As provision of neurology services expands through telehealth, involvement of Advanced Practice Providers, including PAs, in teleneurology is likely to grow. 

We collected patient-level demographic, geographic, clinic and visit data at baseline and six months post-implementation for sites receiving PA-led care coordination for teleneurology consultation and control sites.  For the intervention, a PA reviewed available documentation and obtained further needed information or studies before teleneurology visit.   We aggregated logged PA and calculated physician time, converting to costs using provider hourly salary.    For control and intervention sites, we describe mean and standard deviations for continuous metrics and percentages for categorical variables.  We used multivariable generalized linear mixed models to determine adjusted odds of no-show, return to clinic and difference in costs associated with the intervention.

After implementation, for sites receiving the intervention (n=3 sites), persons(n=333) were slightly younger (60.4 years vs. 62.3 years), more often male (90.7% vs 87.1%), and less urban (32.7% vs. 50.0%) than at the eight control sites (n=1311 persons).  The no-show rate was greater in controls (13.7% vs. 8.4%), but adjusted odds of no-show during post-implementation period was not significantly different (OR 0.59, 95% CI 0.8, 1.6, p=0.60).     Mean adjusted cost was $65.25 (95% CI $48.31, $82.12, p<0.001) greater per consultation attributable to the intervention.  There were no significant differences in 90-day follow up rates in intervention and control sites after intervention implementation.

A PA-led care coordination effort for TeleNeurology provided at increased overall cost was accompanied by non-significant reduction in no-show rates and no difference in follow-up rates.   Further research regarding physician and patient satisfaction and association with quality of care would aid in determining the value of this intervention.