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2011 HSR&D National Meeting Abstract

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2011 National Meeting

1006 — Do the Economic Benefits of Participation in a Diabetes Group Visits Trial Persist after Trial Completion?

Jackson GL (Durham VAMC HSR&D Center of Excellence), Olsen MK (Durham VAMC HSR&D Center of Excellence), Smith VA (Durham VAMC HSR&D Center of Excellence), Edelman D (Durham VAMC HSR&D Center of Excellence), Bosworth HB (Durham VAMC HSR&D Center of Excellence), Powers BJ (Durham VAMC HSR&D Center of Excellence), Kaufman MA (Durham VAMC HSR&D Center of Excellence), Maciejewski ML (Durham VAMC HSR&D Center of Excellence)

The Diabetes Group Visits Trial (HSR&D IIR 03-084) found that among 239 patients with co-morbid hyperglycemia and hypertension, patients receiving group medical visits had a reduction in systolic blood pressure of 7.3 mmHg compared to usual care controls. The goal of our study (QUERI RRP 09-407) is to examine the impact of group visits on the probability of hospitalization, and on healthcare costs, during the 12-month intervention and up to 18 months after completion.

We modeled the probability of receiving inpatient care during 7 half-year time points (2 prior to, 2 during, and 3 after the clinical trial) using Generalized Estimating Equations (GEE). For the same time periods, we also modeled healthcare costs for four categories: primary care, specialty care, total outpatient, and total overall (outpatient + inpatient). GEEs were also used to model the expenditure outcomes with independent variables, including treatment arm, indicators for each half-year time period, and their interactions.

Overall expenditures were significantly lower ($5,207; 95% CI: -$9,180, -$1,234) for intervention patients than control patients 12-18 months after the trial ended, which was driven by a lower probability of inpatient admissions (-0.09; 95% CI: -0.16, -0.02). Primary care costs were greater ($139; 95% CI: $0.34, $278) for intervention patients than control patients 12-18 months after the intervention. This primary care expenditure result occurred despite the fact that during the intervention, primary care costs in the intervention group were less than in the control group (-$129; 95% CI: -$233, -$24) in the first six months and (-$139; 95% CI: -$236, -$43) in the second six months.

The economic benefits of participation in a diabetes self-management trial persisted nearly two years after trial completion because lower inpatient expenditures offset higher primary care expenditures.

In an era of increasing patient demand and use of patient-centered medical homes, it is important to assess the long-term impact of innovations on costs and utilization. Our results indicate that group visits for veterans with diabetes have a longer-term positive impact on overall VA expenditures.

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