To assess Veteran and referring provider satisfaction after TeleNeurology (TN) consult and compare Veteran experience between those with in-home versus in-clinic video visits.

 TN outpatient visits are increasing and can improve access to specialty neurological care for rural or travel-limited patients. The VA National TeleNeurology Program (NTNP) is active in 13 facilities, using both in-home (VVC) and in-clinic (CVT) video visits. 

We conducted telephone interviews with Veterans 2 weeks post- initial consult, asking about satisfaction and likelihood of recommending TN, video/audio experience, and reasons for choosing TN. Provider surveys were sent one week after consult completion, asking about satisfaction and consult clarity. Satisfaction was measured using 7-point (Veteran) and 10-point (provider) scale (higher = better). Audio/video quality, teleneurologist communication, and consult clarity were assessed using 5-point Likert responses. We compared Veteran responses between those with VVC and CVT visits, adjusted for sites, using the Wilcoxon rank sum test. 

Among 243 Veterans interviewed (52% VVC and 48% CVT), satisfaction (mean 6.2) and recommendation (mean 6.3) scores were high. Visit type was not associated with satisfaction (mean 6.28 for VVC vs 6.23 for CVT, p = 0.87) or recommendation of TN (mean 6.28 for VVC vs. 6.30 for CVT, p = 0.68).  Ratings of video quality and neurologist communication did not differ between VVC and CVT, but those with CVT visits reported slightly higher scores for audio quality than VVC (mean 4.72 for CVT vs 4.45 for VVC, p=0.01). Providers (N=107) reported high satisfaction with TN (mean score 8.90) and consult clarity (mean score 9.00). 

Veterans and referring providers report high satisfaction with outpatient TeleNeurology consultations. Satisfaction for patients is similar between in-home and in-clinic visits, although audio quality may be better in-clinic. Future work will examine satisfaction among different clinical diagnosis groups and patient factors related to satisfaction with TN.