Abstract Body: Background: The Mission Act provided VA funding for non-VA care for Veterans under certain conditions where access to care is limited. Comparing the quality of care between outpatient VA Teleneurology (TN) and Community Care Neurology (CCN) stroke consults is important to understand the impact and value of innovative telehealth solutions to increase access to care.
Methods: Veterans with a completed new consult for stroke/TIA in the TN and in CCN at 13 VA facilities from 2021 to 2022 were included. We collected administrative and chart review data for all neurology consults. 4 process measures were defined a priori: antithrombotic (AT) medication, high or medium potency statin, anticoagulation for atrial fibrillation (AF), and dual antiplatelet therapy (DAPT) 90 days or less after the consult completion. The primary quality measure is the without-fail rate (WFR), which is a dichotomous outcome of whether a patient passes all process measures (yes/no) for which they are eligible. For WFR (without-fail rate), a logistic regression model was fit with the effect of interest consult type (TN vs. CCN) after adjustment for patient characteristics of age, Charlson Comorbidity Index (CCI), gender, race, and rurality. The model accounted for subjects clustered within facilities (site) using a Generalized Estimating Equation (GEE) approach. Inverse-probability of treatment weighting was also used since patients were not randomized to consult type. Similar logistic regression models were used to assess the effect of consult type on the pass rate (yes/no) for each individual process measure.
Results: Of 828 completed consults, 594 (72%) were CCN. Table 1 shows participant characteristics by TN vs. CCN. The WFR was 56.0% in TN vs. 59.4% in CCN. Median days to complete consults was 37 (IQR 8 to 70) among TN and 82 (IQR 46 to 128) in CCN. Patients who passed all 4 measures vs those that did not were similar with respect to most demographic characteristics (Table 2). After adjustment for demographics and CCI, there was no difference in the WFR for TN vs CCN, OR 0.90, 95% CI (0.70, 1.15). None of the pass rates for the individual process measures significantly differed by consult type (TN vs. CCN) (Table 3). Model results were similar when including stabilized inverse probability weights (data not shown).
Conclusions: VA teleneurology care may be a way to improve the timeliness to outpatient stroke care without impacting quality of care for outpatient stroke care.