Polytrauma/TBI System of Care
Teleconsultation for TBI Evaluation Expands
VHA screens all Veterans separating from military service after September 11, 2001 for possible Traumatic Brain Injury (TBI) using a 4 question screen. Veterans with a positive screen are referred to a TBI specialist for a Comprehensive TBI Evaluation (CTBIE). TBI specialists are often located at VA medical centers thereby requiring Veterans served at Community Based Outpatient Clinics to drive to the affiliated medical center for a CTBIE.
In 2012, the Office of Health Care Transformation funded a project to develop a standardized CTBIE protocol delivered via telehealth technology. Rehabilitation and Prosthetic Services in collaboration with the Telehealth Service wrote the protocol with experts in traumatic brain injury, rehabilitation, telehealth, neuropsychology and research.
A CTBIE Teleconsultation provides a TBI evaluation utilizing Telehealth allowing the Veteran to be seen at a site, typically a Community Based Outpatient Clinic, removed from the TBI specialist. The consultation uses trained clinical staff (telepresenter) to assist the remote TBI specialist completing the evaluation. The telehealth appointment provides the Veteran with the same services they would receive if they were in a face-to-face appointment utilizing the telepresenter as the “hands” of the TBI specialist. A TBI Specialist must be a neurologist, physiatrist, neurosurgeon, neuro-psychiatrist, or a licensed independent practitioner with additional TBI training. The comprehensive evaluation includes a review of trauma history, examination, definitive diagnosis, and a patient centered treatment plan.
The CTBIE Teleconsultation pilot began in FY2013 at 16 sites, and over 40 sites have been trained during the pilot. CTBIE teleconsultation results, including outcomes and satisfaction, are being studied by VA researchers. Training materials for TBI specialists, telepresenters, and administrative support staff were produced during the pilot and are available on the VA Talent Management System, allowing for additional sites to complete training and initiate CTBIE teleconsultations.
VA/DoD Clinical Practice Guideline: Management of Concussion/mTBI
VHI: Traumatic Brain Injury
Joel Scholten, MD
Physiatrist and TBI Specialist, Washington DC VAMC
Acting National Director, Physical Medicine and Rehabilitation, VA Central Office
Physician Lead, CTBIE Teleconsultation Pilot
Nan Musson, M.A., CCC-SLP, BC-ANCDS
Speech Language Pathologist, North Florida/South Georgia VHS
Speech Pathology Discipline Lead, Rehabilitation & Prosthetics Services, VA Central Office
Project Lead, CTBIE Teleconsultation Pilot