Stroupe Kevin T, Martinez Rachael, Hogan Timothy P, Evans Charlesnika T, Scholten Joel, Bidelspach Douglas, Osteen Chad, Taylor Brent C, Smith Bridget M
Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, Hines, Illinois.
Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois.
Telemed J E Health. 2019 Dec;25(12):1144-1153. doi: 10.1089/tmj.2018.0182. Epub 2019 Mar 15.
Background:Mild traumatic brain injury (TBI) is prevalent among Afghanistan (Operation Enduring Freedom [OEF]) and Iraq (Operation Iraqi Freedom [OIF]) Veterans. With clinical video telehealth (CVT), Veterans screening positive for potential deployment-related TBI can receive comprehensive TBI evaluations by providers at specialized centers through interactive video communication.
Introduction:We examined health care utilization and costs for Veterans during the 12 months before and after being evaluated through CVT versus in-person.
Materials and Methods:We examined OEF/OIF Veterans receiving comprehensive evaluations at specialized Veterans Affairs facilities from October 2012 to September 2014. Veterans evaluated through CVT and in-person at the same facilities were included. We used a difference-in-difference analysis with propensity score weighted regression models to examine health care utilization and costs between TBI evaluation groups.
Results:There were 554 Veterans with comprehensive evaluations through CVT (380 with and 174 without confirmed TBI) and 7,159 with in-person evaluations (4,899 with and 2,260 without confirmed TBI). Veterans in the in-person group with confirmed TBI had similar increases in outpatient, inpatient, and total health care costs as Veterans who had TBI confirmed through CVT. However, Veterans with a confirmed TBI evaluated in-person had greater increases in rehabilitation and other specialty costs.
Discussion:When visits are in-person, Veterans may have opportunities to discuss more issues and concerns, whether TBI-related or not. Thus, providers might make more referrals to rehabilitation and specialty care after in-person visits.
Conclusion:Veterans receiving in-person evaluations who were diagnosed with TBI had similar increases in health care costs as Veterans with TBI confirmed through evaluations through CVT.
轻度创伤性脑损伤（TBI）在阿富汗（持久自由行动[OEF]）和伊拉克（伊拉克自由行动[OIF]）退伍军人中很常见。通过临床视频远程医疗（CVT），筛查出可能与部署相关的TBI呈阳性的退伍军人可以通过交互式视频通信接受专业中心的医疗服务提供者进行的全面TBI评估。
我们研究了通过CVT与亲自就诊进行评估的退伍军人在评估前后12个月的医疗保健利用情况和费用。
我们研究了2012年10月至2014年9月在专门的退伍军人事务设施接受全面评估的OEF/OIF退伍军人。包括在同一设施通过CVT和亲自就诊进行评估的退伍军人。我们使用倾向得分加权回归模型的差异分析来研究TBI评估组之间的医疗保健利用情况和费用。
有554名退伍军人通过CVT进行了全面评估（380名确诊TBI，174名未确诊TBI），7159名通过亲自就诊进行了评估（4899名确诊TBI，2260名未确诊TBI）。亲自就诊组中确诊TBI的退伍军人在门诊、住院和总医疗保健费用方面的增加与通过CVT确诊TBI的退伍军人相似。然而，亲自就诊评估确诊TBI的退伍军人在康复和其他专科费用方面的增加更大。
当亲自就诊时，退伍军人可能有机会讨论更多问题和担忧，无论是否与TBI相关。因此，医疗服务提供者在亲自就诊后可能会更多地转诊至康复和专科护理。
被诊断为TBI且接受亲自就诊评估的退伍军人在医疗保健费用方面的增加与通过CVT评估确诊TBI的退伍军人相似。
