Abstract Body: Background: e-consults for outpatient stroke/TIA care can improve timeliness of neurologic care, however it is unknown whether active implementation of an e-consult impacts the overall volume of outpatient stroke care provided in one healthcare system vs another.
Methods: We studied the implementation of an e-consult for outpatient stroke/TIA care in a stepped-wedge trial in 10 VA facilities in the VA National TeleNeurology Program (NTNP). Sites were randomized to one of three sequential 6-month active implementation waves (after 2 months of usual care where the e-consult was available) that included a stroke prevention lecture for primary care (PC) providers, as well as participation in monthly PC meetings to review cases and utilization of the consult. After the 6-month active implementation (sustainability period), no data were presented to PC teams. The primary outcome was whether a consult was placed in the VA versus community care neurology (CCN) for outpatient stroke/TIA care. A generalized linear mixed model (GLMM) with binomial distribution and log link fit to the primary outcome was used to estimate the effect of active implementation with baseline serving as the reference. Other effects in the model included a priori selected variables: demographics, site data (stroke volume, median consult wait time, rurality, availability of local neurology, indicator for sustainability), time block (as categorical 2-month blocks) and random site effect. A similar model was fit including 4 control sites, with an added site-level indicator for intervention vs control site.
Results: Of the 1545 consults placed for stroke/TIA, 21% (322/1545) were NTNP (within VA). The GLMM model demonstrated that the odds of a stroke/TIA consult being placed within the VA increased during active implementation: OR 1.92 (1.17-3.16, p = 0.01, Table). Adding data from 4 NTNP control sites who had access to the e-consult but did not receive the active implementation showed no trend in consult location over time but added additional variability to the model, resulting in a decrease in the effect (N = 1680, OR 1.48, 95% CI 0.96-2.28, p = 0.07).
Conclusion: Active implementation of a stroke/TIA e-consult may increase the likelihood of further outpatient care being provided in that healthcare system. This may be relevant to healthcare systems seeking to improve continuity of care for post-acute stroke follow-up through innovative care models and use of asynchronous telehealth modalities.