VA TeleNeurology Program Helps Compensate for Shortage of Neurology Specialists

December 12, 2024

Takeaway: As the mismatch between the proportion of the population with neurologic conditions and the number of neurologists grows, teleneurology outpatient care is one way to improve patient access to neurologic specialists. The National VA TeleNeurology Program (NTNP) — a finalist in the VA Shark Tank competition — showed a demonstrated positive impact on Veterans’ access to care, with high satisfaction ratings from Veterans and referring providers

Background

Expenditures for neurological care in the community are staggering, totaling more than $27 million. Further, there is a high demand for neurologists to manage the many chronic neurologic conditions that affect Veterans. However, a report from the American Association of Medical Colleges (AAMC) showed only about 1.5% of all practicing physicians in the United States are neurologists. There is also a national shortage of general neurology physician staff within VA, and many rural areas have little to no VA neurology coverage and access to this important care. Studies show access to specialty care improves outcomes in some neurological diseases. Therefore, Veterans who are not able to access this care are at risk for poorer outcomes. Seeking ways to enhance access to this care is a priority.

In January 2020, VA funded the National TeleNeurology Program (NTNP), a national telehealth program that leverages technology to bring neurological services to some of the most rural areas of the country where there is limited access to care for Veterans. The program recruited and coordinated providers from across the country to work remotely and, in turn, successfully implemented services at multiple sites.

Linda S. Williams, MD, co-lead of EXTEND QUERI and a senior investigator for HSR’s Center for Health Information and Communication (CHIC), conducts research on implementing and evaluating stroke and neurological care quality and outcomes. With EXTEND QUERI, she helped lead the implementation and evaluation of NTNP. Dr. Williams and colleagues conducted three recent studies that examined the impact of NTNP on Veterans.

• Wilkinson and colleagues examined NTNP’s impact on the timeliness of Veterans’ access to neurological care, and the volume of Community Care Neurology consultation among participating and non-participating VA sites. Synchronous telehealth visits were conducted using either video-to-home or video in an outpatient clinic. Veterans could choose between NTNP and other neurology services for which they were eligible, including Community Care Neurology.
• Findings show that NTNP resulted in more timely neurologic care compared to Community Care (44 vs. 97 days from consult order to appointment) and no significant increase in Community Care Neurology consults over time (mean change of five consults per month). In contrast, control sites that did not implement NTNP had a significant increase in Community Care Neurology consultation volume over time (mean increase of 24 consults per month).

• Damush and colleagues conducted a prospective implementation evaluation of NTNP using the pragmatic application of the RE-AIM framework. Investigators collected and analyzed data from the first two years of NTNP activity (FY2021–FY2022) in the five RE-AIM domains: Reach, Effectiveness, Adoption, Implementation, and Maintenance.
  • Results demonstrated that NTNP was successfully implemented in 13 VAMCs over two years. The total NTNP new patient consult volume in FY2021 was 836 (58% rural Veterans); this increased to 1,706 in FY2022 (55% rural Veterans). Total (new and follow-up) NTNP clinical encounters were 1,306 in FY2021 and 3,730 in FY2022. Overall, sites reported positive experiences with program implementation and perceived the program was serving Veterans with little access to neurological care. Veterans also reported high satisfaction with NTNP.
  • NTNP demonstrated substantial reach, adoption, effectiveness, implementation success, and maintenance over the first two years of the program. NTNP was highly acceptable to the clinical providers making the referrals and the Veterans who received referred video care.

• Seigal and colleagues investigated whether Veterans’ neurologic diagnosis was associated with their acceptance of teleneurology care, and determined what other factors influence acceptability. Veterans’ acceptability was assessed via telephone interview two weeks after their new outpatient teleneurology visits with NTNP.
• Findings show that among 277 Veterans with a completed teleneurology visit, overall acceptance scores were high, with a mean score of 18 out of a maximum score of 21. There was no significant difference in scores among diagnosis groups. The only factor independently associated with acceptance of teleneurology was medical complexity, where those with higher medical complexity were more accepting of teleneurology care.
• Findings suggest that even for older Veterans with complex medical conditions, teleneurology may be useful to increase access to specialty care.

Impact

NTNP implementation was a finalist in the VA Shark Tank competition, based on its demonstrated impact on Veteran access to care and its high satisfaction ratings from Veterans and referring providers. As the mismatch between the proportion of the population with neurologic conditions and the number of neurologists grows, teleneurology outpatient care, as demonstrated by NTNP, is one means of improving patient access to neurologic specialists.

The program continues to grow, completing 2,542 new patient neurology consultations for 2,466 unique Veterans (63% rurally residing) at 18 VAMCs in FY2024, and completing 8,340 total (new and follow-up) patient encounters.

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