Toward a Common Ground for Defining Digital Health Interventions, Mapping Digital Health Frameworks to PICOTS-ComTeC:...

Digital health interventions (DHIs) should be defined in a comparable, structured manner to facilitate research informing clinical and financial decisions. The Population, Intervention, Comparator, Outcomes, Timing, Setting, Communication, Technology, Context (PICOTS-ComTeC) framework was developed to define patient-facing DHIs for health economics and outcomes research. Our objective was to compare PICOTS-ComTeC with established DHI frameworks and guidelines to determine the degree of overlap, additional value of PICOTS-ComTeC, and how the frameworks might be used together.

An expert group selected comparator frameworks. Reviewer pairs extracted information and mapped DHI definitions to 9 domains and 32 subcategories of PICOTS-ComTeC. A third reviewer checked for consistency across frameworks and missing data.

A diverse group of 16 frameworks (9 international, regarding DHI classification, quality, labeling, and reporting; 6 national DHI health technology assessment and payer; 1 international health economic reporting) were compared with PICOTS-ComTeC. Across all frameworks, 81% (116/144) of PICOTS-ComTeC domains matched (range 44%-100%). The mean number of domain matches for a framework was 7.3. Comparator frameworks matched 48% (247/512) of PICOTS-ComTeC subcategories (range 16%-81%).

The degree to which PICOTS-ComTeC is congruous with items in diverse DHI frameworks suggests that PICOTS-ComTeC represents a common ground for defining patient-facing DHIs for research, reporting, and assessment purposes, thereby improving patient care by accelerating adoption of effective DHIs. PICOTS-ComTeC contains items not uniformly present in comparator frameworks. PICOTS-ComTeC can be used to define patient-facing DHIs by adding missing PICOTS-ComTeC items to comparator frameworks or using information from comparator frameworks to describe PICOTS-ComTeC items.