Longitudinal Impact of Home Telehealth Service on Preventable Hospitalization Use

Jia H, Chuang HC, Wu SS, Wang, Doebbeling BN, Chumbler NR. Longitudinal Impact of Home Telehealth Service on Preventable Hospitalization Use. Paper presented at: AcademyHealth Annual Research Meeting; 2008 Jun 9; Washington, DC.

Research Objective: Patients access to timely, effective ambulatory care could reduce the risk of hospitalization for selective medical conditions. The purpose of this study was to assess the longitudinal impact of a Department of Veterans Affairs (VA) patient-centered care coordination/home telehealth (CCHT) program for older veterans diagnosed with diabetes mellitus (DM) on potentially preventable hospitalization use over a four-year period. Study Design: In this retrospective, matched case-control study, the case group included 391 VA DM patients who were enrolled in the CCHT program at 4 VA Medical Centers (VAMC) within a VA network. The CCHT program consisted of a care coordinator who used disease management principles through the care continuum by equipping the patient in selfmanagement skills. The criteria for enrolling in the program included: had used more than once of inpatient OR emergency care 12-month pre-enrollment and lived at home with a telephone land line. The control group consisted of 388 VA DM patients who had not received the telehealth service and been matched by a propensity score. All patients were followed for 4 years post-baseline or enrollment date. VA automated inpatient, outpatient and extended care databases were used to obtain patient information. Institute of Medicine’s preventable hospitalization definition was applied. Defined by panels of physicians, the definition consists of 14 ambulatory care sensitive conditions (ACSC). A generalized linear mixed model was fit to estimate the longitudinal impact of the telehealth service on preventable hospitalization use over a period of 4 years post-baseline, adjusting for patient sociodemographics (age, gender, marital status, race/ethnicity), clinical and utilization characteristics (priority for VA healthcare, comorbidity, 12-month pre-baseline inpatients use, VAMC site). Population Studied: Community-dwelling, high service use older veterans with DM. Principle Findings: Bivariate analyses showed no significant differences in baseline sociodemographic, clinical and utilization characteristics between the two groups (case vs. control). The case group, however, had significantly less 4-year average preventable hospitalization use (0.6 vs. 0.9), smaller proportion of death (18.4% vs. 24.5%), and survived longer time (1353.2 vs. 1292.3 average survival days) than the control group. The first 3 categories of ACSCs contributing to the preventable hospitalization use were the same for both groups (congestible heart failure, diabetes readmission, and kidney/urinary tract infection). Linear mixed analysis indicated that the case group had 50% less preventable hospitalization use during the first 6 months as compared to the control group at 0.05 significance level, and that the differences reduced significantly as the study time progressed, even after adjusting for patient sociodemographic, clinical and utilization characteristics. Conclusion: Using information and communication technology to deliver health services, expertise and information over distance, home-telehealth approaches may enhance the users’ timely accessibility to the needed care, reduce preventable hospitalization use, and decrease direct and indirect medical cost over time Implications for Policy, Practice or Delivery: Our findings favored the CCHT program for veterans with DM and expended the known benefit from home telehealth by showing that communicating with patients, coordinating their care, and equipping them with self-management skills may have a longterm positive impact on preventable hospitalization use.