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What facility configurations make a difference in implementing a TeleNeurology program? A mixed methods approach.

Nicholas A Rattray1,2,3,4, Alaina K Preddie1,2, Teresa M Damush1,2,3,4

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Translational Behavioral Medicine
|November 13, 2025
PubMed
Summary
This summary is machine-generated.

The Veterans Affairs National TeleNeurology Program (NTNP) improves neurology access. Higher NTNP usage in VA Medical Centers is linked to fewer local neurologists, more clinic days, or lower stroke patient volume.

Keywords:
implementation scienceneurologyrural health servicestelemedicine

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Area of Science:

  • Neurology
  • Health Services Research
  • Telemedicine

Background:

  • The Veterans Affairs National TeleNeurology Program (NTNP) was established to enhance outpatient neurology access via telehealth.
  • Previous studies indicate NTNP reduces wait times, community care consultations, and travel burdens, while improving satisfaction.

Purpose of the Study:

  • To identify facility-level conditions differentiating VA Medical Centers (VAMCs) with high versus low usage of NTNP consults for stroke patients.
  • To understand factors influencing the successful implementation of telehealth neurology services.

Main Methods:

  • A mixed-methods evaluation was conducted on a VA telehealth quality improvement program.
  • Configurational comparative methods analyzed administrative records, facility characteristics, leadership engagement, and interviews.
  • The study compared NTNP consults to community care neurology (CCN) consults for stroke diagnoses, focusing on the ratio of NTNP consults.

Main Results:

  • Facilities with high NTNP usage (≥22.4%) were characterized by an absence of local VA neurologists, more NTNP clinic days (≥0.65/week), or lower annual stroke patient volume.
  • These configurations were sufficient for high NTNP adoption.
  • Findings suggest targeted adjustments in staffing and clinic availability can increase NTNP use, particularly where local neurology access is limited.

Conclusions:

  • A strategic framework for enhancing NTNP implementation involves aligning facility resources with program goals, considering stroke volume and local neurology availability.
  • Successful high-usage implementation of NTNP appears to have more straightforward pathways compared to reasons for lower usage.