Dr. Gray is a native of Baltimore, MD and proud graduate of Morehouse College, Howard University College of Medicine, the Duke University Medical Center Internal Medicine residency, and the Washington University Gastroenterology fellowship. During his training, Dr. Gray engaged communities, health centers, and other stakeholders in improving the quality of health care delivered to vulnerable populations through media promotion, research, and program development, such as the patient navigation program that he started in Saint Louis, Missouri to increase colorectal cancer screening among African Americans. Dr. Gray built upon these interests and skills in stakeholder engagement and enhancing access and utilization of health care services during his tenure in the Mongan Commonwealth Fund Fellowship (graduate class of 2014), through work with the Department of Defense's National Center for Telehealth and Technology in which he framed aspects of cost estimation for the expansion of their telehealth services, particularly in rural areas. Additionally, throughout his training and professional career, Dr. Gray has remained active as a mentor and member of multiple national organization's committees. He envisions using these collective experiences and tools in his role at The Ohio State University Wexner Medical Center to investigate and implement strategies and practices that will improve the landscape of health care for all and advance the "Triple Aim" of better quality care, better population health, and reduced costs of health care.
Darrell M. Gray, II, MD, MPH
Darrell M. Gray, II, MD, MPH
Assistant Professor of Medicine, Director of Community Engagement and Equity in Digestive Health, The Ohio State University Wexner Medical Center, Columbus, OH; Deputy Director of the Center for Cancer Health Equity, OSU Comprehensive Cancer-Center-The James Cancer Hospital
With a master’s from the School of Public Health, physician Darrell Gray hopes to use telecommunications to extend care to underserved neighborhoods.
The man came into the emergency room of St. Louis’ Barnes-Jewish Hospital complaining of abdominal pain. Having no insurance, he had avoided medical care as long as he could, but the pain had finally become too intense.
The gastroenterologist called in to consult that day was Darrell Gray, a young physician from Baltimore doing a fellowship at the hospital, which is affiliated with Washington University School of Medicine in St. Louis.
Telehealth in the Military Health System: Balancing opportunity and cost in the management of mental disorders and traumatic brain injury
The primary goals of this project were to frame key assumptions around which a model can be constructed to estimate cost benefit and cost utility of expanding telehealth services in the Military Health System and synthesize data that addresses the tenability of each assumption. A secondary goal was to provide a clinical lens through which the organization can critically appraise the policy and practice implications.
Mental illness and traumatic brain injury (TBI) are serious public health problems. Data from 2011-2012 show that 42.5 million adults experienced mental illness and it is estimated that the burden has since increased. Additionally, TBI, which may be associated with co-morbid mental illness including depression, post-traumatic stress disorder, is a significant source of disability and death. This is staggering in the context of 2.5 million TBIs occurring in 2010 and incidence rates as high as 20% among US veterans who served in Iraq or Afghanistan. Furthermore, considering the growing and aging population that is estimated to grow from 314 million to 400 million in 2050, the current and projected distribution and deficiency of care providers, and the political push to control costs of health care, the issue of mental disorder and TBI management becomes more salient.
Telehealth, an innovative technology that allows for exchange of medical information and a synchronous connection between a health care provider at one site and a patient at another, aims to improve access to care, quality, and cost. The Department of Defense is actively increasing telehealth capabilities, particularly for psychological health outcomes. The expectation is that increased usage of telehealth will increase access to services for beneficiaries of all types.
A component of evaluating the expansion of telehealth, particularly in rural areas, will relate to overall program costs and the associated benefits and utility gained. Valid approaches to address this dimension of evaluation require reliable estimates of cost and potential benefits from using telehealth. As with any analysis, however, assumptions must be made to enable estimation and subsequent comparisons with alternative approaches.
A structured review of medical literature was performed to address the tenability of two key hypotheses: a) the provision of mental health and/or traumatic brain injury services via synchronous telehealth will be of similar quality and efficacy to the provision of the same service via an in-office encounter, the current standard of care, and b) providing outpatient services to patients who are currently not receiving such services will improve prognosis and reduce the incidence of more intensive interventions (e.g., hospitalization).
Synchronous telehealth is just as effective as face-to-face consultation in the assessment and treatment of mental health disorders and traumatic brain injury. Additionally, outpatient management of mental illness plays a significant role in preventing escalation of care and reducing length of hospital admissions, readmissions, and mortality rates. We are not aware of similar data regarding the outpatient management of TBI. However, it follows that outpatient management of both mental illness and TBI via synchronous telehealth may reduce need for escalation of care (ie. hospitalization) and thus reduce costs of care.
It is our goal that this cost model will drive the requirements for sites that could most benefit from using telehealth. Thus, after the model is constructed, it will be pilot tested at Camp Lejeune. We expect that other, currently unknown, metrics will need to added before being implemented at future sites. Ultimately, we envision that through such modeling, we will be able accurately predict and inform decisions regarding the "value" of initiating and using telehealth at specific sites site, even specific to the type of telehealth service delivered (ie. tele-Med board exams, telepsychiatry, telecardiology, etc).
Derek J. Smolenski, PhD, M.PH, Epidemiologist & Quantitative Methodologist, Research, Outcomes and Investigations |ROI|, National Center for Telehealth and Technology |T2|, Department of Defense |DoD|