of mobile phone apps for mental health responses to natural disasters and to identify gaps in the literature.

Methods: We identified relevant keywords and subject headings and conducted comprehensive searches in 6 electronic databases. Studies in which participants were exposed to a man-made disaster were included if the sample also included some participants exposed to a natural hazard. Only full-text studies published in English were included. The initial titles and abstracts of the unique papers were screened by 2 independent review authors. Full texts of the selected papers that met the inclusion criteria were reviewed by the 2 independent reviewers. Data were extracted from each selected full-text paper and synthesized using a narrative approach based on the outcome measures, duration, frequency of use of the mobile phone apps, and the outcomes. This scoping review was reported according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews).

Results: Of the 1398 papers retrieved, 5 were included in this review. A total of 3 studies were conducted on participants exposed to psychological stress following a disaster while 2 were for disaster relief workers. The mobile phone apps for the interventions included Training for Life Skills, Sonoma Rises, Headspace, Psychological First Aid, and Substance Abuse and Mental Health Services Administration (SAMHSA) Behavioural Health Disaster Response Apps. The different studies assessed the effectiveness or efficacy of the mobile app, feasibility, acceptability, and characteristics of app use or predictors of use. Different measures were used to assess the effectiveness of the apps’ use as either the primary or secondary outcome.

Conclusions: A limited number of studies are exploring the use of mobile phone apps for mental health responses to disasters. The 5 studies included in this review showed promising results. Mobile apps have the potential to provide effective mental health support before, during, and after disasters. However, further research is needed to explore the potential of mobile phone apps in mental health responses to all hazards.

Introduction

Rising global average temperatures and associated changes in weather patterns result in extreme weather events that include hazards such as heatwaves, wildfires, hurricanes, floods, and droughts [ 1 ]. These extreme events linked to climate change are resulting in overlapping and so-called cascading disasters leading to record numbers of “billion dollar” disasters with significant losses of lives and property [ 2 , 3 ]. In 2021 alone, approximately 10,000 fatalities caused by disasters were reported globally, while the economic loss was estimated at approximately US $343 billion [ 4 ]. Disasters are predicted to become more recurring as a result of the impact of human activities such as burning fossil fuels and deforestation, which release greenhouse gases into the atmosphere that trap heat and cause global temperatures to rise [ 5 ].

These catastrophes can adversely affect physical health, mental health, and well-being in both the short and long term as a result of changes due to the political and socioeconomic content, evacuations, social disruption, damage to health care facilities, and financial losses [ 6 - 10 ]. It is estimated that about 33% of people directly exposed to natural disasters will experience mental health sequelae such as posttraumatic stress disorders (PTSDs), anxiety, and depression, among others [ 11 , 12 ].

There is growing recognition of the importance of incorporating mental health into medical and emergency aspects of disaster response [ 12 , 13 ]. However, in contrast to most medical response strategies that are largely curative, mental health response to disasters is predicated on the principles of preventive medicine, thus, emphasizing health promotion, disaster prevention, preparedness, and mitigation [ 14 ]. The strategies of mental health response span across primary prevention (mitigating the risk of ill health before it develops), secondary prevention (early detection and intervention), and tertiary prevention (managing established ailment and averting further complications) [ 15 ].

Mobile health (mHealth) technology has shown great promise in mental health and has been applied across the 3 levels of prevention [ 16 - 20 ]. For example, SMS text messaging and mobile apps have been developed to promote mental health awareness among young people and older adults (primary prevention) [ 21 ]. Additionally, during the COVID-19 pandemic, mHealth was deployed at the population level in Canada to screen for symptoms of anxiety and depression (secondary prevention) [ 22 ]. In addition, mHealth interventions were deployed to support first responders and essential workers during the pandemic [ 23 , 24 ]. Further, the technology has been deployed for therapeutic purposes in patients diagnosed with mental health conditions while simultaneously providing support against complications such as suicidal ideation (tertiary prevention) [ 25 ].

Although videoconferencing and phone calls can be used for mental health conditions, mobile apps provide more mobility and accessibility, are interactive, more adaptable to users’ routines, and can be used repeatedly [ 26 , 27 ]. While numerous academic studies have been conducted on the app of mHealth in the preventive and curative management of mental health conditions in clinical, community, and public health settings, including epidemic response and control, little is known about the use of mobile apps in the mental health components of natural disaster management. This scoping review aims to fill this gap in the literature by mapping where and how mobile apps have been used as part of natural disaster mental health response strategies.

