title: Effect of Telehealth Interventions on Hospitalization Indicators: A Systematic Review.
abstract: Telehealth has been defined as the remote delivery of healthcare services using information and communication technology. Where resource-limited health systems face challenges caused by the increasing burden of chronic diseases and an aging global population, telehealth has been advocated as a solution for changing and improving the paradigm of healthcare delivery to cope with these issues. The aim of this systematic review is to investigate the effect of telehealth interventions on two indicators: hospitalization rate and length of stay.
  
  
  
  The reviewers searched the PubMed, ScienceDirect, and Springer electronic databases from January 2005 to November 2013. A search strategy was developed using a combination of the following search keywords:impact, effect, telehealth, telemedicine, telecare, hospitalization, length of stay,andresource utilization.Both randomized controlled trials and observational studies were included in the review. To be included in the review, articles had to be written in English. The results of study were compiled, reviewed, and analyzed on the basis of the review aims.
  
  
  
  This systematic review examined 22 existing studies with a total population of 19,086 patients. The effect of telehealth on all-cause hospitalization was statistically significant in 40 percent of the related studies, whereas it was not statistically significant in 60 percent. Similarly, the effect of telehealth on the all-cause length of stay was statistically significant in 36 percent of the studies and nonsignificant in 64 percent.
  
  
  
  Considering the fact that hospitalization rate and length of stay can be confounded by factors other than telehealth intervention, studies examining the effect of the intervention on these indicators must take into account all other factors influencing them. Otherwise any judgment on the effect of telehealth on these indicators cannot be valid.
authors.affiliation: Medical informatics and health information technology in School of Management and Medical Informatics and researcher at Tabriz Health Services Management Research Center in Tabriz, Iran.
authors.forename: Leila R
authors.initials: LR
authors.lastname: Kalankesh
authors.affiliation: Medical informatics in School of Management and Medical Informatics at the Tabriz University of Medical Sciences in Tabriz, Iran.
authors.forename: Faramarz
authors.initials: F
authors.lastname: Pourasghar
authors.affiliation: IFHIMA (2007-2010), Independent HIM Consultant, Rochdale OL11 2XE, Lancashire, UK.
authors.forename: Lorraine
authors.initials: L
authors.lastname: Nicholson
authors.affiliation: Health information technology at Iran University of Medical Sciences in Tehran, Iran.
authors.forename: Shamim
authors.initials: S
authors.lastname: Ahmadi
authors.affiliation: Health information technology at the School of Management and Medical Informatics at Tabriz University of Medical Sciences in Tabriz, Iran.
authors.forename: Mohsen
authors.initials: M
authors.lastname: Hosseini
mesh_terms: D003695:Delivery of Health Care / Q000592:standards; D006760:Hospitalization / Q000639:trends*; D058996:Quality Improvement; D017216:Telemedicine
keywords: hospital admission; impact; length of stay; telehealth; telemedicine