Reduced Cost and Mortality Using Home Telehealth to Promote Self-Management of Complex Chronic Conditions: A Retrospective Matched Cohort Study of 4,999 Veteran Patients

Abstract

This study corroborates previous positive VHA analyses of CCHT but contradicts results from recent non-VHA studies, highlighting the efficacy of the VHA's standardized CCHT model, which incorporates a biopsychosocial approach to care that emphasizes patient self-management.

Does Greater Continuity of Veterans Administration Primary Care Reduce Emergency Department Visits and Hospitalization in Older Veterans?

“…Another possible explanation is that the VA system of care coordination and computerized patient record system helped to attenuate the effect of PCP discontinuity, even in patients in the lowest category of continuity. Innovative services in VA, such as the use of home‐based primary care and home telehealth, have also been associated with lower risk of ED visits and hospitalizations in elderly veterans …”

“…31 The occurrence of any ED visits and any hospitalizations was modeled using generalized estimating equations with logistic regression, accounting for clustering according to the assigned VA PCP and usual site of VA primary care. Because of concerns regarding collinearity between continuity of care and number of outpatient clinic visits, 17,24,29 the analysis was stratified according to the total number of outpatient visits to all clinics during the 2-year baseline period (<9, [9][10][11][12][13][14][15][16][17][18][19], ≥20, based on distribution of the data). Number of outpatient visits is a marker of health-seeking behavior and presence of complex chronic disease, and it has been associated with ACSC-related hos-pitalization.…”

“…8 These findings on the relationship between PCP continuity and use of ED and inpatient services are qualitatively similar to those reported in other studies, but the strength of association is more modest (possibly because use of non-VA care was accounted for). In a cross-sectional study of individuals in a large VA primary care clinic (shortly after PACT implementation), individuals who had at least one visit with their assigned PCP had lower ED use than (1,2,4,6,7,9,11,15,16,17,18,19,20,22,23). HMO = health maintenance organization; FY = fiscal year.…”

“…In the early 1990s, the Department of Veterans Affairs (VA) recognized the need for a robust system of primary care and the importance of continuity with an identifiable primary care provider . Over the past 15 years, VA began to provide access to a broad range of support services (including home‐based primary care, home telehealth, and homemaker services) that help families care for family members at home . In 2010, VA launched the Patient Aligned Care Team (PACT) initiative, which is based on the patient‐centered medical home model and aims to provide continuous, comprehensive, and coordinated care to veterans while improving access to first‐contact care .…”

“…9 Over the past 15 years, VA began to provide access to a broad range of support services (including home-based primary care, home telehealth, and homemaker services) that help families care for family members at home. 10,11 In 2010, VA launched the Patient Aligned Care Team (PACT) initiative, which is based on the patient-centered medical home model and aims to provide continuous, comprehensive, and coordinated care to veterans while improving access to first-contact care. 12,13 Nevertheless, several countervailing forces in primary care reduce the likelihood of individuals seeing the same PCP at repeated visits: growing demand for same-day access and the advent of open access scheduling, greater use of dual sources of primary care, more providers working part time, and frequent changes in insurance coverage.…”