This scoping review was reported according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) [ 28 ]. The PRISMA-ScR checklist is available in Multimedia Appendix 1 . The protocol was not registered.

Search Strategy

A medical librarian (JYK) collaborated with the research team to identify relevant keywords and subject headings for the review, such as mHealth or m-health; mobile health or mobile applications; public health emergency, disaster, or catastrophe; and flood, earthquake, or hurricane. Equipped with this knowledge, the librarian developed and executed comprehensive searches in 6 electronic databases, including Ovid MEDLINE, Ovid Embase, APA PsycInfo, CINAHL, Scopus, and Web of Science Core Collection. The search was conducted on June 30, 2022, and was limited to the English language. The full search strategies are available in Multimedia Appendix 2 .

Inclusion and Exclusion Criteria

We included papers that applied mobile apps for mental health responses to disasters. Papers were included if the study participants were persons affected by a natural disaster (setting), the intervention included using a mobile phone app, and the outcome included the assessment of a mental health problem. Studies in which participants were exposed to a man-made disaster were included if the sample also included some participants exposed to a natural disaster. The mental health conditions included were stress, anxiety, depression, and PTSD. Only full-text studies published in English were included. Studies that did not include any intervention with a mobile app for mental health, those focused on videoconferencing or phone calls, and papers on protocols, trial registration, or review were excluded.

Selection of Studies

The search identified papers that were retrieved from the databases. After removing duplicates, the initial titles and abstracts of the unique papers were screened by 2 independent review authors based on the inclusion criteria in a web-based tool called Covidence (Veritas Health Innovation Ltd) [ 29 ]. Full texts of the selected papers that met the inclusion criteria were reviewed by the 2 independent reviewers. The research team resolved disagreements through discussion. The bibliographies from the included studies were also reviewed to identify additional studies for inclusion.

Data Extraction and Synthesis

Data from each selected full-text paper were extracted into a data extraction form developed by the research team. The data included the author and year of publication, country of study, study design, number of participants, type of natural disaster, name of the mobile app, duration of use of the app, outcome measures, and the study’s findings. These data were synthesized using a narrative approach based on the outcome measures, the duration, frequency of use of the mobile apps, and the outcomes.

Search Results

Of the 1532 papers retrieved from the searches, 976 unique papers had their titles and abstracts screened after deduplication. A total of 38 papers were moved to full-text screening, and data were extracted from 5 papers [ 30 - 34 ] ( Figure 1 ). Table 1 shows the summary of the details of the papers.

a TLS: Training for Life Skills.

b PTSD: posttraumatic stress disorder.

c MBSR: Mindfulness-Based Stress Reduction.

d PFA: Psychological First Aid.

e SAMHSA: Substance Abuse and Mental Health Services Administration.

Characteristics of Included Studies

Of the 5 studies included in this review, 3 (60%) were conducted in the United States [ 30 , 31 , 34 ], while 2 (40%) were conducted in South Korea [ 32 , 33 ]. All studies used different study designs. A total of 3 studies used a quasi-experimental design—the first, a single group postexperiment with 22 participants [ 32 ]; the second, a multiple-baseline single case experimental design with 7 participants [ 30 ], while the third study used a 1-group pre- and posttest design with 318 participants [ 31 ]. The Training for Life Skills (TLS) app study had only a posttest following the use of the app [ 32 ]; the other 2 had baseline and follow-up measurements with the Sonoma Rises app study having, in addition, preintervention and postintervention measurements. The Psychological First Aid (PFA) study was designed as a qualitative study, while the Substance Abuse and Mental Health Services Administration (SAMHSA) study used a mixed methods descriptive design.

Characteristics of the Population

The TLS, Sonoma, and Headspace apps were designed for disaster survivors, while the PFA and SAMHA apps were designed to support disaster relief workers. The TLS app study was administered to adults with a median age of 32 years. Participants of the Sonoma Rises app study had a mean age of 16 (SD 0.98) years, while participants of the Headspace app study had a mean age of 46.1 (SD 10) years. The TLS app study focused on all types of disasters; the Sonoma Rises study focused on adolescents exposed to wildfires, while the Headspace app focused on women who experienced hurricanes and deep-water oil spillage. The PFA study involved 19 disaster health care workers who first underwent disaster simulation training using the mobile app.

