Table of Contents

Welcome
Table of Contents
Impact of Artificial Intelligence on Healthcare Quality: A Systematic
Review and Meta-Analysis
Abstract
Background
Methods
Results
Conclusion
Article Information
Identifiers and Pagination:
Article History:
1. INTRODUCTION
1.1. Rationale
1.1.1. PICO Research Question
1.1.1.1. Population (P)
1.1.1.2. Intervention (I)
1.1.1.3. Comparison (C)
1.1.1.4. Outcome (O)
1.2. Objectives
2. MATERIALS AND METHODS
2.1. Search Strategy
2.2. Critical Appraisal Tools
3. THE PRISMA FRAMEWORK
3.1. Meta-Analysis
3.2. Forest Plots
3.3. Funnel Plots
3.4. Subgroup Analysis
3.5. To Examine the Impact of Robotic-assisted Healthcare on the
Quality of Health
3.6. To Determine the Impact of AI Self-monitoring Hospital
Gadgets on the Quality of Health
4. RESULTS AND DISCUSSION
CONCLUSION
LIST OF ABBREVIATIONS
CONSENT FOR PUBLICATION
STANDARDS OF REPORTING
AVAILABILITY OF DATA AND MATERIALS
FUNDING
CONFLICT OF INTEREST
ACKNOWLEDGEMENTS
SUPPLEMENTARY MATERIALS
REFERENCES
Impact of Artificial Intelligence on Healthcare
Quality: A Systematic Review and Meta-Analysis
Bashar Alzghoul1, *

1 Department of Respiratory Care, College of Applied Medical Sciences in Jubail, Imam Abdulrahman
Bin Faisal University, Jubail 35816, Saudi Arabia

Abstract
Background

Artificial intelligence embodies the ability of computers to emulate human

intelligence and generate well-informed choices. Quality within the healthcare
domain encompasses adopting proficient, patient-centric, secure, and productive
services that are unbiased, comprehensive, punctual, and streamlined. In this
regard, this study aimed to investigate the impact of artificial intelligence on
healthcare quality. This study echoed the World Health Organization’s findings that
artificial intelligence has great potential for distributed clinical automation, delivering
efficient clinical information, and offering extra support in healthcare settings.

Methods

This systematic review employed PRISMA methodology and inclusion and

exclusion criteria to search through central databases exploring the impact of
artificial intelligence on healthcare quality. Specifically, this study concentrated on
randomized controlled trials published in PubMed. The search process employed
Boolean operators (AND) and (OR) and the main keywords detailed in the
methodological section. As a result, two thousand five hundred forty-four sources
were identified. The identified sources underwent a rigorous screening process,
which entailed the removal of duplication. These eligibility criteria considered
studies published in the English language, availability of full text, thorough
description of the research aims, objectives, methodology, findings, and conclusion,
the number of references, and general presentation. Out of 2544 identified sources,
only 18 sources passed the eligibility criteria and were included in this research.
The Meta-analysis was conducted using RevMan 5, Mantel-Haenszel, random
effect, and 95% confidence intervals.

Results

Overall, the studies were substantially heterogeneous at I2=92%, Z score was 1.93,
and the P-value was within the range of less than or equal to 5. Therefore, the
general studies provided a significant positive impact of artificial intelligence on
healthcare quality. The heterogeneity was minimized through subgroup analysis,
where the studies were divided about the objectives. Generally, 6/18 studies yielded
an odd ratio of more than 1, reflecting the positive influence of artificial intelligence
on healthcare quality. 12/18 studies positively used artificial intelligence in assisted
healing or medication adherence, but none were statistically significant.
 Conclusion

Artificial intelligence does not directly influence healthcare quality but helps improve
other functions within healthcare services. Healthcare quality is comprehensive,
encompassing evidence-based practice, patient-centric care, effective
communication, care coordination, effective risk management strategies, health
information technology, health promotion, and disease prevention.

Keywords: Artificial intelligence, Healthcare, Quality, Technology, Meta-analysis, Systematic

review.

Article Information

Identifiers and Pagination: Article History:

Year: 2024 Received Date: 06/08/2023

Volume: 17 Revision Received Date: 13/01/2024
E-location ID: e18749445181059 Acceptance Date: 24/01/2024
Publisher Id: e18749445181059 Electronic publication date: 06/09/2024
DOI: Collection year: 2024
10.2174/011874944518105924020105
4546

Open-Access License: This is an open access article distributed under the terms of the Creative
Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at:
https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use,
distribution, and reproduction in any medium, provided the original author and source are credited.

