Abbott Daniel E, Macke Ryan A, Kurtz Jodi, Safdar Nasia, Greenberg Caprice C, Weber Sharon M, Voils Corrine I, Fisher Deborah A, Maloney James D
William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terrace, Madison, WI 53705.
Department of Surgery, University of Wisconsin School of Medicine and Public Health, 750 Highland Ave, Madison, WI 53726.
Mil Med. 2018 Jan 1;183(1-2):e71-e76. doi: 10.1093/milmed/usx006.
Access to specialty health care in the Veterans Affairs (VA) system continues to be problematic. Given the potential temporal and fiscal benefits of telehealth, the Madison VA developed a virtual consultation (VC) mechanism to expedite diagnostic and therapeutic interventions for Veterans with incidentally discovered pulmonary nodules. Materials and.
VC, a remote encounter between referring provider and thoracic surgeon for incidentally discovered pulmonary nodules, was implemented at the Madison VA between 2009 and 2011. Time from request to completion of consultation, hospital cost, and travel costs were determined for 157 veterans. These endpoints were then compared with in-person consultations over a concurrent 6-mo period.
For the entire study cohort, the mean time to completion of VC was 3.2 d (SD ± 4.4 d). For the 6-mo period of first VC availability, the mean time to VC completion versus in-person consultation was 2.8 d (SD ± 2.8 d) and 20.5 d (SD ± 15.6 d), respectively (p < 0.05). Following initial VC, 84 (53%) veterans were scheduled for virtual follow-up alone; no veteran required an additional office visit before further diagnostic or therapeutic intervention. VA hospital cost was $228 per in-person consultation versus $120 per episode for VC - a 47.4% decrease. The average distance form veteran home to center was 86 miles, with an average travel reimbursement of $112 per in-person consultation, versus no travel cost associated with VC.
VC for incidentally discovered pulmonary nodules significantly decreases time to consultation completion, hospital cost, and veteran travel cost. These data suggest that a significant opportunity exists for expansion of telehealth into additional practice settings within the VA system.
退伍军人事务部（VA）系统中获得专科医疗保健仍然存在问题。鉴于远程医疗可能带来的时间和财政效益，麦迪逊VA开发了一种虚拟会诊（VC）机制，以加快对偶然发现肺结节的退伍军人的诊断和治疗干预。材料与方法：VC是指转诊医生与胸外科医生就偶然发现的肺结节进行的远程会诊，于2009年至2011年在麦迪逊VA实施。确定了157名退伍军人从申请到会诊完成的时间、医院成本和差旅费。然后将这些终点指标与同期6个月内的面对面会诊进行比较。结果：对于整个研究队列，VC完成的平均时间为3.2天（标准差±4.4天）。在首次提供VC的6个月期间，VC完成的平均时间与面对面会诊分别为2.8天（标准差±2.8天）和20.5天（标准差±15.6天）（p<0.05）。首次VC后，84名（53%）退伍军人仅安排了虚拟随访；在进一步进行诊断或治疗干预之前，没有退伍军人需要额外的门诊就诊。VA医院面对面会诊的成本为每次228美元，而VC每次为120美元——降低了47.4%。退伍军人住所到中心的平均距离为86英里，面对面会诊的平均差旅报销为每次112美元，而VC无差旅成本。结论：针对偶然发现的肺结节的VC显著缩短了会诊完成时间、医院成本和退伍军人差旅成本。这些数据表明，在VA系统内将远程医疗扩展到更多实践环境存在重大机会。