Characteristics of the Mobile App Interventions

The included studies revealed several mobile phone apps used as interventions. The first, the TLS app, was used as a psychological first aid program for disaster survivors with content on information, psychological healing, and mood change [ 32 ]. The second was the Sonoma Rises app, a Health Insurance Portability and Accountability Act (HIPAA)–compliant, cloud-based mobile app with daily push notifications as reminders designed to help survivors of wildfires or other disasters to find their new routines, build resilience, and increase well-being. The app included 6 self-paced content sections, psychoeducation, and direct connections to free and local mental health care services. The third was the Headspace app for a mindfulness-based stress reduction program that included a series consisting of 10 sessions designed to be used for about 10 minutes per day. The SAMHSA Disaster App equips behavioral health providers to respond to all kinds of traumatic incidents by enabling them to readily access disaster-specific information and other important materials directly on their mobile devices [ 34 ]. The PFA mobile app provided evidence-based information and tools for disaster workers to prepare for, execute, and recover from providing psychological first aid during disasters. Accessibility via smartphones and the inclusion of multimedia interventions and assessments tailored for disaster contexts were key features enabling its use integrated with the simulation training [ 33 ].

Frequency and Duration of App Use

The 3 survivor-based apps had variations in the duration of the intervention (app use), which were 8 weeks, at least 5 times a week, frequency of use per day not specified [ 32 ]; 4 weeks for 10 minutes per day [ 30 ]; and 6 weeks for 5-10 minutes per day [ 31 ]. Both the TLS app and the Sonoma Rises app studies had weekly follow-up assessments. The different interventions were applied at least a year following the disasters. Participants in the Sonoma Rises app study used the app on an average of 17 (SD 8.92) days and visited the app an average of 43.50 (SD 30.56) times, with an average session lasting 56.85 (SD 27.87) seconds. The mean time spent on the app was 35.77 (SD 30.03) minutes, while for the TLS app study, the median time spent on the app over the 8 weeks of use was 200-399 minutes. Participants used the Headspace app an average of 24 (SD 36) days and logged in an average of 36 (SD 80) times. There was no description of the frequency and duration of use for the relief worker apps.

Effectiveness Outcomes

Effectiveness outcomes refer to the effects or impact of an intervention or program on the intended outcomes or goals. Different measures were used to assess the effectiveness of the apps’ use as either the primary or secondary outcome. Emotional quotients (emotional stability), basic rhythm quotients (brain stability), alpha-blocking rates (increased positive mood), and brain quotients assessed using electroencephalogram (EEG)–measured brainwave activities adjusted for self-reported app use time were used in the TLS app study [ 32 ]. The Headspace app study assessed effectiveness using a combination of measures such as trait mindfulness using a 15-item Mindful Attention Awareness Scale (MAAS)—trait version; depressive symptoms using the Center for Epidemiologic Studies Depression Scale-10 (CESD-10); perceived stress with the Perceived Stress Scale, 4-item version (PSS-4); and sleep quality using the Pittsburgh Sleep Quality Index (PSQI) [ 31 ]. The Sonoma Rises app study measured efficacy using daily ratings of anxiety and fear, weekly measures of post-traumatic stress symptoms using the Child PTSD Symptom Scale (CPSS-5) for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition ( DSM-5 ), internalizing and externalizing symptoms using the Behaviour and Feelings Survey (BFS), psychosocial functioning using the Ohio Scale for Youth—Functioning subscale (OSY), and measures of anxiety (Generalized Anxiety Disorder-7 [GAD-7]), depression (Patient Health Questionnaire-9 [PHQ-9]), well-being—Warwick-Edinburgh Mental Well-being Scale (WEMWBS), sleep (Insomnia—Severity Index [ISI]), academic engagement (Student Engagement Instrument [SEI]), and perceived social support (Wills’ Social Support Scale [WSSS]) [ 30 ].