*Address correspondence to this author at the Department of Respiratory Care, College of Applied
Medical Sciences in Jubail, Imam Abdulrahman Bin Faisal University, Jubail 35816, Saudi Arabia; E-
mail: [email protected]

1. INTRODUCTION
Artificial intelligence is the game-changer across various industries on a global scale, and healthcare is
certainly not exempt. Within the realm of healthcare, the pursuit of optimal outcomes necessitates the
integration of artificial intelligence. At its core, artificial intelligence embodies the ability of computers to
emulate human intelligence and generate well-informed choices [1]. Conversely, quality within the
healthcare domain encompasses adopting proficient, patient-centric, secure, and productive services
that are unbiased, comprehensive, punctual, and streamlined services [2]. Therefore, the integration of
artificial intelligence in healthcare completes the quality equation. Many industries worldwide reckon the
enormous benefits and use of artificial intelligence in healthcare. Ideally, prominent health reformers
anticipate a future of complete use of artificial intelligence in delivering healthcare services [3]. For
instance, the World Health Organization echoes artificial intelligence's potential to perform distributed
health automation, give clinical information, and offer extra clinical support [4]. Therefore, this study
appreciates that artificial intelligence creates centric and distributed big data hubs that provide informed
health information and insights into well-being. Big data is critical in dispensing artificial intelligence in
the healthcare industry. The Big data coffers are integrated with machine learning algorithms to
diagnose better, identify specific indicators, and inform treatment outcomes [5] on the 20% more polyps
than the regular examination [6-8]. AI integrated with machine learning algorithms has a 5% better-
improved accuracy and error reduction rate. AI in healthcare potentially reduces medical and operational
costs; for instance, a study [9] provided an example of a pill-cam that performed better endoscopy for
stomach cancer examinations. Also, a study [10] reported the successful use of AI tools to test acute
leukemia, a relatively cheaper exercise than traditional methods. From the dystopian perspective, a
question lies on the accountability aspect of artificial intelligence.

For instance, on May 7th, 2016, the Tesla Model S autonomous car encountered a malfunction that led
to the demise of a person. Who was accountable for the Tesla Model S accident is a question that can
trouble the medical field. Who can account for AI causes of misdiagnosis, failed treatment, or general
failure? Nevertheless, the gains surpass the risks, and in this regard, this paper examines the impact of
artificial intelligence on healthcare quality.

Despite the growing interest in using artificial intelligence (AI) in healthcare, there is still a lack of
comprehensive research on the potential impact of AI on healthcare quality. While some studies have
explored the use of AI in healthcare, there is still a need for a systematic review and meta-analysis
examining the current state of AI in healthcare and its potential benefits and drawbacks. This study aims
to fill this gap by providing a comprehensive analysis of the current state of AI in healthcare and its
potential impact on healthcare quality. The findings of this study will provide insights into how AI can be
used to improve healthcare quality and inform future research in this area.

1.1. Rationale

The study investigates the impact of artificial intelligence on healthcare quality. In this respect, this study
recognizes the revolutionary nature of artificial intelligence in healthcare services. Therefore, the
rationale concerns increasing AI integration in healthcare quality, including treatment, diagnostics,
planning, and administration. AI growth is on the uptrend; therefore, understanding its impact on
healthcare quality is crucial for healthcare professionals, stakeholders, and policymakers. Current AI
applications in healthcare showcase its potential in decision-making, especially in data analytics and
predictions. AI enhances diagnostic accuracy, efficient resource allocation, and personalized treatment,
which significantly implicates the quality of health. However, concerns arise in regulatory frameworks,
algorithmic bias, and ethical implications. Therefore, this study explores extensive literature about the
impact of artificial intelligence on healthcare quality, providing insights to healthcare providers,
stakeholders, and policymakers on future recommendations and current decision-making. The study
provides evidence-based information to showcase the impact of AI integration in healthcare.

1.1.1. PICO Research Question

What is the impact of artificial intelligence on healthcare quality?

1.1.1.1. Population (P)

The population of interest in the studies are patients and individuals in diverse demographic groups and
with various conditions.

1.1.1.2. Intervention (I)

The utilization and implementation of artificial intelligence in healthcare quality, including administrative
processes, treatment planning, predictive analytics, and diagnostic tools.

1.1.1.3. Comparison (C)

The study compares traditional healthcare practices and systems to the age of artificial intelligence and
its implications on quality.

1.1.1.4. Outcome (O)

The outcome measure is healthcare quality, which includes efficiency and accuracy in treatment and
healing processes.

1.2. Objectives

To explore the use of AI integration in mobile technology and its impact on the quality of health.
To examine the impact of robotic-assisted healthcare on the quality of health.
To determine the impact of AI self-monitoring hospital gadgets on the quality of health.

