title: Healthcare utilization among veterans undergoing chemotherapy: the impact of a cancer care coordination/home-telehealth program.
abstract: The 2001 Institute of Medicine report indicted that the US healthcare system fails to provide high-quality care, and offered 6 aims of improvement that would redesign the delivery of care for the 21st century. This study compared the use of Department of Veterans Affairs (VA) inpatient and outpatient services of cancer patients enrolled in a Cancer Care Coordination/Home-Telehealth (CCHT) program that involved remote management of symptoms (eg, emotional distress, pain) via home-telehealth technologies to a control group of cancer patients receiving standard VA care. Using a matched case-control design, 2 control patients per case were selected, matched by tumor type and cancer stage. There were 43 Cancer CCHT patients and 82 control group patients. Based on a medical record review of each patient, the total number of cancer-related services (defined as visits that were expected given the patients' cancer diagnosis and treatment protocol) and preventable services (defined as visits needed outside of those expected given the cancer diagnosis and planned treatment) were calculated over a 6-month period. Poisson multivariate regression models were used to estimate the adjusted relative risks (RRs) for the effects of the Cancer CCHT program on the service use outcomes. Cancer CCHT patients had significantly fewer preventable services (clinic visits: RR = 0.03, 95% confidence interval [CI] = 0.00-0.24; bed days of care (BDOC) for hospitalization [all-cause]: RR = 0.50, 95% CI = 0.37-0.67; hospitalizations [chemotherapy related]: RR = 0.43, 95% CI = 0.21-0.91; and BDOC for hospitalizations [chemotherapy related]: RR = 0.49, 95% CI = 0.34-0.71) than the control group. This study offered some preliminary evidence that patients enrolled in a Cancer CCHT program can successfully manage multiple complex symptoms without utilizing inpatient and outpatient services.
authors.affiliation: VA HSR&D/RR&D Rehabilitation Outcomes Research Center and VA HSR&D Stroke QUERI, North Florida/South Georgia Veterans Health System, Gainesville, FL 32608, USA. Neale.Chumbler@va.gov
authors.forename: Neale R
authors.initials: NR
authors.lastname: Chumbler
authors.forename: Rita
authors.initials: R
authors.lastname: Kobb
authors.forename: Linda
authors.initials: L
authors.lastname: Harris
authors.forename: Lisa C
authors.initials: LC
authors.lastname: Richardson
authors.forename: Adam
authors.initials: A
authors.lastname: Darkins
authors.forename: Melanie
authors.initials: M
authors.lastname: Sberna
authors.forename: Neha
authors.initials: N
authors.lastname: Dixit
authors.forename: Patricia
authors.initials: P
authors.lastname: Ryan
authors.forename: Molla
authors.initials: M
authors.lastname: Donaldson
authors.forename: Gary L
authors.initials: GL
authors.lastname: Kreps
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006699:Home Care Services / Q000458:organization & administration; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy*; D017216:Telemedicine / Q000458:organization & administration; D014481:United States; D014728:Veterans