All 3 survivor-based apps were found to have positive benefits in addressing mental health issues among persons exposed to natural disasters. The TLS mobile app was shown to be effective in increasing positive and decreasing negative psychological factors according to app use time. The TLS mobile apps’ use had a significant effect on the emotional quotients (β=.550; P <.008), explanatory power (EP) was 30%, had a significant positive effect on the basic rhythm quotient (left brain: β=.598; P <.003; EP 35; right brain: β=.451; P <.035; EP 20%). Additionally, it had a significant positive effect on the alpha-blocking rate (left brain: β=.510; P <.015; EP 26%; right brain: β=.463; P <.035, EP 21%); and a significant positive effect on the brain quotient (β=.451; P <.035; EP 20%) [ 16 ]. The Headspace app had a positive effect on depression (odds ratio [OR] 0.3, 95% CI 0.11-0.81), physical activity (OR 2.8, 95% CI 1.0-7.8), sleep latency (OR 0.3, 95% CI 0.11-0.81), sleep duration (OR 0.3, 95% CI 0.07-0.86), and sleep quality (OR 0.1, 95% CI 0.02-0.96); however, there was no change in mindfulness scores from baseline to follow-up. For the Sonoma Rises app, no significant effects were observed for the clinical and functional outcomes because the longitudinal part of the study was affected by limited statistical power as a result of small sample size and historical confounds that made the participants miss data submission. However, visual inspection of individual data following the intervention showed downward trends across the study phases for daily levels of anxiety, fearfulness, and individual posttraumatic stress symptom severity.

For the PFA app, the qualitative study explored disaster health workers’ experiences with simulation training using focus group discussions. A total of 19 participants engaged in disaster scenarios with standardized patients, using a PFA app for guidance. Workers valued the practical educational approach, felt increased self-efficacy to support survivors, and identified areas for enhancing simulations and app tools to optimize effectiveness.

Implementation Outcomes

Implementation outcomes refer to the effects of an intervention or program implementation on various aspects of the implementation process, such as the fidelity of implementation, acceptability, adoption, feasibility, and maintainability. In the papers reviewed, feasibility was assessed using enrollment, program participation, and retention. Acceptability was measured using how well participants liked the app using a rating scale, how much of the app program was completed, the biggest barriers, and whether the app would be recommended to others. Data on characteristics of app use (engagement) were measured using the total number of log ins, average log ins per program completer, platform used (iOS, Android, or web-based), day of week of use (weekday vs weekend), and time of day of use (in 4-hour blocks) [ 30 , 31 ].

The Headspace app was reported to be cost-effective to implement and easy to use [ 31 ]. For engagement, only 14% (43/318) of the enrolled women used the app. The level of engagement with the app was high, with 72% (31/43) of participants completing some or all the sessions. Retention was also high with 74% (32/43) of the participants completing the follow-up survey. Lack of time was cited as the main barrier to using the app for 37% (16/43) of users and 49% (94/193) of nonusers. The majority of the users (32/43, 74%) reported high levels of satisfaction with the app. Acceptability was also high, with most participants (32/43, 74%) reporting that they liked the app and 86% (37/43) reporting that they would recommend it to others. Characteristics of app use showed that of the 1530 log ins, most participants (n=1191, 78%) used the iOS platform, mainly on weekdays (n=1147, 75%) and at different times of day mostly from noon to 4 PM (n=375, 25%).

Sonoma Rises was found to be feasible in terms of engagement and satisfaction among teens with high levels of disaster-related posttraumatic stress symptoms [ 30 ]. The self-assessment and data visualization features of the Sonoma Rises app strongly appealed to all the participants, and they were willing to recommend the app to their friends. Self-satisfaction with the mobile app was rated as extremely high (mean 8.50, SD 0.58, on a scale of 0 to 10, with 10 as totally satisfied). The participants agreed or strongly agreed to recommend this intervention to a friend. The participants found the intervention helpful (mean 2, SD 0.82); had the content, functions, and capabilities they needed (mean 3, SD 1.12); and were satisfied with how easy it was to use the app (mean 2, SD 0), on a scale of 1 to 5 with 1 as strongly agree and 5 as strongly disagree. In the qualitative feedback, to make the use of the app better, the participants suggested more notifications to return to the app and the use of the app immediately after a disaster. Implementation outcome was not an objective of the TLS app, hence, none was reported.