2. MATERIALS AND METHODS

2.1. Search Strategy

A literature search was conducted from June 5th, 2023, to July 20th, 2023, to identify relevant articles
related to the research topic. The search strategy incorporated the Preferred Reporting Items for
Systematic Reviews and Meta-Analyses (PRISMA), inclusion, and exclusion criteria [11]. The PRISMA
guidelines were imperative for extending the reproducibility and transparency of this review [11]. A
PRISMA structural framework is integrated after thoroughly examining the sources through the inclusion
and exclusion criteria. Factors considered for inclusion were as follows:

Language – Only studies published in English were included in this study. It is because highly
reputable and impactful journals are published in English. Many researchers use the English
language for standardization and call for international collaboration. Also, journals published in
English are easy to understand and access.
Study design- this study majored in Randomized controlled trials (RCTs). RCTs have high internal
validity, which reduces bias while helping to control confounding variables in the relationships
between the outcomes and the interventions. RCTs offer strong evidence-based practice and help
establish the effectiveness of interventions.
Type of Publications- This study opted for only journal articles published in the PubMed database.
Studies from PubMed extensively explore the literature, increasing credible evidence in the
generalization. Also, PubMed is user-friendly and standardized. Finally, PubMed has a broad
spectrum of biomedical studies.
Date- Studies published from 2012 and below were excluded. Only studies published in 2012 were
included due to their relevance to the issues of artificial intelligence and healthcare quality. The
limitation ensures the publications included are relevant to the current and revolutionary topic of
study. Therefore, this research addressed notable changes in artificial intelligence and healthcare
quality.

An extensive search process incorporated keywords searched using Boolean operators (AND, OR). The
operators created a string of variables that simplified the search process, as shown below.

Artificial intelligence
Artificial
Intelligence
Healthcare
Quality
Healthcare Quality
Artificial intelligence in healthcare

2.2. Critical Appraisal Tools

After the initial screening of the articles based on their titles and abstracts, two reviewers independently
evaluated each record for eligibility. The reviewers worked alone and were blinded to each other’s
decisions. Any discrepancies between the two reviewers were resolved through discussion and
consensus. The inclusion criteria for the systematic review and meta-analysis were based on the
research question and were pre-specified in the protocol. The final selection of articles was based on
the inclusion criteria and the quality of the studies. Using the PRISMA and Critical Appraisal Skills
Programme (CASP) checklists significantly enhanced the quality of this systematic review. The CASP
questions were pivotal in meticulously screening the sources before their final inclusion in this review.
These questions examined whether the studies appropriately addressed the research question,
emphasizing the considered outcome, administered intervention, and targeted population. The primary
objective of this review was to ascertain the potential impact of artificial intelligence on healthcare
quality. The population under scrutiny consisted of patients undergoing medical treatment after clinical
diagnosis and medical chart reviews. Furthermore, randomized trials were considered to analyze the pre
and post-effects of artificial intelligence implementation. Consequently, this review diligently verified that
participant assignments to interventions were randomized effectively to minimize the likelihood of
systematic bias. Additionally, a thorough assessment was conducted to ensure that exclusions and
follow-up procedures during and after randomization were adequately accounted for, with careful
consideration given to any instances of premature discontinuation of the process. The screening
process also considered whether the intervention effects were sufficiently reported, considering the
precision of estimates, and whether the experimental intervention considered harms and costs in the
entire process. Finally, the transferability and accuracy of the findings were central throughout the
screening process.

3. THE PRISMA FRAMEWORK

As discussed earlier, this study majored in randomized controlled trials on the impact of artificial
intelligence on healthcare quality published in PubMed. As a result, 2544 sources that emphasized the
impact of artificial intelligence on healthcare quality were identified. However, 850 sources were
duplicates and removed from this study due to irrelevant and inconsistency with this research. Two
hundred more records were removed because of insufficient information regarding the topic and
methodology. Two hundred ninety-four records qualified for the screening process, whereas 188
sources still needed to meet the year of publication requirements. This study excluded records
published from 2012 and below. Moreover, 55 sources were removed since more detailed information
concerning the authors was needed. Only 51 records qualified for eligibility, whereas another nine
sources failed because they required precise details concerning the intervention and the control groups.
Twelve sources were considered close to this topic but slightly different from this research and thus
removed. Twelve sources contained mixed research methods, which took more work to follow up on the
controls and the intervention groups (Fig. 1). Only 18 sources were included, as shown in the PRISMA
flowchart below [7] (Table 1).
Fig. (1)
PRISMA flowchart.
Table 1 Table characteristics (Researcher, 2023).
n=
Author(s) and Control Intervention
Method Objectives Sample Results Imp
Date Group Group
Size
1. Brath H, Morak Controlled The aim was to 150 75 53 The study T
J, Kästenbauer T, Randomized assess mobile concluded that
Modre‐Osprian R, Crossover health (mHealth) mHealth-based bli
Strohner‐ design based remote medical ap
Kästenbauer H, medication adherence was
Schwarz M, Kort adherence well accepted m
W, Schreier measurement and provided re
G.2013([2] system(m A M S) possible results
for patients with for reduced e
cardiovascular cardiovascular
disease. risk. s

