Journal article
Chronic Disease Management through Clinical Video Telehealth on Health Care Utilization, and Mortality in the Veterans Health Administration: A Retrospective Cohort Study
Telemedicine journal and e-health, Vol.30(5), pp.1279-1288
05/2024
DOI: 10.1089/tmj.2023.0285
PMID: 38206653
Abstract
Background:Chronic health diseases such as congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), and diabetes mellitus (DM) affect 6 in 10 Americans and contribute to 90% of the $4.1 trillion health care expenditures. The objective of this study was to measure the effect of clinical video telehealth (CVT) on health care utilization and mortality. A retrospective cohort study of Veterans ≥65 years with CHF, COPD, or DM was conducted.
Measures:Veterans using CVT were matched 1:3 on demographic characteristics to Veterans who did not use CVT. Outcomes included 1-year incidence of ED visits, inpatient admissions, and mortality, reported as adjusted odds ratios (aORs) and 95% confidence intervals (CIs).
Results:Final analytical cohorts included 22,280 Veterans with CHF, 51,872 Veterans with COPD, and 170,605 Veterans with DM. CVT utilization was associated with increased ED visits for CHF (aOR: 1.24; 95% CI: 1.15–1.34), COPD (aOR: 1.20; 95% CI: 1.14–1.26), and DM (aOR: 1.07; 95% CI: 1.00–1.10). For CHF, there was no difference between CVT utilization and inpatient admissions (aOR: 0.98; 95% CI 0.91–1.05) or mortality (aOR: 1.03; 95% CI: 0.93–1.15). For COPD, CVT was associated with increased inpatient admissions (aOR: 1.08; 95% CI: 1.02–1.13) and mortality (aOR: 1.36; 95% CI: 1.25–1.48). For DM, CVT utilization was associated with lower risk of inpatient admissions (aOR: 0.83; 95% CI: 0.80–0.86) and mortality (aOR: 0.89; 95% CI: 0.84–0.95).
Conclusions:CVT use as an alternative care site might serve as an early warning system, such that this mechanism may indicate when an in-person assessment is needed for potential exacerbation of conditions. Although inpatient and mortality varied, ED utilization was higher with CVT. Exploring pathways accessing clinical care through CVT, and how CVT is directly or indirectly associated with immediate and long-term clinical outcomes would be valuable.
Details
- Title: Subtitle
- Chronic Disease Management through Clinical Video Telehealth on Health Care Utilization, and Mortality in the Veterans Health Administration: A Retrospective Cohort Study
- Creators
- J Priyanka Vakkalanka - University of IowaAndrea Holcombe - Office of Rural Health, Veterans Rural Health Resource Center-Iowa City, Iowa City Veterans Affairs Health Care System, Iowa City, Iowa, USAMarcia M Ward - University of IowaKnute D Carter - University of IowaKimberly D McCoy - Office of Rural Health, Veterans Rural Health Resource Center-Iowa City, Iowa City Veterans Affairs Health Care System, Iowa City, Iowa, USAHeidi M Clark - Office of Rural Health, Veterans Rural Health Resource Center-Iowa City, Iowa City Veterans Affairs Health Care System, Iowa City, Iowa, USAJeydith T Gutierrez - University of IowaKimberly A S Merchant - University of IowaNicholas M Mohr - University of Iowa
- Resource Type
- Journal article
- Publication Details
- Telemedicine journal and e-health, Vol.30(5), pp.1279-1288
- DOI
- 10.1089/tmj.2023.0285
- PMID
- 38206653
- NLM abbreviation
- Telemed J E Health
- eISSN
- 1556-3669
- Language
- English
- Electronic publication date
- 01/10/2024
- Date published
- 05/2024
- Academic Unit
- Neurology; Remote care & Telehealth Research Center; Health Management and Policy; Epidemiology; Emergency Medicine; Biostatistics; Anesthesia; Injury Prevention Research Center; General Internal Medicine; Internal Medicine
- Record Identifier
- 9984544631102771
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