Other Mobile Apps With Potential Use in Disasters

Some mobile apps not meeting the inclusion criteria showed promise for supporting mental health in disasters. PTSD Coach provides tools for managing PTSD symptoms [ 35 ]. Though not disaster-specific, its psychoeducation, symptom tracking, and coping strategies could aid survivors. Similarly, COVID Coach was designed to help manage pandemic-related stress and anxiety [ 36 ]. These apps are summarized in Table 2 .

a PTSD: posttraumatic stress disorder.

Principal Findings

This review sought to identify and map the use of mobile apps for the mental health component of natural disaster management. We found only 5 studies meeting the inclusion criteria. The scarcity of published literature in this area suggests that mobile apps have not been extensively used in mental health responses to natural disasters. Academic studies on the public’s use of mobile technologies in disaster management are still nascent [ 37 ], but there has been increased interest in developing and deploying digital technology and mobile apps by governments and nonstate actors as part of disaster preparedness and response [ 38 , 39 ]. A recent systematic review found that there is a lack of mental health preparedness in most countries when it comes to disasters [ 40 ]. The 5 studies included in our scoping review confirmed this gap and further demonstrated that mobile apps can provide mental health support to disaster-affected individuals and communities. The studies found that the use of mobile apps was associated with improvements in mental health outcomes, such as decreased anxiety and depression symptoms and increased resilience. The reviewed studies also suggest that mobile apps can be effective in delivering psychoeducation and coping skills training to disaster-affected individuals. A 2017 scoping review found that mobile apps have been largely used for communication purposes in disaster management [ 37 ]. The scope of use was classified into 5 categories which are not mutually exclusive. These categories are (1) crowdsourcing (organize and collect disaster-related data from the crowd), (2) collaborating platforms (serve as a platform for collaboration during disasters), (3) alerting and information (disseminate authorized information before and during disasters), (4) collating (gather, filter, and analyze data to build situation awareness), and (5) notifying (for users to notify others during disasters) [ 37 ].

Some authors classify disaster response into 3 phases: preparedness, response, and mitigation [ 41 ]. The studies included in this review exclusively examined the use of mobile apps during the recovery phase of disaster management. However, none of the studies explored the potential of mobile apps during the preparedness or response phases of disaster management. By addressing this gap, future research could help to provide more comprehensive and effective strategies for the use of mobile apps throughout all phases of disaster management. Examples of potential opportunities are demonstrated in Figure 2 .

Preparedness Phase

Mobile apps can play a critical role as primary prevention interventions by raising awareness and promoting mental health literacy in the community in preparation for natural disasters. These apps can provide information on common mental health problems that may arise during and after disasters and offer tips on staying mentally healthy. For example, apps can include psychoeducation modules on coping skills, stress reduction, and self-care techniques, as well as information on how to prepare for a disaster and what steps to take to protect one’s mental health during and after a disaster. The use and effectiveness of mobile apps in health literacy have been demonstrated in the literature [ 19 ], thus providing a foundation for adaptation in disaster management.

Response Phase

Mobile apps can be used to connect people in need of mental health support with mental health professionals or other resources. For example, apps can provide information on emergency hotlines, crisis intervention services, and support groups. This was demonstrated as effective during the COVID-19 pandemic [ 42 ]. Mobile apps can also provide coping strategies and techniques to manage stress and anxiety in response to other natural disasters [ 34 ]. In this scoping review, we found that 3 apps had positive benefits in addressing mental health issues among persons exposed to natural disasters.

Recovery Phase

As part of secondary and tertiary prevention strategies, mobile apps can provide valuable ongoing support to those affected by disasters. For secondary prevention, mobile apps can be designed to support early detection and intervention for mental health problems after a natural disaster. These apps can include screening tools to identify common mental health issues such as anxiety, depression, and PTSD and offer appropriate referral pathways [ 43 ]. Additionally, apps can provide symptom-tracking tools to help individuals monitor their mental health over time [ 43 ]. For tertiary prevention, mobile apps can support the ongoing management of established mental health problems after a natural disaster. For example, apps can provide evidence-based psychotherapy interventions, such as cognitive-behavioral therapy, to help individuals manage their symptoms [ 44 ]. They can also connect individuals with support groups and peer-to-peer networks to provide additional emotional support and help individuals connect with others who have experienced similar challenges. Furthermore, mobile apps can offer self-help tools, such as meditation exercises and mood tracking, to help people cope with the ongoing mental health effects of the disaster. They can also provide information on local mental health services and support groups, helping individuals access the resources they need to manage their mental health.

