The Effectiveness of Mobile-Health Technologies to Improve Health Care Service Delivery Processes: A Systematic Review and Meta-Analysis

BackgroundMobile health interventions could have beneficial effects on health care delivery processes. We aimed to conduct a systematic review of controlled trials of mobile technology interventions to improve health care delivery processes. Methods and FindingsWe searched for all controlled trials of mobile technology based health interventions using MEDLINE, EMBASE, PsycINFO, Global Health, Web of Science, Cochrane Library, UK NHS HTA (Jan 1990–Sept 2010). Two authors independently extracted data on allocation concealment, allocation sequence, blinding, completeness of follow-up, and measures of effect. We calculated effect estimates and we used random effects meta-analysis to give pooled estimates. We identified 42 trials. None of the trials had low risk of bias. Seven trials of health care provider support reported 25 outcomes regarding appropriate disease management, of which 11 showed statistically significant benefits. One trial reported a statistically significant improvement in nurse/surgeon communication using mobile phones. Two trials reported statistically significant reductions in correct diagnoses using mobile technology photos compared to gold standard. The pooled effect on appointment attendance using text message (short message service or SMS) reminders versus no reminder was increased, with a relative risk (RR) of 1.06 (95% CI 1.05–1.07, I2 = 6%). The pooled effects on the number of cancelled appointments was not significantly increased RR 1.08 (95% CI 0.89–1.30). There was no difference in attendance using SMS reminders versus other reminders (RR 0.98, 95% CI 0.94–1.02, respectively). To address the limitation of the older search, we also reviewed more recent literature. ConclusionsThe results for health care provider support interventions on diagnosis and management outcomes are generally consistent with modest benefits. Trials using mobile technology-based photos reported reductions in correct diagnoses when compared to the gold standard. SMS appointment reminders have modest benefits and may be appropriate for implementation. High quality trials measuring clinical outcomes are needed. Please see later in the article for the Editors' Summary研究背景：移动健康干预措施可对医疗服务流程产生积极影响。本研究旨在针对旨在优化医疗服务流程的移动技术干预措施的对照试验开展系统综述。 研究方法与结果：我们通过医学文献分析与检索联机系统（MEDLINE）、荷兰医学文摘（EMBASE）、心理学文摘（PsycINFO）、全球健康数据库（Global Health）、科学引文索引（Web of Science）、考克兰图书馆（Cochrane Library）、英国国民保健服务卫生技术评估项目（UK NHS HTA），检索了1990年1月至2010年9月期间发表的所有基于移动技术的健康干预对照试验。由两名研究者独立提取分配隐藏、分配序列、盲法、随访完整性以及效应量相关数据。我们计算了效应量估计值，并采用随机效应模型元分析（meta-analysis）获取合并效应量。本研究共纳入42项对照试验，所有试验均存在较高偏倚风险。针对医疗服务提供者支持的7项试验共报告了25项与疾病规范化管理相关的结局指标，其中11项显示出具有统计学意义的获益。1项试验表明，使用移动电话可显著改善护士与外科医生之间的沟通效果。2项试验显示，与金标准（gold standard）相比，采用移动技术拍摄的照片进行诊断的正确率出现了具有统计学意义的下降。与无提醒相比，采用短信（短消息服务，即SMS）提醒对就诊随访率的合并效应量显示就诊率有所提升，相对危险度（relative risk, RR）为1.06（95%置信区间CI：1.05~1.07，I²=6%）。关于取消预约次数的合并效应量显示，相对危险度为1.08（95% CI：0.89~1.30），差异无统计学意义。与其他类型的提醒方式相比，采用短信提醒的就诊随访率无显著差异（RR=0.98，95% CI：0.94~1.02）。为弥补本次检索时间较早的局限性，我们同时检索了近年的相关文献。 研究结论：针对医疗服务提供者支持的干预措施在诊断与管理结局方面的研究结果，整体显示出适度的获益。采用移动技术拍摄照片进行诊断的试验显示，其诊断正确率相较于金标准出现下降。短信就诊提醒具有适度的应用价值，具备推广实施的可行性。未来仍需开展针对临床结局指标的高质量对照试验。详见本文后文的编辑总结（Editors' Summary）。