Remote telemedicine evaluation of deep brain stimulation candidacy: Retrospective cohort analysis

Abstract

Objective: To determine whether initial presurgical evaluation of deep brain stimulation (DBS) candidacy with video telemedicine (VTEL) can reliably predict surgical candidacy (patients who will eventually undergo DBS surgery) and decrease resource utilization when compared to an in-person evaluation.

Methods: In this retrospective, cohort analysis, all out-of-state referrals to the San Francisco Veterans Affairs from 2008 to 2013 for DBS therapy were reviewed and their surgical outcomes were assessed until 2017. Patients were designated as good, borderline, or poor surgical candidates after initial evaluation, and their rates of undergoing DBS were recorded. An assessment of patient travel costs was performed.

Results: There were 60 out-of-state DBS referrals identified out of the 148 initial presurgical DBS evaluations completed for surgical treatment of dystonia, essential tremor, or Parkinson disease; 24 patients underwent in-person consultation and 36 patients underwent evaluation via VTEL. There was no difference between the rates of undergoing surgical treatment with DBS based on surgical candidacy for patients in the in-person and VTEL cohorts. Patients who underwent initial presurgical screening via VTEL saved time and money.

Conclusions: VTEL can be used to facilitate presurgical screening for DBS and saves costs.

Figure 1. Home addresses of patients referred for deep brain stimulation

This outlines the home address of each patient who was referred out-of-state for evaluation for DBS. Each color represents the local Veterans Affairs medical center that referred patients to San Francisco Veterans Affairs. These cities are part of the San Francisco Parkinson's Disease Research, Education and Clinical Centers catchment area. DBS = deep brain stimulation.

Figure 2. Flow diagram of patient evaluation for deep brain stimulations

Patients were seen initially via traditional in-person consultation or via VTEL. Based on the surgical candidacy determined at that consultations, patients would undergo additional subsequent evaluations as outline prior to potentially undergoing deep brain stimulation at SFVA. SFVA = San Francisco Veterans Affairs; VTEL = video telemedicine.