The Impact of a Care Coordination/Home-Telehealth Program on Mortality

Chumbler NR, Wu SS, Chuang HC, Wang X, Kobb R, Jia H. The Impact of a Care Coordination/Home-Telehealth Program on Mortality. Paper presented at: VA HSR&D National Meeting; 2008 Feb 15; Baltimore, MD.

Objectives: Diabetes Mellitus (DM) is associated with high rates of morbidity and mortality when timely and efficient ambulatory care is not accessible. The VA Care Coordination/Home Telehealth (CCHT) program was implemented at 4 local VAMCs to enhance patients’ self-management, improve accessibility, and reduce preventable hospitalizations. This study assessed the longitudinal impact of the CCHT program on mortality among a cohort of VA DM patients. Methods: DM patients enrolled in the CCHT program (n = 391) were prospectively followed for three years, and compared with a retrospective, propensity-score matched comparison group (n = 367). The criteria for enrollment in the program included having had (1) > 2 VA hospitalizations, and/or (2) > 2 VA emergency department visits in the 12 months before enrollment, and (3) access to a working telephone line, and (4) to be non-institutionalized. Survival rates for both groups were computed according to the Kaplan-Meier method. In addition, multifactorial Cox Regression analysis was performed to consider the effect of the CCHT program, including the following covariates: age, marital status, race, priority for VA healthcare, program site, and co-morbidity score. All analyses were performed using SAS. Results: There were no significant differences in baseline characteristics between the two groups, except that the CCHT program patients had a 0.6 higher co-morbidity score on average (p < .0001). There were 46 (11.8%) deaths in the CCHT group and 57 (15.5%) deaths in the comparison group, representing a 3.7% difference in mortality in the 36-month follow-up. The difference in mortality mainly occurred during the first year of program implementation. Cox Regression analyses indicated that the CCHT program significantly reduced mortality (Hazard Ratio = .61, 95% CI = .4 -.9, p = .0211), while age, priority for VA healthcare, and co-morbidity score were also significantly (p < .05) associated with mortality. Implications: Mortality was significantly reduced for CCHT program DM patients, which indicates the importance of having a care coordinator monitor symptoms at regular intervals to identify problems promptly to reduce short- and long-term complications. Impacts: The findings positively supported the CCHT program for DM patients in mortality outcome by preventing escalation to a level of complexity that averted adverse complications and enhanced health.