• Kristen E Gray, Mayuree Rao, Eric Gunnink, Lee Eschenroeder, John R Geyer, Karin M Nelson, and Ashok Reddy.
• Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, USA.
• J Gen Intern Med. 2022 Sep 1; 37 (12): 3089-3096.

BackgroundHome telehealth (HT) programs enable communication and remote monitoring of patient health data between clinician visits, with the goal of improving chronic disease self-management and outcomes. The Veterans Health Administration (VHA) established one of the earliest HT programs in the country in 2003; however, little is known about how these services have been utilized and expanded over the last decade.ObjectiveTo describe trends in use of VHA's HT program from 2010 through 2017 and correlates of length of enrollment in HT services.DesignRetrospective observational cohort study.ParticipantsPatients enrolled in HT between January 1, 2010 and December 31, 2017.Main MeasuresWe described the number and characteristics of patients enrolled in HT, including the chronic conditions managed. We also identified length of HT enrollment and examined patient and facility characteristics associated with longer enrollment.Key ResultsThe total number of patients enrolled in HT was 402,263. At time of enrollment, half were >65 years old, 91% were male, and 59.3% lived in urban residences. The most common conditions addressed by HT were hypertension (28.8%), obesity (23.9%), and diabetes (17.0%). The median time to disenrollment in HT was 261 days (8.6 months) but varied by chronic condition. In a multivariable Cox proportional hazards model, covariates associated with higher likelihood of staying enrolled were older age, male gender, non-Hispanic Black race/ethnicity, lower neighborhood socioeconomic status, living in a more rural setting, and a greater burden of comorbidities per the Gagne index.ConclusionsAcross 8 years, over 400,000 veterans engaged in HT services for chronic disease management and over half remained in the program for longer than 8 months. Our work provides a real-world evaluation of HT service expansion in the VHA. Additional studies are necessary to identify optimal enrollment duration and patients most likely to benefit from HT services.© 2022. This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply.

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