Enterprise-Wide Initiative (EWI) - Specialty Care
National TeleNeurology Program (NTNP)
Background
The mission of the National TeleNeurology Program (NTNP) is to improve access to outpatient neurology care for Veterans residing in rural areas. There is a national shortage of neurologists both in the community and in Veterans Health Administration (VHA).1 The NTNP neuro-Patient Aligned Care Team (PACT) model provides a dynamic, flexible and cost-effective way to leverage both telehealth and enhanced provider recruitment incentives (e.g., flexible tours; telework) to build a national virtual neurology clinic to serve rural Veterans suffering from neurological illnesses. Telehealth is increasingly utilized in VA healthcare systems to improve access to specialty care and better allocate limited resources, especially for rurally residing persons who face unique barriers to care.
Access to specialty care has been shown to improve outcomes, including nursing home placement and other clinical complications. Therefore, programs like this, which improve access, not only result in improved outcomes for Veterans, but likely reduced associated costs, both internally for VHA and also in the community. Since its beginning in 2020, NTNP has been successful at developing, launching, and growing its program and impact on the health care can rural Veterans health.
In addition to providing general outpatient neurological care, NTNP began developing additional subspecialty-based programs and initiatives. This program is the first-ever in neurology to develop, deploy, and successfully scale a truly national network to provide sustainable outpatient neurology coverage to rural, underserved regions.
Current program elements and reach include:
- Development of a Neuro-PACT team model that engages neurology providers, nursing, social work, pharmacy, speech-language pathology, and other specialties in caring for Veterans with neurologic conditions.
- Delivery of ongoing TeleNeurology care at 16 VAMCs via Clinical Video Telehealth (CVT) visits at VA Community Based Outpatient Clinics (CBOCs) and via VA Video Connect Telehealth (VVC) visits in Veterans ’ homes, as well as e-Consult services.
NTNP Mission / Vision
Mission Statement:
To break down the walls of traditional neurological care to reduce disparities and give all Veterans access to the highest quality, patient-centered, innovative neurological care.
Vision Statement:
To honor and serve Veterans by providing quality virtual neurological care.
Goals
The NTNP has two primary goals:
- Increase access to timely, patient-centered neurological care for enrolled rural Veterans.
- Develop a national system of neurology telehealth to offer comprehensive neurological services to rural spoke facilities, their CBOCs, and directly into Veterans’ homes.
Methodology
NTNP implementation processes include a checklist for participating facilities, consult and note templates, and weekly program facilitation meetings to assist VA Medical Centers in administrative set-up of NTNP services. NTNP consultation is managed by facility Referral Coordination Teams with facility-based scheduling according to Veteran preferences. TeleNeurology consults are conducted via CVT or VVC. VA teleneurologists document the consultation, place orders, and communicate with referring VA providers via standard CPRS and VA communication tools at the patient site.
The NTNP evaluation uses administrative data from the VA Central Data Warehouse to track the volume of NTNP and Community Care Neurology consultations, time to consult completion (wait times), and demographics of Veterans referred. Veterans with a completed NTNP consult are surveyed by email to monitor Veteran experience including assessment of their overall satisfaction with their TeleNeurology appointment, their likelihood of recommending TeleNeurology to other Veterans, and their assessment of the audio/video quality of their telehealth visit. Provider experience is assessed via email surveys in the first six months of NTNP implementation at each site.
Impact on Rural Veteran Health
NTNP was designed to create a virtual outpatient neurology team to provide comprehensive outpatient general neurology and related services to rurally residing Veterans in areas with insufficient neurology support.
Overall, the volume of NTNP appointments has increased over time, from 3,730 in fiscal year (FY) 2022 to 8,340 in FY 2024..- Of the 8,340 appointments in FY 2024:
- 62% of these Veterans were rurally residing
- 30% of visits were new patient consultations
- In FY 2024, Veterans in NTNP were seen by a neurologist sooner than those in Community Care Neurology-CCN (median 54 days for NTNP vs. 70 days for Community Care Neurology, p < 0.001).
- Facilities that implemented NTNP in FYs 2021-2022 did not have a significant growth in monthly CCN consults following program implementation (mean increase of 4.6 consults per month); similarly, resourced VA facilities without NTNP had a significant rise in community consults during the same time period (mean increase 24.4 consults per month).
- Veterans rate TeleNeurology care as highly acceptable (average score of 18.3 of possible 21-points); acceptability did not differ by neurologic diagnosis and most Veterans would highly recommend NTNP care to other Veterans.
- Staff and leadership at NTNP facilities report improved access to Neurology care (92%), improved continuity of care for Veterans with neurologic conditions (100%), and wide adoption of NTNP (79%).
