A greener approach to improving patient care

Overview

Many healthcare systems are increasingly aware not only of the growing health concerns of climate change but also recognize the need to reduce the environmental impacts generated by the healthcare system itself.

Telemedicine programs- like the VA Health Care System’s Advanced Comprehensive Diabetes Care (ACDC)- hold the potential to both enhance patient care and reduce the carbon footprint of providing care.

In a recent article published in NEJM Catalyst, researchers demonstrated that ACDC improved care for diabetes patients while also reduced patient travel time, out-of-pocket costs, and greenhouse gas emissions.

Health care and the environmental

Health care contributes 8.5% of national greenhouse gas emissions, primarily resulting from emissions associated with delivery of care and maintenance of facilities. Many healthcare systems have sought to measure their environmental impact and to take action to reduce their carbon footprint. This work is especially critical for healthcare providers as climate change presents an increasingly paramount threat to human health. 

“Climate change is one of the greatest threats to the health of our patients and communities that we may see in our lifetimes,” said Dr. Bill Weppner, associate professor (General Internal Medicine) and section head at the Boise VA Medical Center who is first author on the NEJM Catalyst paper.

“We have the opportunity to positively impact this, but that means we have to start considering our contributions as a health care system. Taking time to measure the greenhouse gas contributions alongside the costs and quality of care is more important than ever,” Weppner said.

One key source of emissions is travel for in-person clinical visits—by both patients and visitors.

Expanding telemedicine services is one example of co-beneficial care – what Weppner and coauthors describe as an action that results in “both a measurable reduction in patient travel–related carbon emissions and, thus, the environmental impact of providing care, while offering comparable or better chronic disease and preventive health outcomes.”

VA Diabetes telemedicine program

Weppner and coauthors at the Durham, North Carolina VA Health Care System evaluated the ACDC program, a national telemedicine initiative, for its environmental impact compared to traditional, in-person visits.

ACDC is a successful, evidence-based telemedicine program for veterans whose diabetes has not responded to clinic-based care. The program utilizes existing infrastructure for telemedicine through the VA Health Care System and provides up to 12 telephone-based sessions over 6 months, primarily delivered by VA Home Telehealth nurses. ACDC components include telemonitoring, self-management support, and medication management with a clinical pharmacist.

Specifically, the study looked at encounters that took place within 13 VA medical centers across the United States between 2017 and 2022.

For the study, the researchers assumed that every telehealth visit in ACDC replaced an in-person visit to the nearest suitable VA clinic or hospital. Using patient data, they calculated how far veterans would have had to travel, how much gas they would have used, and how much CO2 that travel would have produced.

Notable results

• Each telehealth visit saved an average of 17.6 miles of travel.
• Over the course of the study period, this added up to avoiding 82.2 metric tons of CO2, which is like taking 20 cars off the road for a year.
• The environmental savings per person were compared to the emissions from producing 68 beef steaks.
• Program participants’ average starting blood sugar (HbA1c) level was high, but after 6 months in the program, it dropped significantly and stayed lower for 3 years.

Weppner emphasized that this study demonstrates the potential for programs that reduce unnecessary travel to deliver high-quality, climate-conscious care.

“Climate conscious care parallels high quality care by emphasizing patient-centered delivery, meeting them where them are (literally!) and taking approaches to provide co-benefits for the patient’s individual health and the environment in which we all live,” Weppner said.

“These don’t have to be either/or decisions – with appropriate information and systems of care, we can achieve both.”

Potential

Both healthcare systems and patients have increasingly embraced telemedicine, especially following the COVID-19 pandemic. Today, telehealth visits make up about 23% of all healthcare visits nationwide, providing more accessible care and, in cases like ACDC, improving outcomes.

These visits also reduce time, costs, and emissions linked to patient travel.

The study authors note that research has shown that during the pandemic, increases in telehealth visits in a large health care system reduced greenhouse gas production related to care by 36%, despite an overall increase of 13% in total visits.

Co-beneficial medical interventions offer potential for improving patient experiences and making the healthcare industry more sustainable.

“There is increasing evidence of ways to provide co-benefits for patients & the environment – active transportation, plant-forward diets, reducing low value care or unnecessary time and cost from travel,” Weppner said.

“We need to continue work to understand and identify co-benefits at a health care system level – in which quality population health care is provided, but at in a cost- and carbon-efficient manner.”