Presentation is loading. Please wait.

Presentation is loading. Please wait.

Long-term impact of home telehealth service on preventable hospitalization use Huanguang “Charlie” Jia, PhD Research Health Scientist VA RORC REAP North.

Similar presentations


Presentation on theme: "Long-term impact of home telehealth service on preventable hospitalization use Huanguang “Charlie” Jia, PhD Research Health Scientist VA RORC REAP North."— Presentation transcript:

1 Long-term impact of home telehealth service on preventable hospitalization use Huanguang “Charlie” Jia, PhD Research Health Scientist VA RORC REAP North Florida/South Georgia VHS Gainesville, Florida

2 Co-authors  Ho-Chih Chuang, MS  Samuel S. Wu, PhD  Xinping Wang, PhD  Brad N. Doebbeling, MD  Neale R. Chumbler, PhD

3 Acknowledgement  This work was funded by the Community Care Coordination Service at VA VISN 8 through the Rehabilitation Outcomes Research Center (RORC REAP) at N. Florida/S. Georgia VHS, Gainesville, FL.  The views expressed in this report are those of the authors and do not necessarily represent the views of Department of Veterans Affairs.

4 Background: ACSC & Preventable Hospitalization Hospitalizations for ACSCs may be prevented if timely and appropriate ambulatory care were accessible. Hospitalizations for ACSCs may be prevented if timely and appropriate ambulatory care were accessible. Barriers to accessibility include provider unavailability, costs, health insurance absence. Barriers to accessibility include provider unavailability, costs, health insurance absence. Improved access at community level would lower ACSC hospitalization. Improved access at community level would lower ACSC hospitalization. References: 1) Weissman JS, et al. Rates of avoidable hospitalization by insurance status in Massachusetts and Maryland. JAMA. 1992;268:2388-2394 2) Bindman AB, et al. Preventable hospitalizations and access to health care. JAMA. 1995;274:305-311 3) Culler SD, et al. Factors related to potentially preventable hospitalizations among the elderly. Med Care. 1998;36:804-817 4) Friedman B, Basu J. The rate and cost of hospital readmissions for preventable conditions. Med Care Res Rev. 2004;61:225-240 5) Basu J, et al. Primary care, HMO enrollment, and hospitalization for ACSCs. Med Care. 2002;40:1260-1269

5 Background: Home Telehealth Application of modern telecommunications. Application of modern telecommunications. Link patients to out-of-home sources of care information, education, or service. Link patients to out-of-home sources of care information, education, or service. Medical benefit: early detect problems, frequently monitor conditions, increase access, improve care plan compliance. Medical benefit: early detect problems, frequently monitor conditions, increase access, improve care plan compliance. Home telehealth reduces inpatient & ER use within short-term. Home telehealth reduces inpatient & ER use within short-term. References: 1) Koch S. Home telehealth--current state and future trends. Int J Med Inform. 2006;75:565-576 2) Hailey D, et al. Systematic review of evidence for the benefits of telemedicine. J Telemed Telecare. 2002;8 (Supplement 1):1-30 3) Barnett TE, et al. The effectiveness of a care coordination home telehealth program.. Am J Manag Care. 2006;12:467-474 4) Chumbler NR, et al. Evaluation of a home-telehealth program for veterans with diabetes. Eval Health Prof. 2005;28:464-478

6 Objective To test 4-year effect of a VA patient- centered, care coordination/home telehealth (CCHT) program on potentially preventable hospitalization use by veteran patients diagnosed with diabetes mellitus. To test 4-year effect of a VA patient- centered, care coordination/home telehealth (CCHT) program on potentially preventable hospitalization use by veteran patients diagnosed with diabetes mellitus.

7 Study Design Retrospective, matched treatment and control study design. Retrospective, matched treatment and control study design. Treatment group (n=387): DM patients, enrolled in the CCHT program at 4 VAMCs. Treatment group (n=387): DM patients, enrolled in the CCHT program at 4 VAMCs. Control group (n=387): DM patients in the 4 VAMCs matched by a propensity score. Control group (n=387): DM patients in the 4 VAMCs matched by a propensity score. References: 1) Barnett TE, et al. The effectiveness of a care coordination home telehealth program for veterans with diabetes mellitus: A 2-year follow- up. Am J Manag Care. 2006;12:467-474 2) D'Agostino RB, Jr. Propensity score methods for bias reduction in the comparison of a treatment to a non-randomized control group. Stat Med. 1998;17:2265-2281

8 VA CCHT Program Transition from hospital-based care to patient- centered and ambulatory care. Transition from hospital-based care to patient- centered and ambulatory care. Care coordination by nurse practitioner. Care coordination by nurse practitioner. Disease monitoring using supportive home telemonitoring technology. Disease monitoring using supportive home telemonitoring technology. Each enrollee has a messaging device installed at home using basic land-line telephone service. Each enrollee has a messaging device installed at home using basic land-line telephone service. Daily basis: patients answer scripted questions from the messaging device about their diabetes symptoms and health status. Daily basis: patients answer scripted questions from the messaging device about their diabetes symptoms and health status. Care coordinators monitor the patients’ daily updates from the devices. Care coordinators monitor the patients’ daily updates from the devices.

9 CCHT enrollment criteria Diagnosed with DM. Diagnosed with DM. ≥1-time VA hospitalizations or ≥1-time VA ER visits in 12 months prior to enrollment. ≥1-time VA hospitalizations or ≥1-time VA ER visits in 12 months prior to enrollment. Non-institutionalized. Non-institutionalized. A telephone land-line at home. A telephone land-line at home.

