If you tuned in to the PCORI Annual Meeting last November, you may have heard PCORI Executive Director Nakela L. Cook, MD, MPH, discuss our new Rapid Review series.
We are excited to share that the very first PCORI Rapid Review was published in December as a report on our website and as a concise journal article in Annals of Internal Medicine. We look forward to the continued contribution of these products to decision making here at PCORI and for our stakeholders.
What Is a Rapid Review?
A rapid review is an approach that accelerates and streamlines evidence synthesis methods to meet requirements of end users, producing rigorous and transparent evidence for decision making in a resource-efficient manner. PCORI commissions rapid reviews to understand an evidence base on a compressed timeline, which allows PCORI and its stakeholders to answer research questions and identify evidence gaps in a much shorter timeframe than the traditional systematic review.
A Rapid Review of Video-Teleconferencing for Disease Prevention, Diagnosis, and Treatment
PCORI’s first Rapid Review summarized evidence of the benefits and harms of video-teleconferencing (VTC) virtual visits for disease prevention, diagnosis, and treatment when used to augment or replace for usual care. Despite the widespread and accelerated uptake of telehealth in recent years, and especially during the COVID-19 pandemic, the relative benefits and harms of VTC compared to usual in-person care had not been thoroughly reviewed in the past five years.
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Thirty-eight recent, randomized controlled trials were identified that studied VTC-delivered care for diabetes, respiratory conditions, neurologic conditions, pain-related disorders, post-operative follow-ups, cardiovascular conditions, orthopedic conditions, chronic kidney disease, enteral nutrition, HIV, rheumatoid arthritis, genetic counseling, and multiple chronic conditions. Twenty (53%) of the trials were rated as having a low or moderate risk of bias and were included in the analysis.
Across the 20 included trials, the review found that for the health conditions studied, the use of VTC for care delivery appeared to be as effective as usual care. The results also suggest that VTC may improve patient outcomes when used as part of a comprehensive strategy involving other intervention components. Important limitations of the evidence remain, however, including lack of evidence regarding the effects of VTC on health equity or disparities and limited data on the risk of harms associated with the use of VTC, as just under half of the included studies reported harms outcomes.
The Rapid Review includes an evidence map of the clinical contexts in which VTC was studied and where gaps in the research remain. (Fig. 2, page 62 of the report) The review outlined several primary research priorities to address remaining research gaps, many of which support the Cycle 3 2021 Broad PCORI Funding Announcement’s Special Area of Emphasis on telehealth for chronic disease management among vulnerable populations with complex needs. These are:
- Studies investigating the benefits and harms of VTC in underserved and vulnerable populations. Additionally, it will be important to understand how VTC might increase access to care for underserved groups.
- Multicomponent VTC interventions designed specifically for a disease or condition that aim to improve outcomes. Where possible, these studies should incorporate component-level analysis.
- Interventions that focus on collaborative care models and/or patients with multiple chronic conditions.
- Pragmatic clinical trials investigating real-world hybrid interventions.
- VTC interventions that focus on the prevention and diagnosis of disease.
Six months after the final protocol for this review, PCORI had the final report in hand, providing valuable insights into evidence gaps and research priorities to inform future funding decisions on a rapid timeline. You can read the full Rapid Review report and link to the Annals of Internal Medicine article here on the PCORI website.
Up Next in the PCORI Rapid Review Series
Stay tuned for the next two PCORI Rapid Reviews, which will be wrapping up in the coming months. The first is another telehealth-focused rapid review, Telehealth Strategies for the Delivery of Maternal Healthcare, which will assess the clinical effectiveness and potential harms of telehealth strategies intended to supplement or replace usual care, including alternative care models or strategies with multiple telehealth components. The second ongoing rapid review, Health Equity and Social Needs Interventions, builds upon the evidence map, Social Needs Interventions to Improve Health Outcomes, and will assess the extent to which studies of social needs interventions evaluate differential impact by race and ethnicity. It will also explore how social needs interventions are tailored for historically underserved communities.
We look forward to the further development of PCORI Rapid Reviews and hope they serve to provide timely, trustworthy, and useful information to our stakeholders.
What's Happening at PCORI?
The Patient-Centered Outcomes Research Institute sends weekly emails about opportunities to apply for funding, newly funded research studies and engagement projects, results of our funded research, webinars, and other new information posted on our site.
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