title: Teleneurology: successful delivery of chronic neurologic care to 354 patients living remotely in a rural state.
abstract: BACKGROUND
  Delivery of specialty healthcare to rural citizens in the United States remains largely unmet. The Veterans Health Administration is in a unique position to deliver specialty care to rural Veterans because it is mandated to deliver medical care to all eligible Veterans regardless of residence. To accomplish this, the VHA developed large national telehealth networks that provided over 1 million episodes of care in 2012. We investigated whether clinical video telehealth technologies can provide quality efficient neurologic follow-up care to Veterans living in the rural southwest United States.
  
  
  METHODS
  Veterans with chronic neurologic conditions living remotely in New Mexico, southern Colorado, eastern Arizona, and western Texas were offered follow-up teleneurology care at 11 rural community-based outpatient clinics following initial evaluation at the Albuquerque, NM, neurology outpatient clinic.
  
  
  RESULTS
  Over a 2-year period, 87% of 354 consecutive patients returned a performance improvement satisfaction questionnaire. Ninety percent of the patients were fully satisfied with their visit, and 92% felt teleneurology saved them time and money. We calculated an average time savings of 5 h and 325 miles driven, plus at least $48,000 total cost savings. Ninety-five percent reported they wanted to continue their neurologic care by teleneurology.
  
  
  CONCLUSIONS
  Our study confirms earlier pilot studies of successful follow-up care through telemedicine. Our patients were highly satisfied with the convenience and quality of their teleneurology visit, and the neurology providers were convinced that neurologic care to both teleneurology and clinic follow-up patients was equivalent. Teleneurology to rural Veterans can provide quality neurologic care and overwhelming patient satisfaction and save considerable time and money.
authors.affiliation: 1 Neurology Service, New Mexico Veterans Affairs Healthcare System , Albuquerque, New Mexico.
authors.forename: Larry E
authors.initials: LE
authors.lastname: Davis
authors.forename: Julia
authors.initials: J
authors.lastname: Coleman
authors.forename: JoAnn
authors.initials: J
authors.lastname: Harnar
authors.forename: Molly K
authors.initials: MK
authors.lastname: King
mesh_terms: D000328:Adult; D000368:Aged; D001130:Arizona; D015331:Cohort Studies; D003120:Colorado; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000175:diagnosis / Q000628:therapy*; D009462:Neurology / Q000379:methods*; D009516:New Mexico; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D016730:Program Development; D015397:Program Evaluation; D019114:Remote Consultation / Q000458:organization & administration; D019035:Rural Health Services / Q000458:organization & administration*; D012424:Rural Population / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D017216:Telemedicine / Q000458:organization & administration*; D013781:Texas; D014481:United States; D014493:United States Department of Veterans Affairs / Q000458:organization & administration; D014728:Veterans / Q000706:statistics & numerical data*; D055815:Young Adult