Expansion of Access to Rheumatology Care for Rural Veterans: Program Development and Initial Feasibility of the National Tele‐Rheumatology Program Using the RE‐AIM Framework

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PURPOSE: To describe and assess the initial feasibility of the National Tele-Rheumatology Program (NTRP), a centrally managed hub-and-spoke telehealth model designed to expand access to rheumatology care for Veterans served by facilities with high proportions of rural Veteran populations. METHODS: Using the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework, we analyzed Veterans Affairs (VA) program records, administrative and electronic health record data, Veteran questionnaires, and staff interviews from July 2024 through June 2025. Feasibility indicators included enrollment of spoke sites, delivery of care to Veterans in rural or highly rural areas, growth in encounter volume, changes in non-VA care utilization, Veteran satisfaction, and identification of implementation barriers and adaptations. FINDINGS: Eleven spoke sites enrolled during NTRP's first year. NTRP reached 1227 Veterans (82% male, 81% White; mean age 62.8 years), including 47% from rural or highly rural areas, and delivered 2577 encounters, 45.3% to rural or highly rural Veterans. Among 149 Veterans with a non-VA rheumatology care claim in the prior year, 89.3% had no further claims after their first NTRP visit. Veteran satisfaction was moderate to high and did not differ by rurality. Staff interviews identified technology access, reluctance to virtual care, and workflow variation as recurring challenges and described adaptations, including technology support and alternative clinic-based video access. CONCLUSIONS: Early feasibility indicators are promising. The NTRP reached its intended population, was acceptable to Veterans across rural and urban settings, and produced a preliminary signal of reduced non-VA care utilization. Continued evaluation should assess sustainment, costs, and clinical outcomes, with particular attention to rural-specific outcomes as the program grows.

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