The effectiveness of a care coordination home telehealth program for veterans with diabetes mellitus: a 2-year follow-up.
OBJECTIVE
To assess healthcare use among veterans with diabetes mellitus (DM) enrolled in a Department of Veterans Affairs (VA) Care Coordination Home Telehealth (CCHT) program during 24 months and to contrast this utilization with the service use of a comparison group of veterans with DM not enrolled in the program.


METHODS
Two-year, retrospective, concurrent matched cohort study design.


METHODS
The VA CCHT program included older veterans with type 2 DM at high risk for multiple VA inpatient and outpatient visits. Healthcare utilization (hospitalizations, length of stay, and outpatient visits by type) was assessed at baseline and at 24 months after intervention for the treatment (n = 400) and comparison (n = 400) groups. Propensity scores were used to improve the balance between the treatment and comparison groups. A difference-in-differences approach was used to control for selection bias and for intervening time factors.


RESULTS
Two years after enrollment, the treatment group exhibited a statistically significant reduction in the likelihood of all-cause and DM-related hospitalizations. In a subgroup analysis in which we controlled for patients' baseline glycosylated hemoglobin levels, the treatment group had a lower likelihood of having any care coordinator-initiated primary care clinic visits (in which the care coordinator initiated referral to primary care based on health information received from patients' CCHT technology).


CONCLUSIONS
After controlling for selection bias and for intervening time factors, the VA CCHT program reduced avoidable healthcare services for DM (such as hospitalizations) and reduced care coordinator-initiated primary care clinic visits.
Barnett
Tracey E
TE
Veterans Affairs Health Services/Rehabilitation Research and Development, Rehabilitation Outcomes Research Center, North Florida/South Georgia Veterans Health System, 1601 SW Archer Road #151B, Gainesville, FL 32608, USA. tracey.barnett@va.gov
Chumbler
Neale R
NR
Vogel
W Bruce
WB
Beyth
Rebecca J
RJ
Qin
Haijing
H
Kobb
Rita
R
D000368:Aged; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2; D005500:Follow-Up Studies; D006699:Home Care Services / Q000458:organization & administration*; D006801:Humans; D008297:Male; D015397:Program Evaluation; D012189:Retrospective Studies; D017216:Telemedicine; D014481:United States; D014728:Veterans