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

UMMS Affiliation

Department of Quantitative Health Sciences, Division of Health Informatics and Implementation Science

Publication Date


Document Type



Epidemiology | Health Services Administration | Health Services Research | Military and Veterans Studies | Nervous System Diseases | Telemedicine


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.


cost analysis, head injury, health care utilization, operation enduring freedom, operation Iraqi freedom, traumatic brain injury, veterans, telemedicine, telehealth, e-health

DOI of Published Version



Telemed J E Health. 2019 Mar 15. doi: 10.1089/tmj.2018.0182. [Epub ahead of print] Link to article on publisher's site

Journal/Book/Conference Title

Telemedicine journal and e-health : the official journal of the American Telemedicine Association

PubMed ID


Related Resources

Link to Article in PubMed