We evaluated a Veterans Health Administration (VHA) care coordination/ home-telehealth (CC/HT) program on the utilization of health care services and health-related quality of life (HRQL) in veterans with diabetes. Administrative records of 445 veterans with diabetes were reviewed to compare health care service utilization in the 1-year period before and 1-year period post-enrollment and also examined self-reported HRQL at enrollment and 1 year later. Multivariate analyses indicated a statistically significant reduction in the proportion of patients who were hospitalized (50% reduction), emergency room use (11% reduction), reduction in the average number of bed days of care (decreased an average of 3.0 days), and improvement in the HRQL role-physical functioning, bodily pain, and social functioning. The results need to be interpreted with caution because we used a single-group study design that may be influenced by regression to the mean. Ideally, future research should use a randomized controlled trial design.

We assessed the utilization of health-care services and clinical outcomes in veterans with diabetes who were enrolled in two care coordination/home telehealth programmes. One group of patients was monitored weekly (n = 197), with more intensive evaluations, while the other was monitored daily (n = 100), but less intensively. Although patients in the two groups were fairly similar in demographic terms and in their clinical characteristics at baseline, they had different service utilization patterns during the 12-month pre-enrollment period. Over the 12-month study period, the proportion of one or more hospital admissions and number of bed days of care decreased in the daily monitoring group, and increased in the weekly monitoring group, more or less doubling in the former and being halved in the latter. Unscheduled primary care clinic visits were lower in the daily monitored group than in the weekly monitored group. The differences between the two groups were significant (P < 0.01). There were no significant differences between the groups in the clinical outcomes. Future research should employ randomized controlled trial designs to determine if intensities of home monitoring lead to differences in service utilization and health outcomes.

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Veterans with chronic heart failure (HF) are frequently elderly, have numerous comorbid chronic medical illnesses, frequent hospitalizations, and have high rates of cardiovascular events. Within the Veterans Health Administration (VHA), primary care providers are required to manage the majority of HF patients because access to cardiac specialty care within the VHA may be limited. We designed and implemented a care-coordinated, nurse-directed home telehealth management program for veterans with difficult-to-manage or new onset chronic systolic HF. An in-home telehealth message device was provided to the patient at enrollment, and patients received daily HF-specific education via the nurse coordinator and/or the device throughout their continuum of care. We collected demographic characteristics, clinical characteristics, and outcome data at the time of enrollment and at nearly 6 months after enrollment. A total of 92 patients were enrolled, with complete data available on 73. The mean patient age was 67 years, the mean left ventricular ejection fraction (LVEF) was 23%, and nearly all patients (99%) were men. After enrollment, significant improvements were found in blood pressure (129/73 to 119/69 mm Hg, p < 0.05), weight (196 to 192 pounds, p < 0.01), and shortness of breath rating (0-10 scale, 4.0 to 2.7, p = 0.02). Average daily doses of fosinopril (24 to 35 mg/d, p < 0.01) and metoprolol (84 to 94 mg/d, p = 0.05) were also improved. The total number of inpatient hospital days were reduced while on the home telehealth program (from 630 for the previous year to 122 for the duration of the program) with only 31% of the hospitalizations related to HF while on the program. Our nurse-directed, care coordinated home telehealth management program was associated with improved early outcomes in a group of elderly male veterans with chronic HF.