Evaluating technologies for providing health services at a distance: outcome-driven quality improvement

A variety of technologies has been developed to allow remote providers to deliver health services. For most of these applications, there are limited data regarding effects on health status, costs of providing care, or patterns of utilization. Establishment of any application of clinical telemedicine should proceed concurrently with an outcome-based program of continuous quality improvement (OBQI). OBQI involves the ongoing collection and analysis of patient outcome data. Risk-adjusted outcomes can be compared with a reference standard, and change in an institution´s outcomes may be monitored. Used in conjunction with data regarding specific processes of care, outcome data can identify both exemplary and deficient health services. Such services may be modified and the results of those modifications tracked over time for comparison with previous periods. The implementation of OBQI is illustrated in the context of a chronic disease management program