Since 2020 the VHA Office of Rural Health has funded a nationwide TeleNeurology hub-spoke program that targets rural Veterans with poor access to neurology services. Spoke sites undergo an 8-week implementation process and virtual encounters are completed into Veterans’ homes or VHA clinics. Documentation of patient care is entered into the patient-site medical record.

A summary of program sites and personnel is provided. Total NTNP encounters completed from Fiscal Year (FY)21 through FY24 were tabulated. Demographic characteristics and time to consult completion were compared between TeleNeurology (TN) and Community Care Neurology (CCN). All analyses were conducted in SAS Enterprise v8.3 (SAS Institute, Cary, NC). Veteran satisfaction surveys were assessed using a Likert scale.  

Since inception the NTNP has served 19 VA medical centers in 9 VISNS and 25 states. Currently, the NTNP includes 20 neurologists, 9 nurses, 8 telehealth clinical technicians, 2 neuropsychologists, program manager, administrative officer, chief technology officer, associate medical director and medical director. Besides general neurology, referrals for subspecialty e-consultations, headache education, neuropsychology, social work, clinical pharmacy and speech/language pathology have been added.

Between FY21 and FY24 the number of NTNP encounters increased more than 6-fold (1306 to 8340, respectively) and the majority were rural. The top three provisional diagnoses for NTNP referrals in FY24 were headache (24.4%), movement disorders (18%), and symptoms (15.4%). Veterans seen by TN were slightly younger, more likely to be female, rural and had less co-morbidities compared to CCN referrals. For each FY, the time to completion of TN referrals was significantly shorter than CCN. Patient satisfaction was overwhelmingly positive highlighting access and convenience.

Since 2020 the NTNP continues to expand providing even greater access to comprehensive TeleNeurology care for rural Veterans.