Preventive Health Inventory Boosts Diabetes and Hypertension Management Without Increasing Hospitalizations Among Veterans: New Study

A population-level care management initiative implemented across the Veterans Health Administration (VHA) was associated with improved diabetes and hypertension control without increases in preventable emergency department (ED) visits or hospitalizations, according to a cohort study published in JAMA Network Open. The Preventive Health Inventory (PHI), a multicomponent intervention designed to help primary care teams identify and address delayed care during the COVID-19 pandemic, was evaluated using VHA administrative data collected from February 2019 through February 2022.

The study included multiple propensity score–matched cohorts of veterans with diabetes and/or hypertension who either did or did not receive PHI-supported care. Receipt of PHI was defined as completion of a templated electronic health record note documenting the intervention.

Key Findings

Across cohorts ranging from 8 434 to 97 695 PHI recipients, the intervention was associated with significant improvements in clinical quality measures for chronic disease management:

• Veterans who received PHI had a 2.9-percentage-point lower probability of poor diabetes control (95% CI, −3.8 to −1.9 percentage points), defined as hemoglobin A1c >9% or no A1c measurement within the prior year.
• The probability of achieving blood pressure control increased by 4.0 percentage points among PHI recipients (95% CI, 2.6–5.3 percentage points).
• Rates of statin therapy for diabetes were similar between PHI recipients and nonrecipients (0.08%; 95% CI, −0.05% to 1.63%).

The intervention did not increase potentially avoidable health care use. Rates of preventable ED visits and hospitalizations for ambulatory care–sensitive conditions did not differ significantly between groups (difference in preventable ED visits: 9.9 visits per 1 000 veterans; 95% CI, −3.9 to 20.1). Hospitalizations for ambulatory care–sensitive conditions were also similar (4.4 per 1 000; 95% CI, −5.3 to 14.1).

However, PHI was associated with higher overall outpatient use, with 310 more outpatient visits per 1 000 veterans (95% CI, 272–348). Authors noted this may reflect efforts to reengage veterans in care after pandemic-related disruptions.

Study Context and Methods. The PHI program includes a national dashboard of quality measures, a structured telehealth visit with a primary care nurse, and a templated checklist covering chronic disease management, cancer screenings, and mental health needs. It was deployed to address substantial declines in chronic disease monitoring observed during the pandemic, including fewer A1c checks, fewer prescription refills, and delays in blood pressure follow-up.

The study used a difference-in-differences approach to compare outcomes before and after PHI implementation, adjusting for patient, practitioner, and clinic characteristics. Matching ensured balanced cohorts, with all standardized mean differences <0.1.

Implications for Primary Care. Investigators estimated that if applied across the more than 9.2 million veterans enrolled in VHA care, improved control could translate to approximately 69 000 fewer veterans with poor diabetes control and 320 000 more with controlled hypertension.

Authors noted that care management interventions embedded within patient-centered medical home models may be particularly beneficial for populations with multimorbidity and high chronic disease burden. The PHI’s association with increased outpatient use, but not preventable ED visits or hospitalizations, suggests the tool may support appropriate reengagement in primary care without increasing unnecessary utilization.

The initiative may also serve as a model for population health strategies aimed at reconnecting patients with chronic and preventive care after disruptions—whether pandemic-related or due to other causes.

Limitations included reliance on template completion as a proxy for intervention delivery, potential unobserved confounding inherent in observational designs, and variable PHI uptake across clinics. Results may not generalize to patients with limited life expectancy, as quality measures were not designed for that population.

Reference

Wheat CL, Reddy A, Shirley SE, et al. Population-Level Health Intervention and Primary Care Quality for Veterans. JAMA Netw Open. 2025;8(11):e2544378. doi:10.1001/jamanetworkopen.2025.44378.