期刊
INTERNATIONAL JOURNAL OF MEDICAL INFORMATICS
卷 83, 期 12, 页码 870-880出版社
ELSEVIER IRELAND LTD
DOI: 10.1016/j.ijmedinf.2014.09.002
关键词
Telehealth; Telemedicine; Adaptive design; Interim analysis; Multi-arm trials; Sample size re-estimation; Enrichment designs; Group sequential designs
资金
- EPSRC iCase studentship
- MRC [G0800860]
- Medical Research Council [MC_UP_1302/2] Funding Source: researchfish
- MRC [MC_UP_1302/2] Funding Source: UKRI
Background: The field of telehealth and telemedicine is expanding as the need to improve efficiency of health care becomes more pressing. The decision to implement a telehealth system is generally an expensive undertaking that impacts a large number of patients and other stakeholders. It is therefore extremely important that the decision is fully supported by accurate evaluation of telehealth interventions. Objective: Numerous reviews of telehealth have described the evidence base as inconsistent. In response they call for larger, more rigorously controlled trials, and trials which go beyond evaluation of clinical effectiveness alone. The aim of this paper is to discuss various ways in which evaluation of telehealth could be improved by the use of adaptive trial designs. Results: We discuss various adaptive design options, such as sample size reviews and changing the study hypothesis to address uncertain parameters, group sequential trials and multi-arm multi-stage trials to improve efficiency, and enrichment designs to maximise the chances of obtaining clear evidence about the telehealth intervention. Conclusion: There is potential to address the flaws discussed in the telehealth literature through the adoption of adaptive approaches to trial design. Such designs could lead to improvements in efficiency, allow the evaluation of multiple telehealth interventions in a cost-effective way, or accurately assess a range of endpoints that are important in the overall success of a telehealth programme. (C) 2014 The Authors. Published by Elsevier Ireland Ltd.
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