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Health Services Utilization of a Care Coordination/Home-Telehealth Program for Veterans With Diabetes: A Matched-cohort Study

Chumbler, Neale R. PhD; Vogel, W. Bruce PhD; Garel, Mischka MPH; Qin, Haijing MS; Kobb, Rita MS, MN; Ryan, Patricia MS, RN

Journal of Ambulatory Care Management: July-September 2005 - Volume 28 - Issue 3 - p 230–240
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This study examined the effectiveness of a veterans affairs (VA) patient-centered care coordination/home-telehealth (CC/HT) program as an adjunct to treatment for veterans with diabetes. Using an adapted version of the Chronic Care Model, we analyzed the differences in healthcare service use between a cohort of 400 veterans with diabetes who were enrolled in a VA CC/HT program and a matched comparison cohort of 400 veterans with diabetes who received no CC/HT intervention. Propensity scores were used to improve the balance between the treatment and comparison groups. Service use outcomes were assessed at 12 months before and after enrollment. A difference-in-differences approach was used in the multivariate models to assess the treatment effect for patients in the CC/HT programs. Twelve months after enrollment, there was a significant difference between the treatment and comparison groups in terms of need-based primary care visits (newly scheduled visits that enable the veteran to be seen “just in time,” where the health status is monitored and met before health deteriorates), increasing in the treatment group and decreasing in the comparison group (P < .01). In a subgroup analysis, where we were able to control for the patients' Hb A1c values, we found that the treatment group had a lower likelihood of having 1 or more hospitalizations than patients in the comparison group. Our findings have implications for management in that the CC/HT program appears to improve the ability of older veterans with diabetes to receive appropriate, timely care, thereby improving the quality of care for them and making more efficient use of VA healthcare resources.

VA HSR&D/RR&D Rehabilitation Outcomes Research Center, North Florida/South Georgia Veterans Health System (Drs Chumbler and Vogel and Mss Garel and Qin), VA HSR&D Stroke QUERI, Department of Health Services Research, Management and Policy, University of Florida (Dr Chumbler), Department of Health Policy and Epidemiology, University of Florida (Dr Vogel), Gainesville; and VHA Office of Care Coordination, Washington, DC (Mss Kobb and Ryan).

Corresponding author: Neale R. Chumbler, PhD, VA HSR&D/RR&D Rehabilitation Outcomes Research Center, North Florida/South Georgia Veterans Health System, Gainesville, FL 32608 (e-mail: Neale.Chumbler@med.va.gov).

This research was funded by a contract from the VA VISN-8 Community Care Coordination Service. Also, this material is the result of work supported with resources and the use of facilities at the Department of Veterans Affairs Health Services Research and Development/Rehabilitation Research and Development Rehabilitation Outcomes Research Center, North Florida/South Georgia Veterans Health System, Gainesville, Fla. The authors thank Charlene McCarthy, Rebecca Beyth, and Britta Neugaard for their assistance.

Versions of this article were presented at the 2005 Annual Meeting of the Academy Health in Boston, Mass.

© 2005 Lippincott Williams & Wilkins, Inc.