WVU Researchers Try to Determine How Much Telehealth is Enough

With telehealth use skyrocketing over the past year and a half due to the coronavirus pandemic, some have wondered if there’s a limit to its effectiveness. Is there a certain number of virtual visits that a patient – especially one with a chronic condition – should get, after which the technology outlasts its value?

The answer, according the researchers at the University of West Virginia, is … uncertain.

Led by Jennifer Mallow, of the WVU School of Nursing, the team of researchers conducted a systematic review of telehealth interventions delivered to “community dwelling adults experiencing chronic illness or disability related to effectiveness, quality, safety, and cost.” They sifted through roughly 80 abstracts, looking for patterns tied to value.

“As researchers, we recognized there is a gap in the current science,” Mallow, an associate professor in the School of Nursing’s Adult Health Department, said in a recent news release. “We don’t know how much or how often telehealth should be used to impact outcomes yet. So, we needed to do the work in order to push what we know about telehealth forward.”

The results, recently published in Scientific Research, were inconclusive, making it clear that defining value in a telehealth service isn’t that easy.

“Even though we’ve been doing the ramp-up of telehealth for over a year, we still don’t have the answers to these questions,” she said.

The challenge may be in finding a common value proposition for a connected health platform that tends to be personal, and to produce different outcomes for each patient. Telehealth has proven its worth in a number of ways, including its ability to allow healthcare providers to tailor treatment to the specific patient at home, and to adjust care management on the fly when the data points to that need.

There may be some general conclusions to draw from the study – Mallow and her team, for example, found that telehealth programs of 37 or 38 weeks produced mixed of neutral results, while those still in place at 51 weeks were more successful. But that doesn’t translate to a hard and fast formula for every patient in the program. If anything, it may prove that longer programs are more apt to be successful.

Mallow and her team aren’t giving up. In fact, they’ve taken their research up a notch.

They’ve launched a telehealth program called “Take Me Home, West Virginia.” Backed by funding from the Centers for Medicare & Medicaid Services, they’re using telemedicine technology to treat older West Virginians and those with disabilities at home, and tracking the results.

“We’re collecting information related to dose,” Mallow said. “How long do we spend with participants? What are the nurses doing, and how long does it take them? How long does it take us to review remote patient monitoring? Are we talking to patients on the phone? As we collect this information in a standard way, we can begin to make those links between dose and outcome.”

They’re also expanding the palette, and studying how a telehealth platform could embrace more than just vital signs and medication management. This includes making phone calls every few weeks to patients to talk about alcohol use, anxiety, depression and loneliness.

“We know that people with multiple chronic conditions have higher loneliness scores and that these scores are linked to functional decline, depressive symptoms and poorer physical health outcomes, including higher blood pressure,” Laurie Theeke, a professor and director of the PhD program at the School of Nursing and part of the research team, said in the press release. “Using telehealth to connect with chronically lonely people in a way that works to diminish loneliness and enhance their perception of belonging could be key to improving measures of chronic illness control.”

In addition, add in the value of a telehealth visit in addressing social determinants of health.

“Lack of access to healthcare services, transportation options and social supports are social determinants of health that have contributed to health disparities such as heart disease, diabetes and depression in West Virginia,” added Steve Davis, an associate professor in the School of Public Health who was involved with the study. “Telehealth has the potential to address these service and support gaps.”

The end result of this project may be a finding that telehealth programs hold value in many different uses, and that assigning a value to the number of visits or “doses” will be difficult. What might work in a couple months for one person won’t be as effective for another.

They might be able to come up with guidelines for specific chronic conditions, like COPD or diabetes, but the defining of value in telehealth treatment won’t be as simple as, say, an apple a day.