a
2. Chandler J, Sox Randomized To test the efficacy 54 28 26 The use of real-
L, Kellam K, Controlled of real-time time s
Feder L, Nemeth Trials monitoring using smartphone ena
L, Treiber F. 2019 wireless health monitoring re
[12, 13] technology in provided
controlling blood practical m
pressure (BP) and solutions for ad
monitoring medication s
medication adherence and re
adherence. statistically
significant u
results in h
controlling BP
and
 n=
Author(s) and Control Intervention
Method Objectives Sample Results Imp
Date Group Group
Size
uncontrolled
HTN.
3. Goldstein CM, To test medical 60 30 30 The devices M
Gathright EC, adherence using were not
Dolansky MA, telehealth significant in re
Gunstad J, Sterns medication versus determining ma
A, Redle JD, pillbox for patients medical pat
Josephson R, with systolic and adherence. r
Hughes JW. 2014 diastolic heart b
[14] failure. ala

s
4. Greer JA, Randomized The study tested 181 90 91 Smartphone Mo
Jacobs JM, Trials how smartphone mobile re
Pensak N, Nisotel applications applications did b
LE, Fishbein JN, enhanced not provide co
MacDonald JJ, adherence to oral improved
Ream ME, Walsh therapy for cancer medical cl
EA, Buzaglo J, and symptom adherence, and pa
Muzikansky A, management. there were no
Lennes IT.2020 perceptions of adm
[15] quality of care, o
QoL, and
symptoms
compared to
standard care
alone.
5. Santo K, Randomized To test the 163 81 82 There was no Eve
Singleton A, control groups feasibility and significant
Rogers K, effectiveness of the clinical evidence re
Thiagalingam A, medical apps in in the Coronary
Chalmers J, Chow improving Heart Disease m
CK, Redfern medication Study that adh
J.2019 [16] adherence in the medical
control of Coronary adherence apps s
Heart Disease. could improve
medication
adherence.
6. Johnston N, Randomized The study 174 86 80 The results A
Bodegard J, trials examined whether were not to
Jerström S, smartphone statistically s
Åkesson J, applications significant that
Brorsson H, improved treatment the smartphone
Alfredsson J, adherence and application
Albertsson PA, cardiovascular improved c
Karlsson JE, lifestyle in treatment
Varenhorst myocardial adherence and
C.2016 [17] infarction cardiovascular
(MI)patients lifestyle in MI
patients.
7. Kim JY, Randomized The study 95 43 52 The wireless Se
Wineinger NE, Control Trials examined how self-monitoring
 n=
Author(s) and Control Intervention
Method Objectives Sample Results Imp
Date Group Group
Size
Steinhubl wireless self- program did not
SR.2016 [18] monitoring program provide m
influenced blood significant
pressure levels, results im
medication concerning
adherence, and medicine m
health behaviors adherence but a
strengthened t
campaigns to
reduce alcohol
and drug
consumption.
8. Labovitz DL, Randomized The study tested 29 13 15 There was a Th
Shafner L, Reyes parallel trials the implication of AI 67% absolute
Gil M, Virmani D, integrated into improvement for app
Hanina A.2017 mobile devices in patients
[19] increasing medical monitored by
adherence for the AI app ad
stroke patients based on the pa
undergoing drug levels.
anticoagulation (
therapy. ri
an
9. Marquez Randomized The study 148 77 77 The mobile app T
Contreras, E., Controlled investigated the intervention a
Marquez Rivero, Trial effectiveness of favored im
S., Rodriguez pharmacological pharmacological re
Garcia, E., López- therapeutic therapeutic
García-Ramos, L., adherence through adherence for pha
Carlos Pastoriza a mobile application hypertensive t
Vilas, J., in controlling mild to patients. ad
Baldonedo moderate arterial h
Suarez, A., Gracia hypertension (AHT)
Diez, C., Gil
Guillen, V., Martell
Claros, N. and
Compliance
Group of Spanish
Society of
Hypertension
(SEH-LELHA),
2019 [20].
10. Thimabut N, Randomized The study 26 13 12 The group that
Yotnuengnit P, Controlled investigated using a received robotic ro
Charoenlimprasert Trial RAGT (Robot- training showed ph
