Journal of general internal medicine · 2025
Comparative Analysis of Clinical Outcomes Related to Telehealth and In-Person Encounters Among Older Veterans with Diabetes.
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Syed Quratulain, McGwin Gerald, Johnson Theodore, Phillips Lawrence S, Khakharia Anjali, Echt Katharina V, Rhee Mary, Vaughan Camille P
Аннотация
BACKGROUND: In older adults with diabetes mellitus, there are limited studies of telehealth for chronic disease management.
OBJECTIVE: To compare outcomes of those receiving hybrid telehealth care with those receiving in-person care.
DESIGN: Retrospective cohort study.
PARTICIPANTS: Adults aged ≥ 70 with diabetes (n = 410,640) in Veterans Health Administration during 2019 and 2021. A subgroup analysis included high-need high-risk (HNHR) Veterans (n = 18,414).
INTERVENTIONS: Telehealth-based care in addition to in-person care (hybrid telehealth).
MAIN MEASURES: Co-primary outcomes included glycated hemoglobin (HbA1c), hospitalizations, and emergency department (ED) visits.
KEY RESULTS: Entire cohort: The hybrid telehealth group comprised 51% of the entire cohort. The hybrid telehealth group had higher mean encounters in 2019 [telehealth 6.2 (6.7) and in-person 10.6 (8)] vs the in-person group [4.9 (4.1)] p < 0.001. After adjustment, although mean HbA1c levels of the hybrid group compared to the in-person group remained statistically higher in 2021 (7.19% [95% CI 7.06-7.32] vs 7.13% [95% CI 7.0-7.26] p < 0.001), the difference was clinically negligible. Hybrid telehealth had higher rates of hospitalizations (RR [CI] of 1.22 [1.20-1.24]) and ED visits (RR of 1.24 [1.21-1.27]) in 2021 compared to in-person care.
HNHR SUBGROUP: The hybrid telehealth group had higher mean encounters in 2019 [TH 11 (10) vs in-person 17 (11)] compared to the in-person group [9.7 (7.7)] p <0.001. After adjustment, there was no difference in mean HbA1c of hybrid telehealth compared to in-person care in 2021 (7.19 [95% CI 6.94-7.46] vs 7.17 [95% CI 6.90-7.44] p-0.51). While the rate of hospitalizations was higher for hybrid telehealth vs in-person group in 2021 (RR 1.11 [1.02-1.22]), there was no difference in regard to ED visits (RR 1.05 [1.00-1.12]).
CONCLUSIONS: The high proportion of telehealth use among older adults with diabetes and complex care needs highlights the importance of this modality to promote better health outcomes.
OBJECTIVE: To compare outcomes of those receiving hybrid telehealth care with those receiving in-person care.
DESIGN: Retrospective cohort study.
PARTICIPANTS: Adults aged ≥ 70 with diabetes (n = 410,640) in Veterans Health Administration during 2019 and 2021. A subgroup analysis included high-need high-risk (HNHR) Veterans (n = 18,414).
INTERVENTIONS: Telehealth-based care in addition to in-person care (hybrid telehealth).
MAIN MEASURES: Co-primary outcomes included glycated hemoglobin (HbA1c), hospitalizations, and emergency department (ED) visits.
KEY RESULTS: Entire cohort: The hybrid telehealth group comprised 51% of the entire cohort. The hybrid telehealth group had higher mean encounters in 2019 [telehealth 6.2 (6.7) and in-person 10.6 (8)] vs the in-person group [4.9 (4.1)] p < 0.001. After adjustment, although mean HbA1c levels of the hybrid group compared to the in-person group remained statistically higher in 2021 (7.19% [95% CI 7.06-7.32] vs 7.13% [95% CI 7.0-7.26] p < 0.001), the difference was clinically negligible. Hybrid telehealth had higher rates of hospitalizations (RR [CI] of 1.22 [1.20-1.24]) and ED visits (RR of 1.24 [1.21-1.27]) in 2021 compared to in-person care.
HNHR SUBGROUP: The hybrid telehealth group had higher mean encounters in 2019 [TH 11 (10) vs in-person 17 (11)] compared to the in-person group [9.7 (7.7)] p <0.001. After adjustment, there was no difference in mean HbA1c of hybrid telehealth compared to in-person care in 2021 (7.19 [95% CI 6.94-7.46] vs 7.17 [95% CI 6.90-7.44] p-0.51). While the rate of hospitalizations was higher for hybrid telehealth vs in-person group in 2021 (RR 1.11 [1.02-1.22]), there was no difference in regard to ED visits (RR 1.05 [1.00-1.12]).
CONCLUSIONS: The high proportion of telehealth use among older adults with diabetes and complex care needs highlights the importance of this modality to promote better health outcomes.