To examine factors associated with Veteran referral to community providers for neurology care.

Timely access to healthcare for veterans remains a priority across administrations.  Veteran’s Health Administration (VHA) facilities provide neurology care through staff providers or paid referrals for community care.

Retrospective cross-sectional study of Veteran’s new neurology visits to VHA or community care in fiscal year 2024 (FY24). Multivariable logistic regression models assessed associations of community care referrals with Veteran (e.g., drive time, diagnosis) and VHA facility variables, including binary mean neurology clinic wait time (≥≤ 28 days), facility neurology physician and mid-level provider workforce, and 5-level medical complexity grouping (MCG), ranking facility resources and patient volume/complexity.

In FY24, 22,851/140,710 new Veteran neurology visits (16.2%) were referrals to community care. Odds of community care referral were greater for veterans living outside of a 60-minute drive time to a VHA facility (adjusted odds ratio [aOR] 2.18; 95% confidence interval [CI] 3.05, 3.32) and diminished when the VHA facility average neurology clinic wait times were shorter than 28 days (aOR 95% CI 0.21; 0.73, 0.85). MCG-1A (highest resourced, greatest patient volume/highest complexity) facilities had an increased association with community care referral compared to MCG-3 (lowest resourced, lowest patient volume/lowest complexity) facilities (aOR 1.16; 95% CI 1.08, 1.24).  MCG-1B and MCG-1C facilities had reduced association with community care referrals (aOR 0.69; 95%CI 0.63, 0.74 and aOR 0.78; 95%CI 0.73, 0.84, respectively) compared to MCG-3. Conditions negatively associated with community care referral include epilepsy (aOR 0.38; 0.36, 0.40), movement disorder (aOR 0.95; 0.91, 0.98) and neuromuscular disorder (aOR 0.45; 0.43, 0.47). For each additional full-time VHA neurologist, community care referral odds decreased by 18.2% (95% CI 19.0%-17.2%).   

Drive times and VHA clinic wait times had the largest impacts on community care neurology referrals, while VHA facility resource groupings had varied effects.