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National Tele-Neurology Program
Share PrintIntegrate tele-Neurology team into a VISN or VA Medical Center to serve Veterans residing in rural parts of the country or residing in areas underserved in Neurological services, either through the VA or non-VA community partners.
Origin:
January 2020, Corporal Michael J. Crescenz Department of Veterans Affairs Medical Center (Philadelphia, Pennsylvania)
Adoptions:
19 successful, 1 unsuccessful
Awards and Recognition:
QUERI Partnered Evaluation Initiative, Diffusion of Excellence Promising Practice, VHA Shark Tank Winner
Partners:
Neurology, Office of Connected Care, Office of Rural Health
Recent Updates
Overview
Problem
There is a national shortage of general neurology physician staff within the VA. The VHA Shortage Occupations Report cites Physician Staff [Medical Officer] as the #1 ranked clinical occupation, and many VA Healthcare systems list neurology among their shortage occupation selections. The expenditures for neurological care in the community are staggering, to
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There is a national shortage of general neurology physician staff within the VA. The VHA Shortage Occupations Report cites Physician Staff [Medical Officer] as the #1 ranked clinical occupation, and many VA Healthcare systems list neurology among their shortage occupation selections. The expenditures for neurological care in the community are staggering, totaling over $27 million. There is a high demand for neurologists to manage the many chronic conditions that affects our country’s Veterans.
There are 2.8 million rurally-residing veterans enrolled in VA care [https://www.ruralhealth.va.gov]. Many of these areas have little to no neurology coverage and access to this important care is difficult. While Care in Community costs reflect some aspect of this resource need, it is likely there are many missed opportunities and Veterans whom simply do not receive this care at all.
VSSC data has shown a double digit increase in percentage of Neurology (general, as well as specialty care) clinical video telehealth (CVT) has been a successful modality to increase access to neurologists by delivering care in a patient-centered modality. https://vssc.med.va.gov/VSSCMainApp/].
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.
- Willis AW, Schootman M, Evanoff BA, Perlmutter JS, Racette BA. Neurologist care in Parkinson disease: a utilization, outcomes, and survival study. Neurology 2011;77:851–857.
- Willis AW, Schootman M, Tran R, et al. Neurologist-associated reduction in PD-related hospitalizations and health care expenditures. Neurology 2012;79:1774–1780. See more
There are 2.8 million rurally-residing veterans enrolled in VA care [https://www.ruralhealth.va.gov]. Many of these areas have little to no neurology coverage and access to this important care is difficult. While Care in Community costs reflect some aspect of this resource need, it is likely there are many missed opportunities and Veterans whom simply do not receive this care at all.
VSSC data has shown a double digit increase in percentage of Neurology (general, as well as specialty care) clinical video telehealth (CVT) has been a successful modality to increase access to neurologists by delivering care in a patient-centered modality. https://vssc.med.va.gov/VSSCMainApp/].
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.
- Willis AW, Schootman M, Evanoff BA, Perlmutter JS, Racette BA. Neurologist care in Parkinson disease: a utilization, outcomes, and survival study. Neurology 2011;77:851–857.
- Willis AW, Schootman M, Tran R, et al. Neurologist-associated reduction in PD-related hospitalizations and health care expenditures. Neurology 2012;79:1774–1780. See more
Solution
Deploy Neurology teamlets to provide outpatient general Neurology services with the goals to:
- provide continuity of neurological care for rurally residing Veterans.
- establish a process that does not require full credentialing and privileging of the Neurologist at the patient VAMC (minimizing administrative burden at the partnered site)
- NTNP do ... Deploy Neurology teamlets to provide outpatient general Neurology services with the goals to:
- provide continuity of neurological care for rurally residing Veterans.
- establish a process that does not require full credentialing and privileging of the Neurologist at the patient VAMC (minimizing administrative burden at the partnered site)
- NTNP documents and charts at the patient VAMC CPRS environment
- order labs/diagnostics/consults directly within the patient home VAMC CPRS environment
- order medications (to include controlled substances) directly from the VA Pharmacy where the patient resides
- Primary Care Providers (PCP) do not have to utilize JLV to access Neurology notes
- PCPs do not have to enter orders/consults on behalf of the Neurology team
Surround the general Neurology teamlets with internal and dedicated clinical care and case management experts.
- Nurse led Headache education clinics
- e-consultant service to access 11 subspecialty Neurology experts, to include Neurosurgical services
- Neuropsychology services and assessment
- Clinical Pharmacy Specialist
- Licensed Clinical Social Workers
- Speech-language Pathologists See more
- provide continuity of neurological care for rurally residing Veterans.
- establish a process that does not require full credentialing and privileging of the Neurologist at the patient VAMC (minimizing administrative burden at the partnered site)
- NTNP do ... Deploy Neurology teamlets to provide outpatient general Neurology services with the goals to:
- provide continuity of neurological care for rurally residing Veterans.