J, Sillapachai T, Assisted Gait more significant pr
Hirano S, Saitoh Training) device to improvement.
E, Piravej K. 2022 improve ambulatory im
[21] functions in
Subacute stroke s
with hemiplegia. h
 n=
Author(s) and Control Intervention
Method Objectives Sample Results Imp
Date Group Group
Size
11. Sconza C, Randomized The study tested 19 9 8 The patients Ro
Negrini F, Di Controlled the effectiveness of improved their t
Matteo B, Borboni Crossover robot-assisted gait gait parameters ph
A, Boccia G, Trial training (RAGT) in significantly gi
Petrikonis I, patients affected by after the RAGT
Stankevičius E, multiple sclerosis training. p
Casale R. 2021 (MS) and
[22] undergoing sc
physiotherapy
treatment.
12. Jayakumar P, Randomized To test whether AI- 129 69 60 The AI-enabled U
Moore MG, Clinical Trials enabled patients platform driv
Furlough KA, improve process- significantly
Uhler LM, level outcomes, improved a
Andrawis JP, functional process-level ess
Koenig KM, Aksan outcomes, patient outcomes and ma
N, Rathouz PJ, experiences, and decision quality.
Bozic KJ. 2021 decision quality. O
[23]
13. Yao X, Randomized The study 22,641 11,068 11,573 The AI-powered A
Rushlow DR, Control trials examined whether ECG increased a
Inselman JW, AI-powered the diagnosis of EC
McCoy RG, electrocardiogram EF. be
Thacher TD, (ECG) can support
Behnken EM, the diagnosis of EF.
Bernard ME,
Rosas SL, Akfaly
A, Misra A,
Molling PE. 2021
[24]
14. Adly, A.S., Single-blinded The use of a 60 30 30 There was a H
Adly, M.S. and randomized Telemanagement significant oxy
Adly, A.S., 2021 clinical trials health care system difference
[25] compared to two between the p
nonpharmacological control group
respiratory and the
treatment methods intervention c
for COVID-19 group. phy
home-isolated and
patients. m
t
15. Rodgers H, To assess the 770 516 254 No R
Bosomworth H, effectiveness of improvement of tr
Krebs HI, van robotic gym- upper limb n
Wijck F, Howel D, assisted training for function after
Wilson N, Aird L, upper limb therapy stroke was fun
Alvarado N, (EULT). observed after
Andole S, Cohen the robotic gym
DL, Dawson training.
J.2019 [26]
16. Seol HY, Stratified To assess the 184 94 90 Using AI- The
Shrestha P, Muth Randomization efficacy of an AI- assisted and the
 n=
Author(s) and Control Intervention
Method Objectives Sample Results Imp
Date Group Group
Size
JF, Wi CI, Sohn S, design assisted CDS tool, GPS systems in
Ryu E, Park M, Asthma-Guidance can improve the
Ihrke K, Moon S, and Prediction efficiency of i
King K, Wheeler System (A-GPS) for clinical reviews pro
P.2021 [27] asthma in asthma
management. management.
m
17. Wilson PM, Cluster To test the 2544 1332 1212 Using machine
Ramar P, Philpot randomized effectiveness of the learning s
LM, Soleimani J, trials machine learning decision tools and
Ebbert JO, Storlie decision tools and and artificial
CB, Morgan AA, artificial intelligence intelligence pa
Schaeferle GM, tools in predicting provided a co
Asai SW, patients requiring higher incidence h
Herasevich V, palliative care of palliative care
Pickering services. consultation
[BW.2023 [28] than usual care.
18. Mori Y, Wang Randomized To test whether 5796 2894 2902 AI increases the A
P, Løberg M, controlled polyp detection can detection rate im
Misawa M, Repici trials be increased using and the de
A, Spadaccini M, artificial intelligence proportion of p
Correale L, during colonoscopy, patients re
Antonelli G, Yu H, requiring di
Gong D, Ishiyama intensive a
M. 2023 [29] colonoscopies.

3.1. Meta-Analysis

This section statistically combines the results of the systematic analysis above to derive conclusions that
inform about the topic of this research. Mainly, this research derives from randomized controlled clinical
trials about the impact of artificial intelligence on healthcare quality, and this section quantifies the
results in the form of forest plots, funnel plots, and risk analysis tables.