General Mental Health Apps Show Promise for Disaster Response

While not specifically designed for disaster contexts, some mobile apps demonstrate strategies to support mental health that could aid disaster survivors. PTSD Coach delivers PTSD psychoeducation, symptom tracking tools, coping skills training, and crisis resource access—elements that could help survivors experiencing common postdisaster issues like trauma or loss [ 35 ]. Though it was tailored for veterans and civilians with PTSD, 1 study found it improved users’ depression and functioning. Similarly, COVID Coach offered pandemic-related stress management through symptom tracking, healthy coping recommendations, and crisis line referrals [ 36 ]. By leveraging the scalability of mobile apps, COVID Coach reached many struggling during a global crisis. These examples illustrate that apps may provide accessible, far-reaching mediums for disseminating disaster mental health resources—even without disaster-specific tailoring. Research should further explore adapting evidence-based, general mental health apps for disaster contexts or incorporate elements of them into future disaster response tools. With mental health needs magnified during disasters, mobile apps with thoughtful design show promise in expanding access to psychosocial support.

There are several potential limitations when using mobile apps for mental health responses to disasters. One of the main concerns is the accessibility of these apps, as not all members of the affected communities may have access to smartphones or internet connectivity. Furthermore, language and cultural barriers may prevent effective use. Another potential limitation is the quality and accuracy of the information provided. Without proper oversight, some apps may provide misinformation or inaccurate advice, which could exacerbate mental health issues. In addition, privacy concerns around collecting and storing sensitive data must be addressed.

Barriers like lack of mobile devices and internet access can impede adoption, especially in marginalized areas. Apps not designed for low literacy users or that are only available in certain languages could also limit accessibility. Concerns around privacy and security may deter some individuals. However, smartphone ubiquity globally enables use by vulnerable groups. Government agencies and nongovernmental organizations (NGOs) can promote adoption by integrating vetted apps into disaster protocols and funding dissemination. Developing apps with stakeholders and prelaunch user testing also facilitate uptake. Monitoring user feedback allows for ongoing optimization and troubleshooting of barriers. Cultural tailoring to address stigma and use local beliefs further enables implementation success. Finally, limited evidence-based research into app effectiveness highlights the need for more rigorous evaluation and testing of mobile apps for disaster mental health response.

This scoping review has certain methodological limitations that should be considered while interpreting its results. First, the search was restricted to 6 electronic databases and only English-language papers were considered. We also searched MEDLINE and not PubMed, and these may have led to the omission of some relevant studies. Second, the study focused on mobile phone apps for mental health response to disasters, disregarding other types of technology that could also be used in disaster management such as telehealth, SMS text messaging, and emails. Moreover, since the study included only 5 papers, it may not offer a comprehensive overview of the use of mobile phone apps in disaster response strategies. There is the possibility of the existence of apps not yet published in academic literature. Fourth, the nonuse of a control group in the design of the studies makes it difficult to determine whether the observed effects were entirely due to the use of the apps or other characteristics of the participants that predisposed them to use the apps. Fifth, the small sample sizes for the studies mean they require caution with generalization. Despite these limitations, the review provides valuable insights into the use of mobile apps in disaster response and serves as a useful resource for developing contextually appropriate mobile apps for disaster management. Last, our study focused on natural disasters, further research should examine the role of apps in supporting mental health in conflict and complex emergencies such as wars, outbreaks of violence, and complex political conflict situations [ 45 ].

Conclusions

This scoping review found that mobile apps have not been extensively used in mental health responses to natural disasters, with only 5 studies meeting the inclusion criteria. However, the studies included in this review demonstrate that mobile apps can be useful in providing mental health support to disaster-affected individuals, as well as equip disaster responders. There is a critical gap identified in this study, as none of the studies investigated the use of mobile apps for potential victims in the preparedness or response phases of disaster management. We, therefore, recommend that mobile apps be integrated into the various phases of disaster management as part of mental health response. Additionally, it is important to ensure that these apps are accessible to all members of the community, taking into account cultural, linguistic, and other factors that may impact their effectiveness. Mobile apps have great potential to provide valuable ongoing support to those affected by disasters, and they can be a valuable resource in disaster management, helping people cope with the mental health effects of disasters and connecting with the necessary support services.

