Telemonitoring in Austrian diabetes care: A systematic analysis of evaluation methodologies

Research area: HTA-methods & steering instruments

Duration: April 2021 to March 2022
Language: German (with English summary)

Publication: HTA Project Report No. 143: https://eprints.aihta.at/1370/

Background: For many years, telemedical services have been used in the medical care of patients with serious and chronic diseases. The usage of these services promises a reduction in outpatient visits and thus saving economic, time and personnel resources. Nevertheless, so far only a few applications have found their way into routine care. Possible barriers may be a lack of acceptance of new technologies or insufficient digital health literacy, both among patients and medical professionals, as well as structural availability and technical obstacles. With telemonitoring it is possible to track vital parameters of patients with diabetes. Here, telemedical solutions represent potential alternatives to the usual face-to-face consultations in the outpatient setting and may provide sufficient access to appropriate diabetes care [1, 2].

In Austria, different strategies are implemented to improve diabetes care. New telemedical technologies (telemonitoring and mHealth) are also being used for this purpose. Particularly notable are the telehealth services DiabCare (Tyrol) and DiabMemory (Styria), which are part of integrated diabetes care projects [3]. Despite the wide variety of telemedical diabetes projects, there is currently no Austria-wide standardised evaluation instrument available that would allow for a structured cross-project accompanying evaluation.

Project objectives and research questions: The aim of the project is to provide decision support, including a concept for a potential outcome measurement of telemedicine-assisted diabetes projects, based on international evidence on evaluation methods/instruments. Recommendations for a joint Austria-wide outcome set are to be developed. The following research questions are to be answered:

FF1: Which telemedical activities for the management of diabetes patients exist in Austria? What are the expectations associated with them?

FF2: Which endpoints or outcome parameters (diabetes-specific, eHealth-specific, organisational, economic or generic) were assessed in reviews, evaluation reports etc. of telemedicine-assisted diabetes programmes in settings comparable to Austria? Which measuring instruments were used for these assessments?

FF3: What were the results of the evaluations of telemedicine-assisted diabetes programmes?

FF4: Which recommendations on relevant endpoints for a supraregional Austria-wide health care data analysis/ accompanying evaluation can be derived from the above results?

A detailed planning or implementation of an evaluation as well as a data evaluation and health care analysis of individual Austrian projects are not within the scope of this report.

Methods: The following methods are used to answer the research questions:

FF1: Overview and mapping of Austrian diabetes projects with telemedicine support. Summaries of the associated expectations and any evaluations of the projects that have already taken place.

FF2: Systematic overview of evaluation methods of telemedicine-assisted diabetes care projects with a focus on diabetes-specific, eHealth-specific, organisational/economic and generic outcomes and their measurement tools. International projects that are part of a health care system (setting) comparable to that in Austria are eligible for this study.

FF3: Systematic overview of results (evidence on efficacy and safety) from the previously identified evaluations of telemedicine-assisted diabetes care projects in settings comparable to Austria. Critical appraisal of the evaluations (risk of bias) with different tools depending on the categorisation of the evidence class (e.g. IHE checklist, ROBINS-I).

FF4: Contrasting of the expectations of Austrian telemedicine-assisted diabetes projects with the existing evidence and deriving recommendations for an overarching outcome set or a concept for a potential accompanying evaluation.

For FF1, the first step is to identify Austrian diabetes projects with telemedicine support in cooperation and coordination with the Austrian Healthcare Insurance (Österreichische Gesundheitskasse, ÖGK) providers. If necessary, contact will be made with additional experts and project managers in the field of diabetes telemedicine. In addition, an extended hand search will be carried out.

For FF2, FF3, and FF4, a systematic literature search of reviews and evaluation reports is conducted in several databases (Medline, Embase, Cochrane Library, INAHTA-HTA, CRD, etc.). This is supplemented by an iterative hand search (in German and English) and a search for relevant literature on the homepages of:

• public health institutions (e.g. NHS, G-BA, KBV, KV, social insurances),
• medical societies (e.g. AWMF, ADA, DDB), and
• HTA and EbM research institutions (e.g. NICE, NIH, KCE, HQO).

Inclusion criteria for the systematic literature search:

Population	Patients with Diabetes mellitus type 1 and type 2
Intervention	eHealth applications (telemonitoring, mHealth) within the framework of integrated care programmes/projects (not: prevention programmes, single eHealth applications)
Comparators	Standard of care (without telemedical support) No control
Outcomes	Diabetes-specific outcomes eHealth-specific outcomes Organisational/economic outcomes Generic outcomes Measuring instruments for the collection of outcome parameters Evaluation results etc.
Setting	Health system comparable to Austria (e.g. social insurance system)
Study design	Observational studies, reviews, evaluation reports, etc.
Publication period	2010 to May 2021
Language	German, English

Following the literature and information retrieval, the endpoints/ measurement instruments identified, as well as the evaluation results, are extracted and summarised. The result will be a qualitative evidence synthesis and a compendium of the endpoints and measuring instruments used. In addition, recommendations for a comprehensive evaluation instrument for Austria will be derived.

All steps (literature selection, extraction) are performed by one person (MW) and controlled by a second person (RJ); the results are subject to internal and external review.

Time schedule:

Period	Activity
April 2021	Scoping, preparation of the project protocol
May to July 2021	Literature search, selection of literature, hand search, contact with experts
June to August 2021	Data extraction, data synthesis, visualisations
August to October 2021	Writing/drafting the report
October to November 2021	Internal and external review, layout, finalisation

References:

[1]   Aberer, F., Hochfellner, D.A. & Mader, J.K. Application of Telemedicine in Diabetes Care: The Time is Now. Diabetes Ther 12, 629–639 (2021). https://doi.org/10.1007/s13300-020-00996-7

[2]   Waschkau, A., Uebel, T. & Steinhäuser, J. Diabetestherapie 2.0 – Telemedizin. Internist 60, 917–924 (2019). https://doi.org/10.1007/s00108-019-0650-3

[3]   AIT Austrian Institute of Technology GmbH. Telegesundheitsdienste Tirol, Steiermark und VAEB. März 2018. URL: https://kit.ait.ac.at/wp-content/uploads/2018/06/TGD-Tirol-Steiermark-VAEB_V2.0-2018-03-30_AIT.pdf [cited: 19/04/2021]