3.2. Forest Plots

The general forest plots of the studies in the systematic analysis are shown below:

Each line represents the study, and the box shows the estimate’s midpoint; in this research, the box
symbolizes the odd ratio. The size of the box represents the weight of the study, which is relative to the
N in each study. The larger the sample size of each study, the greater the weight and the bigger the box
in the forest plot. For instance, studies by Yao X et al. [24] and Mori Y et al. [29] carry the most
significant weight in the study. Fig. (2) is a forest plot indicating the results of the intervention review.
The forest plot represents the study labels, the effect size estimates, confidence intervals, the diamond
marker, the vertical line of no effect, and heterogeneity statistics. The odd ratios (ORs) show the
relationship between the variables in the outcome. It represents the odds of the event occurring versus
the control group. 9 out of 18 studies have an odds ratio greater than 1. Odd ratio >1, which indicates
there is a significant influence of artificial intelligence on healthcare quality. Therefore, the studies [12,
13, 17, 20-22, 26-28,] prove there is a positive impact of artificial intelligence in healthcare quality. An
odd ratio equals 1, indicating no association between artificial intelligence and healthcare quality. In this
respect, 2 out of 18 studies showed no relationship between artificial intelligence and healthcare quality.
The control group provided results equal to those of the intervention groups. An odd ratio of less than 1
indicates reduced odds of the event occurring. In this regard, 6 out of 18 studies showed decreased
odds of artificial intelligence impacting healthcare quality. The studies [15, 18, 19, 29, 16, 24] provided
reduced odds of artificial intelligence impacting quality in healthcare.

Heterogeneity measures inconsistency or the degree of variability among the studies. Heterogeneity is
represented by I2 statistic and as a percentage. The forest plot figure above shows I2 = 92%,
representing considerable heterogeneity, indicating high variation among the studies. The overall effect
value indicates Z= 1.93 and P= 0.05; Z-score is used to test the summary measure's statistical
significance or effect size. The Z-score shows several standard deviations from the null hypothesis in an
observed effect size. Z scores depend on the alpha level in explaining the level of significance where the
P-value is considered less than or equal to 0.05. About Fig. (2) above, the Z score is 1.93, indicating a
statistically positive significant direction of the effect size observed towards the alternative hypothesis.
The null hypothesis is that artificial intelligence does not impact healthcare quality, whereas the
alternative view is that artificial intelligence affects healthcare quality. Therefore, this study proves that
artificial intelligence positively impacts healthcare quality.

3.3. Funnel Plots

A funnel plot is a scatterplot showing intervention estimates effects against the size of each study. The
funnel plots show how the precision of the intervention increases relative to the study size. The effect
estimate of studies with small sample sizes scatter at the bottom of the funnel plot. In this regard, this
study shows an inverted funnel, indicating the absence of publication bias. Most studies are distributed
on the top, meaning extensive studies with no publication bias (Fig. 3).

3.4. Subgroup Analysis

The following section of subgroup analysis is divided in response to the research objectives. The
objectives mention using AI mobile technology, AI robotics in healthcare delivery, and AI gadgets in
healthcare monitoring. The subgroup analyses are intended to reduce the heterogeneity observed in the
general research.

To explore the use of AI integration in mobile technology and its impact on the quality of health.

Fig. (2)
Forest plots of general studies (Researcher, 2023).
Fig. (3)
Funnel plot of general studies (Researcher, 2023).

Fig. (4)
Impact of AI-enabled mobile technology on healthcare quality (Researcher, 2023).

Figure I2 = 0%, which shows that studies relating to AI-enabled mobile technology applications are
consistent (Fig. 4). Three of the seven studies showed a lesser positive relationship between AI-enabled
mobile technology producing positive healthcare quality. 4 out of 7 studies prove the positive relationship
between AI-enabled mobile technology and achieving healthcare quality. A Z score of 1.64 indicates that
AI-enabled mobile technologies contribute to positive results in establishing healthcare quality. The
studies [12-15, 17, 19, 20] expounded on the use of AI, such as mobile health electronic blisters, to
monitor medication adherence in diabetes patients. The electronic blisters provided positive results and
can be applied in promoting various medicine adherence regimens [12]. The use of mHealth medication
regimens to encourage a culture of self-management for hypertensive patients provided positive results
[13]. The use of telemedicine medication reminders to promote medication adherence for older patients
with heart failure [14]. However, the telemedicine medication reminders did not provide significant
results concerning medication adherence. Mobile smartphone applications were used to help patients
with cancer improve adherence to oral therapy [15]. The study observed no perception of care
compared to the usual care for cancer patients. Interactive smartphone applications were used to help
myocardial infarction patients with drug adherence and lifestyle changes [17]. The results were not
statistically significant because interactive smartphone applications help drug adherence for myocardial
infarction. They reduce the risk of no commitment of patients undergoing anticoagulation therapy using
artificial intelligence [19] and smartphone applications to help hypertensive patients with medication
adherence. It can be concluded that AI-powered mHealth applications, smartphone applications, and
machine learning algorithms can help hypertensive and cancer patients’ self-management.
Nevertheless, the applications do not provide significant results regarding medication adherence. The
control and the intervention provided almost similar results. Therefore, artificial intelligence can help
improve healthcare self-management processes but does not reflect on the overall quality of healthcare
services.

