Decarbonizing Health Care: Measuring the Carbon Footprint Impact of a National VA Telehealth Program

Abstract

Health care systems are increasingly recognizing the environmental harms generated by medical care and are seeking to reduce their carbon footprints. They can accomplish measurable reductions in greenhouse gas emissions while maintaining high quality and even improving care by pursuing cobenefits - programs that simultaneously reduce environmental harm and benefit patients' health. The authors describe Advanced Comprehensive Diabetes Care (ACDC), an evidence-based telehealth program for diabetes patients in the U.S. Department of Veterans Affairs (VA) system that has concurrently improved patient care and reduced the VA's carbon footprint. Designed for patients with poor diabetes control, the program leverages existing clinical infrastructure to provide nurse-delivered telemonitoring, self-management support, and provider-aided medication management. ACDC has improved patient outcomes while reducing patient travel time, out-of-pocket costs, and greenhouse gas emissions. ACDC served 576 patients between 2017 and 2022. The authors estimate that the program has prevented over 200,000 miles of driving, saving around US$20,000 in gasoline costs for patients and 82 metric tons of carbon dioxide emission compared with equivalent in-person care. ACDC provides a template for improving health outcomes and patient as well as provider satisfaction while saving money and producing measurable reductions in carbon footprint.

FIGURE 1. Closest Possible Distance Between a U.S. Department of Veterans Affairs (VA) Facility Providing Comparable Care and the Residence of a Veteran Engaging in the Advanced Comprehensive Diabetes Care (ACDC) Diabetes Telehealth Care

This figure displays the shortest possible distance between a veteran receiving ACDC diabetes telehealth care (based on a zip code centroid of residence) and the closest VA facility offering comparable clinical services; actual distance and drive time were calculated using navigable distance. ACDC = Advanced Comprehensive Diabetes Care, CBOC = community-based outpatient clinic, EPA = Environmental Protection Agency, Esri = Environmental Systems Research Institute, FAO, Food and Agriculture Organization of the United Nations, NOAA = National Oceanic and Atmospheric Administration, USFWS = United States Fish and Wildlife Service, USGS, United States Geological Survey, VA = U.S. Department of Veterans Affairs, VAMC = VA medical center, VISN = Veterans Integrated Service Network. Source: Office of Rural Health, U.S. Department of Veterans Affairs NEJM Catalyst (catalyst.nejm.org) © Massachusetts Medical Society