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Health Services Research & Development

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2023 HSR&D/QUERI National Conference Abstract

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1159 — Avoidance of travel costs and greenhouse gas emissions with a telehealth program for Veterans with persistently poor diabetes control

Lead/Presenter: William Weppner,  Boise VAMC/University of Washington Dept of Medicine
All Authors: Weppner WG (Boise VAMC/University of Washington Dept.of Medicine), Jeffreys, AS (Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) Durham VAMC) Coffman C (Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) Durham VAMC) Bosworth H (Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) Durham VAMC) Edelman D (Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) Durham VAMC) Jackson G Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) Durham VAMC) Ambert-Pompey S (Boise VAMC, University of Washington Department of Medicine) Crowley, MJ (Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) Durham VAMC)

Objectives:
To estimate reductions in greenhouse gas (GHG) emissions and patient travel costs attributable to the Advanced Comprehensive Diabetes Care (ACDC) telehealth program (compared to equivalent face-to-face care) among Veterans with refractory poorly-controlled diabetes.

Methods:
ACDC is an evidence-based telehealth program proven to improve diabetes control among Veterans with diabetes that does not respond to clinic-based care. ACDC comprises 12 sessions over 6 months and is primarily delivered by existing Home Telehealth (HT) nurses using standard VA equipment. Using ZIP code centroids (2022 VA Site Tracking dataset) and a sample of ACDC participants with full demographic and address data, we calculated the mean travel distance between Veteran residences and the nearest VHA facility (VA Medical Centers and Community Based Outpatient Clinics). We then used mean travel distance to estimate GHG production prevented (based on 2021 EPA guidance) compared to equivalent in-person care, along with mean travel time and costs prevented (cost per mile of travel based on 2022 federal rates), over the course of the ACDC intervention.

Results:
389 Veterans received ACDC through FY2020, completing an average of 10.1 encounters. The subsample of patients with full demographic/address data (n = 284) had mean [SD] age of 63.6 [11.0]; 79.9% reported white race, 15.4% reported Latinx ethnicity, and 59.2% had rural/highly rural residence. Estimated mean [SD] (range) distance from residence to the closest VHA facility was 17.2 [16.7] (0.19-99.5) miles; excluding smaller clinics potentially unable to offer similar services increased this distance to 28.1 [34.2] (0.5-191.7) miles. Over the course of ACDC, each Veteran avoided a mean [SD] 15.7 [15.2] gallons of gas, 139.4 [134.7] kilograms CO2 generated, 7.4 [5.7] hours of travel, and $203.77 [196.84] travel-related expenses. Overall, an estimated 54 metric tons of CO2 emissions and $80,000 in patient travel costs were avoided through FY2020 with the ACDC program compared to equivalent in-person care.

Implications:
An effective diabetes telehealth program prevented globally impactful GHG generation and saved Veteran travel costs compared to equivalent clinic-based care. Disseminating telehealth programs for refractory chronic diseases may reduce GHG production and travel costs.

Impacts:
GHG production and patient travel costs are important measurable considerations for evaluation of health care delivery.