Chronic Disease Management through Clinical Video Telehealth on Health Care Utilization, and Mortality in the Veterans Health Administration: A Retrospective Cohort Study.

ABSTRACT

Background: Chronic health diseases such as congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), and diabetes mellitus (DM) affect 6 in 10 Americans and contribute to 90% of the $4.1 trillion health care expenditures. The objective of this study was to measure the effect of clinical video telehealth (CVT) on health care utilization and mortality. A retrospective cohort study of Veterans ≥65 years with CHF, COPD, or DM was conducted. Measures: Veterans using CVT were matched 13 on demographic characteristics to Veterans who did not use CVT. Outcomes included 1-year incidence of ED visits, inpatient admissions, and mortality, reported as adjusted odds ratios (aORs) and 95% confidence intervals (CIs). Results: Final analytical cohorts included 22,280 Veterans with CHF, 51,872 Veterans with COPD, and 170,605 Veterans with DM. CVT utilization was associated with increased ED visits for CHF (aOR 1.24; 95% CI 1.15-1.34), COPD (aOR 1.20; 95% CI 1.14-1.26), and DM (aOR 1.07; 95% CI 1.00-1.10). For CHF, there was no difference between CVT utilization and inpatient admissions (aOR 0.98; 95% CI 0.91-1.05) or mortality (aOR 1.03; 95% CI 0.93-1.15). For COPD, CVT was associated with increased inpatient admissions (aOR 1.08; 95% CI 1.02-1.13) and mortality (aOR 1.36; 95% CI 1.25-1.48). For DM, CVT utilization was associated with lower risk of inpatient admissions (aOR 0.83; 95% CI 0.80-0.86) and mortality (aOR 0.89; 95% CI 0.84-0.95). Conclusions: CVT use as an alternative care site might serve as an early warning system, such that this mechanism may indicate when an in-person assessment is needed for potential exacerbation of conditions. Although inpatient and mortality varied, ED utilization was higher with CVT. Exploring pathways accessing clinical care through CVT, and how CVT is directly or indirectly associated with immediate and long-term clinical outcomes would be valuable.