Financial and Temporal Advantages of Virtual Consultation in Veterans Requiring Specialty Care
Financial and Temporal Advantages of Virtual Consultation in Veterans Requiring Specialty Care
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DOI：
10.1093/milmed/usx006
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发表时间：
2018-01-01
影响因子：
1.2
通讯作者：
Maloney, James D.
中科院分区：
文献类型：
--
作者：
Abbott, Daniel E.;Macke, Ryan A.;Maloney, James D.
背景：在退伍军人事务部(VA)系统中获得特殊医疗保健的机会仍然存在问题。考虑到远程医疗潜在的时间和财政利益，退伍军人管理局开发了一个虚拟会诊(VC)机制，以加快对偶然发现的肺结节的退伍军人的诊断和治疗干预。材料和方法：2009年至2011年，在麦迪逊退伍军人事务部实施了VC，这是转介提供者和胸科医生之间因偶然发现的肺结节而进行的一次远程会面。为157名退伍军人确定了从请求到完成咨询的时间、医院费用和旅行费用。然后将这些终点与同时进行的6个月的面对面会诊进行比较。结果：在整个研究队列中，VC完成的平均时间为3.2d(SD+/-4.4d)。在首次获得VC的6个月期间，完成VC与面对面咨询的平均时间分别为2.8d(SD+/-2.8d)和20.5d(SD+/-15.6d)(p<；0.05)。在最初的VC之后，84名(53%)退伍军人被安排单独进行虚拟随访；在进一步的诊断或治疗干预之前，没有退伍军人需要额外的办公室访问。每一次面对面会诊的住院费用为228美元，而每一集的住院费用为120美元--下降了47.4%。退伍军人家庭到中心的平均距离为86英里，每次面对面会诊平均获得112美元的差旅报销，而与VC相关的差旅费用为零。结论：对于偶然发现的肺结节，VC显著减少了会诊完成的时间、住院费用和退伍军人旅行费用。这些数据表明，在退伍军人管理局系统内将远程医疗扩展到更多的实践环境中存在着重要的机会。
Background: 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 Methods: 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. Results: 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. Conclusions: 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.