Use of Patient-Reported Outcome Measures and Patient-Reported Experience Measures Within Evaluation Studies of Telemedicine Applications: Systematic Review

Andreas Knapp, Lorenz Harst, Stefan Hager, Jochen Schmitt, Madlen Scheibe, Andreas Knapp, Lorenz Harst, Stefan Hager, Jochen Schmitt, Madlen Scheibe

Abstract

Background: With the rise of digital health technologies and telemedicine, the need for evidence-based evaluation is growing. Patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) are recommended as an essential part of the evaluation of telemedicine. For the first time, a systematic review has been conducted to investigate the use of PROMs and PREMs in the evaluation studies of telemedicine covering all application types and medical purposes.

Objective: This study investigates the following research questions: in which scenarios are PROMs and PREMs collected for evaluation purposes, which PROM and PREM outcome domains have been covered and how often, which outcome measurement instruments have been used and how often, does the selection and quantity of PROMs and PREMs differ between study types and application types, and has the use of PROMs and PREMs changed over time.

Methods: We conducted a systematic literature search of the MEDLINE and Embase databases and included studies published from inception until April 2, 2020. We included studies evaluating telemedicine with patients as the main users; these studies reported PROMs and PREMs within randomized controlled trials, controlled trials, noncontrolled trials, and feasibility trials in English and German.

Results: Of the identified 2671 studies, 303 (11.34%) were included; of the 303 studies, 67 (22.1%) were feasibility studies, 70 (23.1%) were noncontrolled trials, 20 (6.6%) were controlled trials, and 146 (48.2%) were randomized controlled trials. Health-related quality of life (n=310; mean 1.02, SD 1.05), emotional function (n=244; mean 0.81, SD 1.18), and adherence (n=103; mean 0.34, SD 0.53) were the most frequently assessed outcome domains. Self-developed PROMs were used in 21.4% (65/303) of the studies, and self-developed PREMs were used in 22.3% (68/303). PROMs (n=884) were assessed more frequently than PREMs (n=234). As the evidence level of the studies increased, the number of PROMs also increased (τ=-0.45), and the number of PREMs decreased (τ=0.35). Since 2000, not only has the number of studies using PROMs and PREMs increased, but the level of evidence and the number of outcome measurement instruments used have also increased, with the number of PREMs permanently remaining at a lower level.

Conclusions: There have been increasingly more studies, particularly high-evidence studies, which use PROMs and PREMs to evaluate telemedicine. PROMs have been used more frequently than PREMs. With the increasing maturity stage of telemedicine applications and higher evidence level, the use of PROMs increased in line with the recommendations of evaluation guidelines. Health-related quality of life and emotional function were measured in almost all the studies. Simultaneously, health literacy as a precondition for using the application adequately, alongside proper training and guidance, has rarely been reported. Further efforts should be pursued to standardize PROM and PREM collection in evaluation studies of telemedicine.

Keywords: evaluation; measurement instrument; outcome; patient-reported experience; patient-reported experience measures; patient-reported outcome; patient-reported outcome measures; questionnaire; telehealth; telemedicine.

Conflict of interest statement

Conflicts of Interest: JS received institutional grants for investigator-initiated trials from Novartis, Sanofi, ALK, and Pfizer. He acted as a consultant for Novartis, ALK, Lilly, and Sanofi.

©Andreas Knapp, Lorenz Harst, Stefan Hager, Jochen Schmitt, Madlen Scheibe. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 17.11.2021.

Figures

Figure 1
Figure 1
PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow chart. ICD-10: International Statistical Classification of Diseases and Related Health Problems, 10th revision; PREM: patient-reported experience measure; PROM: patient-reported outcome measure.
Figure 2
Figure 2
Extraction process of outcome measurement instruments. PREM: patient-reported experience measure; PROM: patient-reported outcome measure.
Figure 3
Figure 3
Use of patient-reported outcome measures and patient-reported experience measures by study type. PREM: patient-reported experience measure; PROM: patient-reported outcome measure.
Figure 4
Figure 4
Mean use of patient-reported outcome measures and patient-reported experience measures over time. PREM: patient-reported experience measure; PROM: patient-reported outcome measure.
Figure 5
Figure 5
Number of outcome measurement instruments collected per study. PREM: patient-reported experience measure; PROM: patient-reported outcome measure.
Figure 6
Figure 6
Numbers of studies by study type over time. RCT: randomized controlled trial.
Figure 7
Figure 7
Change over time. PREM: patient-reported experience measure; PROM: patient-reported outcome measure.
Figure 8
Figure 8
Use of patient-reported outcome measures and patient-reported experience measures by application type. PREM: patient-reported experience measure; PROM: patient-reported outcome measure.
Figure 9
Figure 9
Use of patient-reported outcome measures and patient-reported experience measures by use cases. PREM: patient-reported experience measure; PROM: patient-reported outcome measure.

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