3.5. To Examine the Impact of Robotic-assisted Healthcare on the Quality of Health

Fig. (5) below shows that I2 = 75%, which is considerable, but given the few studies, it arises from the
different sample sizes. The Z score of 1.44 with a P-value less than 0.05 indicates that AI-enabled
robotics positively affect healthcare quality. All the studies have a positive odd ratio, meaning that AI
robotics-assisted healthcare is transitioning to quality healthcare. Other studies majored in AI for
assistive healing. For instance, a study [21] sought to improve the ambulatory functions of patients with
sub-acute stroke using a robot-assisted gait training device. An author [22] investigated the impact of
robotic-assisted training for multiple sclerosis patients. An author [26] examined the impact of robotic-
assisted training on stroke patients with upper limbs.

Fig. (5)
Impact of AI-enabled robotics on healthcare quality (Researcher, 2023).

Fig. (6)
Impact of self-monitoring AI-enabled gadgets on healthcare quality (Researcher, 2023).
3.6. To Determine the Impact of AI Self-monitoring Hospital Gadgets on the Quality of
Health

The I2 = 0 shows no heterogeneity among the selected studies on AI self-monitoring hospital gadgets.
Generally, all the studies provided a Z score of 4.75 and a P-value of 0.00001, indicating a positive
relationship between AI-enabled self-monitoring healthcare and enhancing quality of health. However,
the odds of positive influence varied significantly among the studies. A study [24] investigated
electrocardiograms powered by artificial intelligence to help diagnose low ejection fraction. A study [23]
compared the performance of the standard educational materials and artificial intelligence-enabled
decision-making for patients with knee osteoarthritis. A study [25] investigated the use of
Telemanagement for COVID-19-isolated patients in noninvasive oxygen therapy versus the everyday
therapy routines. A study [27] investigated artificial intelligence decision-making for asthma
management. In contrast, a study [28] investigated the capacity of AI to improve palliative care for
hospitalized patients, and another study [29] investigated the use of artificial intelligence for
colonoscopy, which provided more polyp than the conventional process. (Fig. 6).

The studies using artificial intelligence for assistive healing are highly heterogeneous, and the p-value
significantly influences the results, indicating the presence of publication bias. Generally, all the studies
have proven the use of artificial intelligence in healthcare settings as an assistive tool in the diagnosis,
treatment, management, and predictability of diseases. Therefore, artificial intelligence requires a
combination of other factors in healthcare settings to provide the anticipated healthcare quality.

4. RESULTS AND DISCUSSION

This study confirms the effectiveness of artificial intelligence in improving healthcare processes,
especially in assisted healing and medication adherence. For instance, a study [12] examined the use of
mHealth for remote medication adherence, and the study confirmed the widespread acceptance of the
device. Examples of mHealth mobile devices include tablet computers, smartphones, and personal
digital assistants [7]. Healthcare professionals use tablet computers and smartphones for
communication and computing, simplifying the point-of-care processes [30, 31]. Moreover, artificial
intelligence provides expanded functionalities such as sound recorders, high-quality cameras, global
positioning systems (GPS), web searching powered high-resolution screens, significant memories, and
robust operating systems promoting exceptional services and deliveries [7]. However, a study [12]
cautioned the need to examine the devices to gauge their applicability and suitability in daily
applications. According to a study [6], smartphones provide adequate support for caregivers and remote
workers in health services. However, the study [6] argues that smartphones face financial, technical,
security, and communication constraints that may hinder the delivery of the intended benefits. Therefore,
the study [6] confirms the need to employ cautionary measures as provided [12]. Such functionality is
exceptional in providing real-time monitoring, which is significant in controlling lifestyle diseases such as
blood pressure [23]. Real-time health monitoring devices improve the quality of life by helping patients
maintain independence, preventing complications, and minimizing personal costs [32]. In addition, real-
time monitoring helps extend quality care in the comfort of patients' homes [8]. The capacity of real-time
monitoring health devices to monitor and predict trends helps reduce emergency visits and
hospitalization. It improves patients’ psychological parameters, which helps in improving the quality of
healthcare services [8]. However, the study [14] did not observe statistically significant results of
telehealth services versus a pillbox in managing patients with systolic and diastolic heart failure.
Similarly, the study [15] did not observe any advantage of using smartphone applications in assisting
cancer patients in maintaining oral therapy. A Study [16] also confirms that the medical reminder apps
do not significantly improve medication adherence, which is similar to findings postulated by other
studies [17, 18, 26]. Generally, the studies showcased the benefits of artificial intelligence integrated into
computer and smartphone technologies in diagnosis and healing processes in healthcare settings. For
instance, a study [19] observed that AI applications could optimize medical adherence for patients taking
3DOACs (dabigatran, rivaroxaban, and apixaban). A Study [20] Observed the effectiveness of mobile
applications in pharmacological therapeutic adherence for hypertensive patients. AI-based technologies
have significantly transformed the healthcare sector, particularly disease diagnosis and treatment,
encompassing a wide spectrum of medical conditions [33]. The advantages are particularly pronounced
in the context of real-time automatic detection for cancer patients [34]. The amalgamation of AI and
machine learning algorithms confers a multifactorial capacity that enables precise and comprehensive
cancer diagnosis [35]. This progress has facilitated the accessibility of sophisticated healthcare services
for diagnosing and managing complex diseases in rural regions through AI-assisted diagnosis,
prediction, and treatment [36]. Nevertheless, implementing AI-assisted technologies in clinical settings
presents various challenges: financial considerations, hardware utilization, security concerns, and
communication issues. Despite these obstacles, mobile devices provide healthcare professionals with
precise and actionable functionalities, significantly enhancing time and information management
capabilities [7]. The application of AI in managing acute leukemia has yielded remarkable outcomes, as
advanced diagnostic methods now provide highly categorized information [37]. They showcased the
benefits of artificial intelligence integrated into computer and smartphone technologies in diagnosis and
healing processes in healthcare settings.A study [21] showcased the effectiveness of robot-assisted gait
training for sub-acute stroke patients.A study [22] observed the advantages of robot-assisted gait
training for multiple sclerosis (MS) patients. A study [29] observed that AI diagnosis improves polyp
detection rate in colonoscopy. Ideally, robotic technology offers many advantages in improving
healthcare quality. Robotics can perform accurate and precise tasks that reduce the risk of human errors
[38]. Also, robots operate using predefined guidelines and protocols that ensure standardization and
consistency, reducing variability and improving quality [9]. Ideally, robotic-assisted surgeries are less
invasive due to the smaller incisions resulting in reduced pain, faster recoveries, and fewer
complications [10]. In addition, AI-powered robotics help surgeons discover or access difficult areas that
increase precision while reducing complications [39]. AI robotic technology provides greater access in
underserved and remote regions to treat and monitor patients remotely, reducing the need to travel [9].

