Browsing by Author "Mohan, Dilip"
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- ItemComparison of telemedicine with in-person care for follow-up after elective neurosurgery: results of a cost-effectiveness analysis of 1200 patients using patient-perceived utility scores.(0000-00-00) Thakar, Sumit; Rajagopal, Niranjana; Mani, Subramaniyan; Shyam, Maya; Aryan, Saritha; Rao, Arun S; Srinivasa, Rakshith; Mohan, Dilip; Hegde, Alangar SOBJECTIVE The utility of telemedicine TM in neurosurgery is underexplored with most of the studies relating to teletrauma or telestroke programs In this study the authors evaluate the cost effectiveness of TM consultations for follow up care of a large population of patients who underwent neurosurgical procedures METHODS A decision analytical model was used to assess the cost effectiveness of TM for elective post neurosurgical care patients from a predominantly nonurban cohort in West Bengal India The model compared TM care via a nodal center in West Bengal to routine in person per episode care at the provider site in Bangalore India Cost and effectiveness data relating to 1200 patients were collected for a 52 month period The effectiveness of TM care was calculated using efficiency in terms of the percentage of successful TM consultations as well as patient perceived utility values for overall experience of the type of health care access that they received Incremental cost effectiveness ratio ICER analysis was done using the 4 quadrant charting of the cost effectiveness plane One way sensitivity and tornado analyses were performed to identify thresholds where the care strategy would change RESULTS The overall utility for the 3 TM scenarios was found to be higher 89 than for the utility of routine care 80 TM was found to be more cost effective Indian rupee INR 2630 per patient compared to routine care INR 6848 per patient The TM strategy dominates that of routine care by being more effective and less expensive ICER value of 39 400 INR unit of effectiveness Sensitivity analysis revealed that cost effectiveness of TM was most sensitive to changes in the number of TM patients utility and success rate of TM and travel distance to the TM center CONCLUSIONS TM care dominates the in person care strategy by providing more effective and less expensive follow up care for a remote post neurosurgical care population in India In the authors setting this benefit of TM is sustainable even if half the TM consultations turn out to be unsuccessful The viability of TM as a cost effective care protocol is attributed to a combination of factors like an adequate patient volume utilizing TM patient utility success rate of TM and the patient travel distance
- ItemThe impact of telemedicine in the postoperative care of the neurosurgery patient in an outpatient clinic: a unique perspective of this valuable resource in the developing world--an experience of more than...(2014-09-30) Dadlani, Ravi; Mani, Subramaniyan; A U, Jai Ganesh; Mohan, Dilip; Rajgopalan, Niranjana; Thakar, Sumit; Aryan, Saritha; Hegde, Alangar STelemedicine has always been used as a teleconsultation tool in neurological emergencies e g triage in head injuries stroke and cerebrovascular accidents At Sri Sathya Sai Institute of Higher Medical Sciences Bangalore India we have been operating two teleconsultation sessions per week for the postoperative patient population addressing routine follow up and semiemergent conditions in this cohort of patients At our center more than 80 of the neurosurgical procedures are conducted in patients traveling more than 1500 km Telemedicine as a routine tool in clinical medicine has significant financial and psychosocial benefits versus routine outpatient clinics There are very few reports of telemedicine use in routine outpatient teleconsultations in the available neurosurgical literature those that are present do not differentiate or analyze the use in routine versus emergency neurosurgery We discuss the role of this underused resource in the developing countries and retrospectively analyze the clinical data in more than 1500 patients and 3000 teleconsultations during a period of 6 years We address the financial implications psychosocial factors and several other factors that could make this relatively modest technology an indispensible tool in current neurosurgical practice especially in a developing country like India