Virtual Care, What Are We Measuring and What Should We Measure? Scoping Review of Reviews.

Background: Virtual care is here to stay; however, there remains no comprehensive measurement framework to guide evaluation of its impacts, to inform policy decisions, and to support optimization of practice. Objective: This study aimed to conduct a scoping review of reviews to synthesize measures related to virtual care evaluation across clinical conditions and contexts to identify gaps in current evaluation measures and to inform the development of recommendations for future work. Methods: Citations published from 2015 to 2023 were retrieved from MEDLINE, Cochrane Database of Systematic Reviews, Embase, Emcare, Scopus, CINAHL, and Web of Science using search terms grouped by key concepts (virtual care and evaluation or quality measurement). Measures were defined as any quantitative or qualitative evaluation of performance or impact of virtual care on processes, outcomes, or systems. Articles were excluded if they were not a literature review (eg, primary results, commentaries, letters, protocols), dealt exclusively with pediatric populations, were published in a language other than English, or were abstracts only. Measures from retained articles (1233) were thematically grouped against the Proctor Implementation Research Outcomes framework. The study was reported according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guideline extension for scoping reviews. Results: There has been substantial growth in the virtual care literature, particularly since the start of the COVID-19 pandemic. The majority of articles (900/1233, 73.0%) evaluated client outcomes, including satisfaction with virtual care, usability or functionality of platforms, or clinical outcomes. Relative to the other domains of the Proctor framework, implementation measures were poorly defined, and many of the measures were proxy rather than direct measures. Despite the potential impacts of virtual care on health equity, most studies examining health equity were purely qualitative. Measures of safety, privacy, and security of virtual care were sparse and poorly defined. Caregivers play an important role in facilitating virtual visits and providing informal technical support; however, few studies examined implementation or satisfaction with virtual care from the perspective of caregivers. Additionally, clinician experience and acceptance of virtual care have implications for availability and adoption; however, relative to patients, few articles examined this perspective. Conclusions: Our study highlights gaps in current evaluations of virtual care. Work is needed to improve the quality and standardization of virtual care evaluation to ensure reproducibility, generalizability, and comparability of findings. Additionally, compliance with existing measure definitions and conventions should extend to virtual care. Finally, additional theoretical work is needed to standardize and conceptually frame future virtual care evaluations. Future studies should include both the caregiver and clinician as unique perspectives in evaluations and should embed systematic evaluations of the impact of social determinants of health on virtual care access, adoption, and perceptions of care.