In an evaluation of Veterans receiving outpatient care for stroke, e-consultation implementation led to an increase in stroke care performed in VA versus community care3 and NTNP visits occurred significantly faster (median 37 days) compared to CCN median 82 days).4 Quality of care did not differ between NTNP and CCN for four outpatient medication-based stroke indicators.- NTNP has also established a variety of partnerships, including subspecialty neurological care with providers of the Neurology Centers of Excellence (Movement Disorders [Parkinson’s Disease, Research, Education and Clinical Center, PADRECC], Headache, Multiple Sclerosis, Epilepsy, ALS, and the National TeleStroke Program). NTNP works with leaders in WRIISC (War-Related Injury and Illness Study Center), Whole Health, Paralyzed Veterans of America, and the Office of Connected Care to bring state-of-the-art care directly into Veterans Homes. As an example, NTNP developed two VA apps to support Veterans with headache and epilepsy.
- NTNP has worked to develop novel care models to increase access, including a pre-visit program, a robust suicide prevention program, nursing headache education and device/technology clinics, as well as Advanced Practice Provider subspecialty clinics.
- To date, there have been three NTNP peer-reviewed publications2,3,6 and 22 presentations at national VHA, neurology, telehealth, implementation, and specialty care meetings and conferences.
“ This is the most convenient way to access care. It is extremely difficult for me to travel…I find it comforting to know that I can speak to a doctor face-to-face with no disruptions. “
~ Veteran receiving NTNP care
Key Takeaways
NTNP has increased access to timely, patient-centered, high-quality comprehensive neurologic care for rurally residing Veterans in VHA.
- Volume of NTNP care has grown by more than 40% in each year of the program.
- Wait time for NTNP visits are significantly lower than wait times for CCN.
- Veterans’ satisfaction with NTNP is high, and almost all would recommend NTNP care to other Veterans.
- Leadership and staff at NTNP participating facilities agree that NTNP has improved access, continuity of care, and overall care for their Veterans.
- Regularly sharing specialty NTNP consult data and wait times during PACT team meetings may increase the volume of VA specialty telehealth consultations.
- NTNP is committed to expand partnerships and develop innovative care models that bring high-quality comprehensive care from the Nation’s experts, directly into Veterans’ living rooms – removing many barriers typically faced by rurally-residing Veterans to access care.
Download the Printable PDF for Healthcare Providers and Researchers.
References
- Majersik JJ, et al. A Shortage of Neurologists We Must Act Now: A Report From the AAN 2019 transforming Leaders Program. Neurology. 2021; PMID: 33931527].
- Wilkinson, J., Myers, L., Daggy, J., Martin, H., Bastin, G., Yang, Z., Damush, T., Narechania, A., Schriber, S., and Williams, L. S. (2023). The VA national Teleneurology Program (NTNP): Implementing Teleneurology to Improve Equitable Access to Outpatient Neurology Care. Journal of General Internal Medicine, 38(Suppl 3), 887–893. https://doi.org/10.1007/s11606-023-08121-7*
- Seigel, C. R., Martin, H., Bastin, G., Myers, L. J., Taylor, S., Pike, F., Wilkinson, J., & Williams, L. S. (2024). Patient acceptance of teleneurology across neurologic conditions. Journal of Neurology, 10.1007/s00415-024-12200-y. Advance online publication. https://doi.org/10.1007/s00415-024-12200-y*
- Williams, L., Myers, L., Daggy, J., Tang, Q., Kirchgassner, J., Bastin, G., Chagwena, F., Taylor, S., Odrzywolski, K., Nobel, L., Wilkinson, J. (2025, February 5-7). Implementation of Stroke/TIA e-consult Increases Outpatient Stroke Follow-up Care. [Poster presentation]. International Stroke Conference (ISC). Los Angeles, CA.
- Noble, L., Myers, L. Daggy, J., Tang, Q., Kirchgassner, J., Bastin, G., Chagwena, F., Taylor, S., Odrzywolski, K., Wilkinson, J., Williams, L. (2025, February 5-7). Outpatient stroke care quality in VA Teleneurology and Community Care Neurology Consults. [Poster presentation]. International Stroke Conference (ISC). Los Angeles, CA.
- Damush, T. M., Wilkinson, J. R., Martin, H., Miech, E. J., Tang, Q., Taylor, S., Daggy, J. K., Bastin, G., Islam, R., Myers, L. J., Penney, L. S., Narechania, A., Schreiber, S. S., & Williams, L. S. (2023). The VA National TeleNeurology Program Implementation: a mixed-methods evaluation guided by RE-AIM framework. Frontiers in Health Services, 3, 1210197. https://doi.org/10.3389/frhs.2023.1210197*
Contact
- Jayne R. Wilkinson MD, MSCE, Medical Director, National TeleNeurology Program (NTNP), VA Philadelphia Healthcare, Philadelphia, PA. Jayne.Wilkinson@va.gov
- Funding Acknowledgement: Department of Veterans Affairs, Veterans Health Administration, Office of Rural Health, NOMAD #PRFY-00542.
- Suggested Citation: Wilkinson, J.R., (2025). National TeleNeurology Program (NTNP). Department of Veterans Affairs, Veterans Health Administration. Washington, DC: Office of Rural.
Rural Health - Navigation
- Office of Rural Health Home page: https://www.ruralhealth.va.gov/index.asp
- Enterprise-Wide Initiative (EWI) Home page: https://www.ruralhealth.va.gov/providers/Enterprise_Wide_Initiatives.asp
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