New England Journal of Medicine (NEJM)
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 co-benefits — 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.
