The health of populations with limited access to health care is getting increasingly worse. One study assessing the patient's functional status following TBI found that rural TBI patients were more likely to be functionally dependent and report a lower health status than their urban counterparts.(16) This study also showed that financial constraints in accessing the health care system is associated with this worse outcome. Racial and ethnic differences were also described by Gray et al(17) who said that post-acute care interventions specifically targeted at minorities should diminish the inequities of current treatment regimens.
Our successful introduction of teleradiology-enhanced consultations in 11 rural NM hospitals, including three that provide care as part of the Indian Health Service, has helped overcome disparities. From January 2010 to January 2011, patients were triaged with our teleradiology system. Data from one hospital were analyzed further (n=118): Over the observed time period (12 months), we show that 20% of patients with a neurosurgical emergency were retained at GIMC; 25% were discharged after teleradiology enhanced phone consultation. Because of the teleradiology enhanced triage system, 45% of all transports to UNMH were prevented(14) Because all of these transports were by air with an average cost of $30,300 per transport,(18) the cost savings for transport alone totaled $1,484,700.
It is interesting to note that 75% of patients transferred to UNMH underwent emergent surgical intervention. This shows that the more appropriate cases necessitating neurosurgical intervention were sent to UNMH for neurosurgical expertise and that non operative or mTBI cases are treated in the rural setting. Our experience shows that telehealth can be successfully implemented in rural NM to greatly enhance local care, resulting in significant cost savings for the referring facility as well as increased patient safety. Savings in transport costs alone are remarkable, ranging from $12,000 (by ground) to $25,000 (by air) per patient transport.