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

Kevin T. Stroupe*, Rachael Martinez, Timothy P. Hogan, Charlesnika T. Evans, Joel Scholten, Douglas Bidelspach, Chad Osteen, Brent C. Taylor, Bridget M. Smith

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)1144-1153
Number of pages10
JournalTelemedicine and e-Health
Issue number12
StatePublished - Dec 2019


  • Cost analysis
  • E-health
  • Head injury
  • Health care utilization
  • Operation Iraqi freedom
  • Operation enduring freedom
  • Telehealth
  • Telemedicine
  • Traumatic brain injury
  • Veterans

ASJC Scopus subject areas

  • Health Informatics
  • Health Information Management


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