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The VA National TeleNeurology Program implementation: a mixed-methods evaluation guided by RE-AIM framework.

Teresa M Damush1,2,3, Jayne R Wilkinson4,5, Holly Martin3

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The Veterans Health Administration

Keywords:
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Area of Science:

  • Implementation science
  • Health services research
  • Telehealth

Background:

  • The Veterans Health Administration (VHA) National TeleNeurology Program (NTNP) was established to address outpatient neurological care access gaps for Veterans, particularly those in rural areas.
  • The Veterans Affairs (VA) Office of Rural Health (ORH) funded the NTNP as an Enterprise-Wide Initiative (EWI) to improve healthcare delivery.
  • A pragmatic evaluation using the RE-AIM framework was employed to assess NTNP services.

Purpose of the Study:

  • To pragmatically evaluate the implementation of the VHA National TeleNeurology Program (NTNP) using the RE-AIM framework.
  • To assess the reach, effectiveness, adoption, implementation success, and maintenance of NTNP services.
  • To identify factors contributing to high Veteran satisfaction and perceived effectiveness of the program.

Main Methods:

  • A prospective implementation evaluation using a mixed-methods approach guided by the RE-AIM framework.
  • Metrics included NTNP new patient consult volume, clinical encounters, Veteran satisfaction, referring provider perceived effectiveness, site staff interviews, and qualitative analysis of stakeholder assessments.
  • Maintenance was monitored through quarterly TeleNeurology consultation volume.

Main Results:

  • NTNP was successfully implemented across 13 VA Medical Centers over two years, with significant increases in patient consults and clinical encounters.
  • The program demonstrated substantial reach, with over half of new patients residing in rural areas.
  • Veterans reported high satisfaction, citing excellent communication, reduced travel, and access to otherwise unavailable care; referring providers perceived high effectiveness.

Conclusions:

  • The VA NTNP successfully demonstrated reach, adoption, effectiveness, implementation success, and maintenance.
  • The program was highly acceptable to both referring providers and Veterans receiving care.
  • The RE-AIM framework proved appropriate and comprehensive for guiding this implementation evaluation.