- establish a process that does not require full credentialing and privileging of the Neurologist at the patient VAMC (minimizing administrative burden at the partnered site)
- NTNP documents and charts at the patient VAMC CPRS environment
- order labs/diagnostics/consults directly within the patient home VAMC CPRS environment
- order medications (to include controlled substances) directly from the VA Pharmacy where the patient resides
- Primary Care Providers (PCP) do not have to utilize JLV to access Neurology notes
- PCPs do not have to enter orders/consults on behalf of the Neurology team
Surround the general Neurology teamlets with internal and dedicated clinical care and case management experts.
- Nurse led Headache education clinics
- e-consultant service to access 11 subspecialty Neurology experts, to include Neurosurgical services
- Neuropsychology services and assessment
- Clinical Pharmacy Specialist
- Licensed Clinical Social Workers
- Speech-language Pathologists See more
Videos
VA's National Tele-Neurology Program
Results
- Of the original 18 VAMCs that NTNP has partnered with:
- eleven have no VA Neurology services at the VA Medical Center (VAMC)
- one have no community Neurologist within 3 hours of driving from the VAMC, which also has no VA Neurologist.
- remaining five VAMCs have limited VA Neurology presence and is unable to keep up with demand.
- on ... - Of the original 18 VAMCs that NTNP has partnered with:
- eleven have no VA Neurology services at the VA Medical Center (VAMC)
- one have no community Neurologist within 3 hours of driving from the VAMC, which also has no VA Neurologist.
- remaining five VAMCs have limited VA Neurology presence and is unable to keep up with demand.
- one VAMC negated the need to use Community Care for outpatient general neurology care.
- Veterans report high satisfaction (280 interviews completed, mean satisfaction and mean recommendation scores both 6.3 on a 7 point Likert scale); providing opportunity for patients to see a Neurologist via CVT and/or VVC.
- Referring providers (130 completed surveys) also report high satisfaction with mean satisfaction score of 9.0 (10 point Likert scale).
- Nursing education clinics ensures provider clinics are maximized and care plans are followed by the patients.
- In FY21, NTNP was significantly faster than Community Care Network (CCN) to both schedule consults (mean 8.5 vs 26.9 days, p < 0.001) and complete consults (mean 40 vs 89.5 days, p < 0.001). Veterans report high satisfaction (280 interviews completed, mean satisfaction and mean recommendation scores both 6.3 on scale of 1-7). See more
- eleven have no VA Neurology services at the VA Medical Center (VAMC)
- one have no community Neurologist within 3 hours of driving from the VAMC, which also has no VA Neurologist.
- remaining five VAMCs have limited VA Neurology presence and is unable to keep up with demand.
- on ... - Of the original 18 VAMCs that NTNP has partnered with:
- eleven have no VA Neurology services at the VA Medical Center (VAMC)
- one have no community Neurologist within 3 hours of driving from the VAMC, which also has no VA Neurologist.
- remaining five VAMCs have limited VA Neurology presence and is unable to keep up with demand.
- one VAMC negated the need to use Community Care for outpatient general neurology care.
- Veterans report high satisfaction (280 interviews completed, mean satisfaction and mean recommendation scores both 6.3 on a 7 point Likert scale); providing opportunity for patients to see a Neurologist via CVT and/or VVC.
- Referring providers (130 completed surveys) also report high satisfaction with mean satisfaction score of 9.0 (10 point Likert scale).
- Nursing education clinics ensures provider clinics are maximized and care plans are followed by the patients.
- In FY21, NTNP was significantly faster than Community Care Network (CCN) to both schedule consults (mean 8.5 vs 26.9 days, p < 0.001) and complete consults (mean 40 vs 89.5 days, p < 0.001). Veterans report high satisfaction (280 interviews completed, mean satisfaction and mean recommendation scores both 6.3 on scale of 1-7). See more
Metrics
- >1,200 unique patients served in FY'21. >3,700 unique patients served in FY'22. >5,700 unique patients served in FY'23.
Diffusion tracker
Does not include Clinical Resource Hubs (CRH)
Implementation
Timeline
-
5-8 Weeks
Once a Neurologist, Nurse and tele-health technician is assigned to a VAMC, pre-activation activities takes 5-8 weeks prior to the first patient being seen within NTNP.
Departments
- Mental health care
- Pharmacy
- Administration
- Telehealth
- My HealtheVet coordinator
- Primary care
- Neurology
Core Resources
| Resource type | Resource description |
|---|---|
PEOPLE |
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PROCESSES |
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TOOLS |
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Support Resources
| Resource type | Resource description |
|---|---|
PEOPLE |
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Risks and mitigations
| Risk | Mitigation |
|---|---|
| Dedicated Schedulers at Patient VAMC site | Train core team of schedulers from within RCT or OCC to interact with patients, offer them NTNP appointment and schedule within TMP. |
About
Original team
Jayne Wilkinson
Medical Director
Heidi Watson
Nurse Manager
Mattea Schultz
Administrative Officer
Comment
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