The limitations of this systematic review and meta-analysis include the search strategy. It is not
comprehensive enough to identify all relevant studies, as the search was conducted on one PubMed
database. This may have resulted in missing some relevant studies published in other databases or not
indexed in PubMed. This limitation could have been addressed by searching multiple databases and
using different sources such as reference lists of included studies and grey literature.

The results suggest that artificial intelligence has a positive influence on healthcare quality. However, the
studies were substantially heterogeneous, which may limit the generalizability of the results. The lack of
statistical significance in 12/18 studies may be due to the small sample sizes or the lack of
standardization in using artificial intelligence in healthcare. The positive influence of artificial intelligence
on healthcare quality suggests that it may be helpful in assisted healing or medication adherence.
Future research should focus on standardizing the use of artificial intelligence in healthcare and
increasing sample sizes to improve the generalizability of the results. Additionally, future research
should investigate the potential adverse effects of artificial intelligence on healthcare quality and patient
outcomes. The implications of these results for practice and policy suggest that artificial intelligence may
be helpful in improving healthcare quality and patient outcomes. However, more research is needed to
determine the optimal use of artificial intelligence in healthcare and to ensure that it is used ethically and
responsibly.

CONCLUSION
The utilization of artificial intelligence (AI) enhanced by machine learning algorithms and integrated into
mobile technologies and applications was consistently observed throughout the studies. However, none
of the studies demonstrated statistically significant evidence that AI directly improves healthcare quality.
This study uncovers the multifaceted factors contributing to enhancing healthcare quality, such as
ensuring individuals have access to timely healthcare services, including emergency care, specialists,
and primary care. Furthermore, prioritizing the patient’s values, preferences, and needs in healthcare
decision-making can improve patient satisfaction and outcomes. Effective communication, evidence-
based practice, and care coordination are other factors that can help enhance healthcare quality. Finally,
incorporating health information technology, safety, and risk management can help proactively respond
to adverse events and minimize hospital errors, thus improving healthcare quality.
LIST OF ABBREVIATIONS

AI = Artificial Intelligence
CASP = Critical Appraisal Skills Programme
GPS = Global Positioning Systems

CONSENT FOR PUBLICATION

Not applicable.

STANDARDS OF REPORTING
PRISMA guidelines and methodology were followed.

AVAILABILITY OF DATA AND MATERIALS

The data and supportive information are available within the article.

FUNDING
None.

CONFLICT OF INTEREST
The author declares no conflict of interest, financial or otherwise.

ACKNOWLEDGEMENTS
Declared none.

SUPPLEMENTARY MATERIALS
PRISMA checklist is available as supplementary material on the publisher’s website along with the
published article.

Supplementary material is available on the publisher’s website along with the published article.

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