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Box 8.2 Categories of Evaluation Questions for Comparing Telemedicine to Alternative Health Services
What were the effects of the application on the clinical process of care compared to the alternative(s)?
What were the effects of the application on patient status or health outcomes compared to the alternative(s)?
What were the effects of the application on access compared to the alternative(s)?
What were the costs of the application for patients, private or public payers, providers, and other affected parties compared to the alternative(s)?
How did patients, clinicians, and other relevant parties view the application and were they satisfied with the application compared to the alternative(s)?
NOTE: Each question assumes an analysis of results will control for severity of illness, comorbidities, demographic characteristics, and other relevant factors.
consequences for quality through earlier detection and better management of clinical problems. Patient satisfaction is frequently considered in evaluations of the quality of care. Satisfaction or acceptance data are, however, both important in their own right (to the extent that successful telemedicine depends on patient and clinician acceptance) and insufficient as the sole measure of quality.
Proper interpretation of patient outcomes data requires good information on patient characteristics, in particular, the severity of their health problem and any comorbid conditions. The methods for adjusting for differences in patient severity and other patient factors are not completely satisfactory and remain the subject of some disagreement, but evaluators should make an effort to identify and adjust for differences in patient characteristics. Such adjustments are also important in evaluating cost comparisons.
Although significant conceptual and practical challenges remain, the last two decades have seen substantial strides forward in both measurement methodologies and data collection. Progress is particularly notable in the areas of quality assessment and health outcomes measurement. Public and private utilization databases and clinical information systems have grown in both size and scope, as has an appreciation of the complexities of assuring that the information is reliable, valid, complete, and secure from inappropriate disclosure