Bridging the gap for veterans in Appalachia: Pioneering remote infusion services

Veterans Integrated Service Network (VISN) 9 encompasses Kentucky and Tennessee; Appalachian regions with a rurality rate exceeding 50% and some of the nation's highest cancer incidence. Veterans face significant geographical barriers to receiving specialty infusion care, requiring them to choose between long-distance travel to main VA campuses or fragmented care through community partners.

Describe the implementation of two Close to Me (CTM) remote infusion sites while evaluating outcomes, including patient safety and pharmaceutical scope of care. To quantify the economic impact while describing practice innovations and implications for the program's scalability.

Lexington VA Health Care System and Tennessee Valley Healthcare System launched remote infusion sites in two rural locations. Compounded sterile preparations were prepared at their main campuses and transported to remote sites, where interprofessional care teams provided treatments.

The CTM program adapted home infusion principles to a structured hub-and spoke model, making use of existing USP <797> and <800> compliant compounding suites. Innovations included maximizing alternative formulations, adjusting medication protocols, and expansion into additional subspecialties to improve Veteran access.

Data were extracted from a custom analytics dashboard and Veteran Signal satisfaction surveys collected from June 2025 to June 2026.

One hundred eighty-three Veterans have been served through the CTM program to include 166 unique patients seen face to face by CTM providers with 61 Veterans receiving infusions, saving over 100,000 travel miles from all appointment types. Zero infusion reactions were recorded, medication waste was minimal, and Veteran satisfaction and trust in the program was high. Medication cost avoidance totaled approximately $660,000.

The VISN 9 CTM program demonstrates that high-quality, safe, and cost-effective specialty infusion care can be delivered remotely to Veterans in Appalachia, offering a scalable model for expanding access into other rural regions.