1069. Enhancing Diabetes Care through Care Coordination and Home-Telehealth
Neale R Chumbler, PhD, VA HSR&D/RR&D Rehabilitation Outcomes Research Center, North Florida/South Georgia Veterans Health System, B Neugaard, VA HSR&D/RR&D Rehabilitation Outcomes Research Center, North Florida/South Georgia Veterans Health System, P Ryan, VISN 8 Community Care Coordination Service, Bay Pines VAMC, R Kobb, Tec Care Coordination Program, Y Joo, VA HSR&D/RR&D Rehabilitation Outcomes Research Center, North Florida/South Georgia Veterans Health System, H Qin, VA HSR&D/RR&D Rehabilitation Outcomes Research Center, North Florida/South Georgia Veterans Health System, WC Mann, VA HSR&D/RR&D Rehabilitation Outcomes Research Center, North Florida/South Georgia Veterans Health System, PJ Veazie, VA HSR&D/RR&D Rehabilitation Outcomes Research Center, North Florida/South Georgia Veterans Health System

Objectives: To analyze the differences in service use before and one-year after admittance into a VHA care coordination program (enhanced by home-telehealth technologies) for veterans with diabetes.

Methods: A total of 445 ethnically diverse veterans with diabetes were enrolled from four sites in Florida and Puerto Rico. Program fundamentals included daily monitoring and education from a nurse to the patient via home-telehealth devices (in-home messaging device, telemonitor that allowed for glucose monitoring, videophones). Service use outcomes measured at 12 months included hospital admissions, hospital bed days of care (BDOC), emergency room (ER) visits, unscheduled primary care clinic visits, podiatry, opthalmology, and diabetes clinic visits. We adjusted for sociodemographic characteristics, health status characteristics, and pre/post enrollment status. Logistic regression was used for binary outcomes and Poisson regression for count outcomes.

Results: One-year after enrollment, patients were 51% less likely to have been hospitalized (p < .0001) and 11% less likely to have made an ER visit (p = .04). There was a significant reduction in hospital BDOC (mean = 5.03 days vs. 2.47 days, p < .0001). Patients were 35% more likely to have made one or more unscheduled primary care clinic visits (p = .0002).

Conclusions: Evidence was found that care coordination enhanced by home-telehealth technologies was associated with a reduction in hospitalizations, hospital BDOC, and ER visits.

Impact: Diabetes contributes to a substantial proportion of pharmacy costs and hospitalizations within the VHA. Care coordination enhanced by home-telehealth increases access to care by daily monitoring the clinical symptoms of veterans and averting costly, unnecessary resource utilization.