The findings from this scoping review have important implications for policy makers, disaster management professionals, and mental health practitioners. There is a clear need for policies and protocols that integrate evidence-based mobile apps into mental health disaster planning and response. Disaster agencies should invest in developing, evaluating, and widely disseminating mobile apps specifically designed to mitigate psychological trauma before, during, and after catastrophic events. Mental health professionals can incorporate vetted mobile apps into their standard of care for at-risk disaster survivors. Going forward, a collaborative approach across these groups will be essential to leverage mobile technology in building community resilience and addressing the rising mental health burdens in an era defined by climate change–fueled natural disasters.

Acknowledgments

This work was funded by the Department of Psychiatry, Dalhousie University, Halifax, Canada. The funder was not involved in the conceptualization or implementation of the study, nor the decision to publish the findings.

Conflicts of Interest

None declared.

The PRISMA-SCR checklist. PRISMA-SCR: Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews.

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Abbreviations

Edited by G Eysenbach; submitted 13.06.23; peer-reviewed by T Benham, K Goniewicz, R Konu, J Ranse, P Moreno-Peral; comments to author 10.01.24; revised version received 25.02.24; accepted 23.03.24; published 17.04.24.

©Nwamaka Alexandra Ezeonu, Attila J Hertelendy, Medard Kofi Adu, Janice Y Kung, Ijeoma Uchenna Itanyi, Raquel da Luz Dias, Belinda Agyapong, Petra Hertelendy, Francis Ohanyido, Vincent Israel Opoku Agyapong, Ejemai Eboreime. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 17.04.2024.

This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on https://www.jmir.org/, as well as this copyright and license information must be included.

[ORGANIZATION OF MEDICAL CARE FOR CHILDREN WITH A NEW CORONAVIRUS INFECTION IN PATIENT CONDITIONS ON THE EXAMPLE OF THE CHILDREN'S CITY CLINICAL HOSPITAL NAMED AFTER Z. A. BASHLYAEVA]

Affiliations.

• 1 Children's City Clinical Hospital named after Z. A. Bashlyaeva of the Moscow City Health Department, 125373, Moscow, Russian Federation.
• 2 Pirogov Russian National Research Medical University, 117997, Moscow, Russian Federation.
• 3 Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of the Russian Federation, 125993, Moscow, Russian Federation.
• 4 Pirogov Russian National Research Medical University, 117997, Moscow, Russian Federation, [email protected].
• 5 Research Institute for Healthcare Organization and Medical Management of Moscow Healthcare Department, 115088, Moscow, Russian Federation.
• PMID: 34792888
• DOI: 10.32687/0869-866X-2021-29-s2-1343-1349

The article presents an analysis of the work of the largest children's COVID-19 center in Moscow, organized on the basis of the Children's City Clinical Hospital named after Z. A. Bashlyaeva of the Moscow City Health Department. From March to November 2020 at the COVID-19 Center were hospitalized 2,837 patients with suspected/confirmed diagnosis of COVID-19, in total in 2020 1,876 children with a confirmed diagnosis of COVID-19 were treated, 58 (3%) children were in serious condition in the intensive care unit, of which children 11-18 years old were 25%. At the 2020 neonatal COVID-19 center, 215 newborns were observed with suspected COVID-19 diagnosis. The diagnosis of COVID-19 was confirmed in 18 children, while 8 newborns came from the home of COVID-19. In the Center for rehabilitation, where children aged 0 to 3 years old who were born with very low and extremely low body weight are observed, dispensary observation for children who have undergone COVID-19 is organized. 45 children who were observed fell ill with the new coronavirus infection. There were no deaths among children with COVID-19.

Keywords: COVID-19; COVID-center; children; new coronavirus infection; newborns; treatment.

• COVID-19 Testing*
• Child, Preschool
• Hospitals, Pediatric
• Infant, Newborn
• Retrospective Studies