The Impact of a Cancer Care Coordination/Home-Telehealth Program on Preventable Health Service Utilization: A Case Control Study

Chumbler NR, Kobb R, Harris L, Richardson L, Sberna M, Dixit N, Ryan P, Darkins A, Donaldson M, Kreps G. The Impact of a Cancer Care Coordination/Home-Telehealth Program on Preventable Health Service Utilization: A Case Control Study. Paper presented at: VA HSR&D National Meeting; 2007 Feb 22; Arlington, VA.

Objectives: This study compared the use of VA in-patient and out-patient services of cancer patients enrolled in a Cancer Care Coordination/Home Telehealth (CCHT) program that involved remote management of symptoms (e.g., emotional distress; pain; fatigue) with a matched cohort of cancer patients receiving standard VA care. Methods: A case-control design was employed. CCHT patients had a newly confirmed diagnosis of cancer, had a life expectancy > 6 months and had a treatment plan which included chemotherapy given at a single VAMC. Control group patients had the same criteria except that they were not previously enrolled in a CCHT program. Two control patients per case were selected, matched by cancer stage and tumor type. There were 43 treatment group patients and 82 control group patients. The medical record of each patient was reviewed. The total number of cancer related services and preventable services was calculated over a six-month period. Cancer related service use was defined as visits that were expected given the patients’ cancer diagnosis and treatment protocol. Preventable service use was defined as visits outside of those expected given the cancer diagnosis and planned treatment. Poisson multivariate regression modeling was used to estimate the adjusted relative risks (RR) for the effects of the intervention on the service use outcomes. Results: As compared to the control group, CCHT patients had a lower likelihood of several preventable services: 1) fewer clinic visits (RR = 0.03, 95% CI, .00-.24); 2) fewer bed-days-of-care for hospitalizations (all-cause) (RR = 0.50, 95% CI, .37-.67); 3) fewer hospitalizations (chemotherapy related) (RR = 0.43, 95% CI, .21-.91); and 4) fewer bed-days-of-care for hospitalizations (chemotherapy related) (RR = 0.49, 95% CI, .34-.71). Implications: This study offers some evidence that these CCHT patients can successfully manage the complexity of multiple symptoms as indicated by the lower likelihood of preventable inpatient and outpatient services they used compared to a matched control group. Impacts: These results suggest that the CCHT program allows successful management of complex symptoms and can prevent escalation to a level of complexity that is difficult for patients or providers to manage successfully in the outpatient setting.