title: Building the Evidence Base for Tele-Emergency Care: Efforts to Identify a Standardized Set of Outcome Measures.
abstract: To enhance the quality of emergency department (ED) care, some rural hospitals have adopted the use of telemedicine (tele-ED). Without a common set of metrics, it is difficult to quantify the impact of this technology.
  
  
  
  To address this limitation, the Health Resources and Services Administration funded the identification and testing of a core set of measures that could be used to build a business case for the value of tele-ED care.
  
  
  
  A comprehensive environmental scan was conducted to identify existing measures relevant to assessing ED care and the use of telemedicine. Identified measures were assessed against a set of criteria and pilot tested in rural hospitals.
  
  
  
  The environmental scan identified numerous ED-specific measures and a limited set of telehealth-specific measures, but no clearly defined measures specific to tele-ED. Applying evaluation criteria to the measures revealed that few have a well-established evidence base, and fewer have undergone the rigorous testing needed to establish statistical reliability and validity. Nevertheless, a parsimonious set of measures was identified that met many of the evaluation criteria. Pilot testing indicated that collecting data using these measures was feasible.
  
  
  
  For tele-ED benefits to be widely acknowledged, more research is required to demonstrate that care delivered using tele-ED care is as high quality, if not more so, than in-person care. This requires researchers to consistently use a set of clearly defined measures.
  
  
  
  The use of clearly defined and standardized measures will aid interpretation and permit replication in multiple studies, furthering acceptance of study findings.
authors.affiliation: 1 Mathematica Policy Research , Washington, District of Columbia.
authors.forename: Yael
authors.initials: Y
authors.lastname: Harris
authors.affiliation: 1 Mathematica Policy Research , Washington, District of Columbia.
authors.forename: Boyd
authors.initials: B
authors.lastname: Gilman
authors.affiliation: 2 College of Public Health, University of Iowa , Iowa City, Iowa.
authors.forename: Marcia M
authors.initials: MM
authors.lastname: Ward
authors.affiliation: 1 Mathematica Policy Research , Washington, District of Columbia.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Ladinsky
authors.affiliation: 1 Mathematica Policy Research , Washington, District of Columbia.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Crowley
authors.affiliation: 1 Mathematica Policy Research , Washington, District of Columbia.
authors.forename: Cannon
authors.initials: C
authors.lastname: Warren
authors.affiliation: 3 Health Resources and Services Administration, U.S. Department of Health and Human Services , Rockville, Maryland.
authors.forename: Craig
authors.initials: C
authors.lastname: Caplan
mesh_terms: D004632:Emergency Medical Services / Q000592:standards*; D004638:Emergency Treatment / Q000592:standards*; D005260:Female; D006780:Hospitals, Rural / Q000592:standards*; D006801:Humans; D008297:Male; D015203:Reproducibility of Results; D017216:Telemedicine / Q000592:standards*; D014481:United States
keywords: emergency care; quality measures; rural healthcare; telehealth; telemedicine