Comparative Analysis of Clinical Outcomes Related to Telehealth and In-Person Encounters Among Older Veterans with...

In older adults with diabetes mellitus, there are limited studies of telehealth for chronic disease management.

To compare outcomes of those receiving hybrid telehealth care with those receiving in-person care.

Retrospective cohort study.

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).

Telehealth-based care in addition to in-person care (hybrid telehealth).

Co-primary outcomes included glycated hemoglobin (HbA1c), hospitalizations, and emergency department (ED) visits.

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.

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]).

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.