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Study Assesses Long-Term Impact of Home Telehealth on Preventable Hospitalizations for Veterans with Diabetes


Several reports have shown that telehealth programs have a short-term impact on reducing inpatient and outpatient utilization, but little is understood about their long-term impact, particularly on hospitalizations for ambulatory care sensitive conditions (ACSCs). This study assessed the longitudinal effect of a VA Care Coordination Home Telehealth (CCHT) program on preventable hospitalizations for Veterans with diabetes. The CCHT program was developed by VA to provide timely and appropriate care for community-dwelling Veterans with chronic diseases. Patients enrolled in the CCHT program receive a home telehealth device and answer scripted questions about their symptoms and health status. The care coordinators, usually nurse practitioners or registered nurses, monitor the patients’ daily updates and take follow-up actions when necessary (e.g., help patients manage medications, arrange for physician referral). Investigators in this study compared preventable hospitalizations over a four-year period between 387 Veterans with diabetes enrolled in a CCHT program at four VAMCs with 387 Veterans with diabetes who received care at the same four VAMCs, but who were not enrolled in the CCHT program (control group).

Findings showed a statistically significant reduction in preventable hospitalizations for Veterans enrolled in the CCHT program during the initial 18 months of follow-up compared to Veterans in the control group, even after adjusting for potential socio-demographic and clinical risk factors. However, the program did not demonstrate a significant impact after the initial 18 months, which may largely be due to the fact that the control group had more deaths than the CCHT group during those 18 months (40 vs. 12 deaths), likely resulting in the control group’s decreased use of preventable hospitalizations during the remainder of the study period. Over the entire four-year study period, the CCHT group had a lower death rate (19% vs. 26%) and longer survival time (1348 days vs. 1278 days) than the control group, while the control group had much higher frequency in all diabetes-related ACSCs, such as lower-extremity amputations (55 vs. 29), uncontrolled diabetes (15 vs. 4), and bacterial pneumonia (34 vs. 22). Therefore, this study suggests that using telehealth technology to deliver health services over distance may enhance patients’ timely accessibility to needed care, thus reducing preventable hospitalizations and decreasing medical costs over time.

PubMed Logo Jia H, Chuang H-C, Wu S, Wang X, and Chumbler N. Long-term impact of home telehealth service on preventable hospitalization use. Journal of Rehabilitation Research & Development October 2009;46(5):557-66.

This study was partly funded by HSR&D. Drs. Jia, Wu, and Wang, and Mr. Chuang are part of HSR&D’s Rehabilitation Outcomes Research Center in Gainesville, FL. Dr. Chumbler is part of HSR&D’s Center of Excellence on Implementing Evidence-Based Practice in Indianapolis, IN.

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What are HSR&D Publication Briefs?

HSR&D requires notification by HSR&D-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR&D and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR&D based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR&D published articles. Visit the HSR&D citations database for a complete listing of HSR&D articles and presentations.