Telehealth Strategies for the Delivery of Maternal Health Care: A Rapid Review

PCORI commissioned a rapid review to assess evidence on the effectiveness of telehealth strategies for the delivery of maternal healthcare. Because telemedicine has experienced a swift and widespread adoption in the United States, PCORI sought to understand the evidence base on a compressed timeline in order to inform our future research investments.

The evidence synthesized in this rapid review indicates that telehealth for maternal health care delivery is a promising alternative and/or supplement to usual, in-person care. Equally important are the evidence gaps identified in this review that point us to future research priorities. Full results of this rapid review are also available in the Annals of Internal Medicine.

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Study Results that Support Better-Informed Decisions

Telehealth-Based Referrals Improve Access to Hearing Care for Children in Rural Areas

Children in school-based hearing screening programs who received telehealth-based specialist referrals experienced follow-up care up to 17.6 times faster, compared with children who received standard primary care referrals, according to results from the PCORI-funded Hearing Norton Sound Study published in Lancet Global Health. The randomized controlled trial with about 1,500 children in Alaska was led by Susan D. Emmett, MD, MPH, and Samantha Kleindienst Robler, PhD, AuD, from the Center for Hearing Health Equity at the University of Arkansas for Medical Sciences.

The study, which was conducted in 15 rural Alaskan communities between 2017 and 2020, is considered to be the first to demonstrate that telemedicine can reduce a key rural health disparity in access to care. The researchers also suggest that the benefits of telemedicine could translate to other preventive school-based services to improve specialty health care for children in rural areas.

Telehealth Interventions Improve Outcomes for Patients with Advanced Cancer

Patients with advanced cancer who used telehealth to regularly report symptoms improved their overall well-being, compared with those who were seen less frequently via in-person clinical visits, according to results from the PCORI-funded PRO-TECT Trial. The findings were published online in JAMA and presented at the 2022 American Society of Clinical Oncology annual meeting.

The research team compared the benefits of giving patients information about symptom management and the ability to report their symptoms via an internet-based or automated telephone system, with providing patients information about symptom management during in-person clinical visits. Patients who used telehealth to communicate about their symptoms on a weekly basis said they experienced improved physical function, better control of their symptoms, and improved quality of life, compared with those who were evaluated less frequently, during in-person clinical visits.

Online Specialty Skin Care as Effective as In-Person Visits

Adults with the chronic skin disease psoriasis who used an online program to get care from dermatologists and their primary care providers experienced as much improvement in their condition as patients who got in-person care in a clinic, according to results of a PCORI-funded study. The study was led by April W. Armstrong, MD, MPH, at University of Southern California.

The findings, reported in JAMA Network Open, add to evidence about the potential for telehealth to serve as a more widely accessible option for getting specialty care for chronic skin conditions.

Helping Children with Medicaid Initiate the Referral Process for Mental Health Care

Many children who are Medicaid participants with mental health problems don’t receive the care they need, in part because families must first undergo a complex referral process to community mental health clinics (CMHCs) for diagnostic and therapeutic mental health services.

Reporting in Pediatrics, a PCORI-funded study -- led by Tumaini Coker, MD, MBA, at Seattle Children's Research Institute -- found that compared with parents who had usual referrals, those who had video chat referrals were three times more likely to finish screening for specialty mental health care at the CMHC.

Changes to Telehealth Policy, Delivery, and Outcomes in Response to COVID-19

During the COVID-19 pandemic, there has been a rapid shift toward virtual visits and digital tools to monitor and help patients manage their health care. PCORI solicited a landscape review to summarize how reimbursement, regulatory, and delivery systems have changed for telehealth during the coronavirus pandemic.

The goal was to use this information, in combination with conversations with key stakeholders, to better understand how changes in the delivery system during COVID-19 might alter PCORI’s strategic focus on future investment in telehealth research. This report provides a rich summary of changes under the pandemic and highlights some areas in telehealth where additional research may be valuable.

View Landscape Review Report