Health Care Utilization and Costs of Veterans Evaluated for Traumatic Brain Injury Through Telehealth

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.