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2008 HSR&D National Meeting Abstract

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National Meeting 2008

3011 — A Telehealth Education Program for Caregivers of Veterans with Dementia: VA Cost Outcomes

Shulan MD (Stratton VAMC), Wray LO (VISN 2 Center for Integrated Healthcare), Gao J (VISN 2 ), Freeman KE (Stratton VAMC), Vasquez BE (University of New York at Albany), Toseland RW (University of New York at Albany)

Objectives:
HSR&D IIR 003-076 is a project designed to (1) To evaluate the impact of a Telehealth Education Program (TEP) on outpatient veterans with dementia, and (2) to help caregivers gain the knowledge and skills necessary to provide quality care for their spouse. This presentation will focus on an analysis of VA cost data results.

Methods:
The study employed a 2x2x3 randomized control group design (two treatment conditions, two sites, three times of measurement). One hundred and fifty-eight veterans with moderate to severe dementia and their spousal caregivers were enrolled at either Albany VAMC or Buffalo VAMC and randomly assigned to treatment (TEP) or usual care (UC). Spousal caregivers in the TEP group participated in a 10-week, telephone support and education group. Cost data were compared using data collected for six months prior to baseline, six months following completion of the treatment and twelve months following treatment. Cost data were extracted from the Decision Support System for all costs incurred at any VA and were divided into: (1) total outpatient costs, (2) total inpatient hospital costs, (3) total nursing home cost, and (4) total health care costs. Data were analyzed using Mixed-Effects Models.

Results:
Total health costs were significantly less after controlling for baseline, in the TEP group when compared to UC. The cost savings was $2768.19 (F = 3.47, p = 0.032) per person. This difference is due to a short term effect. The costs savings was not maintained in the period six to twelve months after the intervention. Analysis of the subcategories of cost (total outpatient costs, total inpatient costs, and total nursing home costs) found no significant differences between the groups.

Implications:
The TEP intervention resulted in a short term decrease in health care costs for outpatient veterans with moderate to severe dementia. This effect was not maintained over the long term.

Impacts:
Telephone based caregiver groups may decrease the total cost of care in the short term for outpatient veterans with moderate to severe dementia. Additional follow up may be needed for telephone groups to be effective in decreasing costs over the long term.


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