10 Dependent Variable Semi-annual P.H. count by patient. Semi-annual P.H. count by patient. AHRQ defined 12 ACSCs and ICD-9 codes applied. AHRQ defined 12 ACSCs and ICD-9 codes applied. VA automated inpatient databases. VA automated inpatient databases. References: 1) AHRQ. Guide to prevention quality indicators: Hospital admission for ACSCs. March 12, 2007; Version 3.1 2) AHRQ. Prevention quality indicators: Technical specifications. March 12, 2007; Version 3.1

11 Independent & Covariates Treatment/CCHT enrollee: yes, no. Treatment/CCHT enrollee: yes, no. Baseline: age, gender, marital status, race, VA care priority, and study sites. Baseline: age, gender, marital status, race, VA care priority, and study sites. Pre-enrollment: 6-month comorbidity score, 12-month inpatient and outpatient use. Pre-enrollment: 6-month comorbidity score, 12-month inpatient and outpatient use. Post-enrollment: 4-year survival time in days. Post-enrollment: 4-year survival time in days.

12 Statistical Analysis Descriptive statistics. Descriptive statistics. Multicollinearity diagnostics. Multicollinearity diagnostics. A GLIMMIX to estimate the impact of the CCHT program on P.H. use over a period of 4 years, adjusting for patient characteristics and time. A GLIMMIX to estimate the impact of the CCHT program on P.H. use over a period of 4 years, adjusting for patient characteristics and time.

13 Table 1.1. Baseline characteristics (No sig. difference observed) Characteristics Study cohort (N=774) Tx (n=387) Ctrl (n=387) Age 67.6 (10.1) 68.0 (9.2) 67.2 (10.9) Male98.3%98.7%97.9% Being married 61.9%64.3%59.4% White39.4%40.1%38.8% Hispanic49.2%48.8%49.6% High VA priority 97.9%98.2%97.7% Site A 14.6%15.3%14.0% Site B 14.5%15.0%14.0% Site C 46.3%46.1%46.5% Site D 24.7%23.8%25.6%

14 Table 1.2. Pre- & Post- baseline Characteristics Characteristics Study cohort (N=774) Tx (n=387) Ctrl (n=387) Pre-enrollment: 6-m comorb score 6-m comorb score0.2(0.5) 0.3 (0.6) 0.2 (0.5) 12-m inpt. care use 12-m inpt. care use0.8(1.3) 0.7 (1.2) 0.8 (1.5) 12-m outpt. visit ‡ 12-m outpt. visit ‡26.5(21.6) 30.3 (21.7) 22.6 (20.8) 4-year post-enrollment: P.H. counts † P.H. counts †0.8(1.6) 0.7 (1.3) 1.0 (1.9) Crude death rate † Crude death rate †22.9%19.4%26.4% Survival days ‡ Survival days ‡1314(330)1349(266)1278(380) † p value <0.05; ‡ p value <0.01;

15 Table 2. Freq of 4-year P.H. ACSCs occurrences by group P.H. conditions/ACSCs Diabetes long-term complications L. extremity amput. in DM pts Diabetes short-term complication Diabetes uncontrolled Bacterial pneumonia Angina Congestive heart failure Urinary infection C. obstructive pulmonary disease DehydrationHypertension Adult asthma Tx4229742288433311131Ctrl1215528153419673114952

16 Table 3. Results from a GLIMMIX (dependent var=P.H. count) Characteristics Relative Risk (95% CI) P value Treatment: yes vs. no 0.36 (0.21-0.61) 0.0002 Time 0.88 (0.82-0.94) 0.0002 Treatment x time 1.15 (1.04-1.27) 0.0047 Age 1.02 (1.00-1.04) 0.0217 Male: yes vs. no 1.35 (0.37-4.85) 0.6489 Married: yes vs. no 0.54 (0.38-0.77) 0.0006 White: yes vs. no 0.64 (0.38-1.08) 0.0949 VHA priority high: yes vs. no 0.87 (0.26-2.95) 0.8284 6-m prior comorbid score 1.54 (1.13-2.10) 0.0060 12-m prior inpatient use 1.57 (1.40-1.76) <.0001 12-m prior outpatient visit 1.01 (1.01-1.02) 0.0006 Site A vs. C 0.97 (0.48-1.94) 0.9255 Site B vs. C 1.68 (0.97-2.89) 0.0630 Site D vs. C 1.50 (0.83-2.73) 0.1818

17 Main Results The linear mixed results suggest that the CCHT enrollees were less likely to be admitted for a P.H. (RR 0.36, p<0.05). The linear mixed results suggest that the CCHT enrollees were less likely to be admitted for a P.H. (RR 0.36, p<0.05). The difference reduced as time progressed during the 4-year follow-up. The difference reduced as time progressed during the 4-year follow-up.

18 Limitations A single geographic region. A single geographic region. VA healthcare system enrollees. VA healthcare system enrollees. Patients with DM, a diagnosis associated with high rates of morbidity, mortality, and resource use. Patients with DM, a diagnosis associated with high rates of morbidity, mortality, and resource use.

19 Conclusions The VA CCHT program for diabetes patients reduced preventable hospitalizations overtime. The VA CCHT program for diabetes patients reduced preventable hospitalizations overtime. It may reduce healthcare cost. It may reduce healthcare cost.


Download ppt "Long-term impact of home telehealth service on preventable hospitalization use Huanguang “Charlie” Jia, PhD Research Health Scientist VA RORC REAP North."

Similar presentations


Ads by Google