Abstract DP090: Veterans Affairs National Telestroke Program Post Stroke First Steps Clinic: Closing Gaps Through Telehealth in Veterans

Background: Veterans represent a unique population at higher risk for stroke and healthcare disparities. With 1 in 4 survivors experiencing recurrence, early post-discharge follow up is critical to optimize risk factors and secondary prevention. Many lack timely access to outpatient neurology and nearly half miss visits, often due to disability or travel barriers. Telehealth offers a potential solution, with outcomes comparable to in-person care. The VA National Telestroke Program (NTSP) implemented a virtual post hospitalization continuity clinic, the Post Stroke First Steps Clinic (PSFS), to support Veteran stroke survivors as they transition back into their community. Objective: To identify gaps in post-hospitalization stroke care in Veterans addressed through the PSFS clinic model. Methods: Veterans with ischemic stroke or TIA at eligible NTSP sites were offered PSFS follow up. Prior to the encounter, Veterans received a secure, pre-configured tablet and training to ensure proficiency. Veterans completed virtual visits with an NTSP nurse and vascular neurologist (median 45 minutes). Demographics, vascular risk factors, Veteran education, and clinical recommendations were abstracted as part of a preplanned evaluation. Results: From 1/8/2025 to 7/1/2025, 94 Veterans (median age 74 years, 92% male) from 12 VA facilities were seen in the PSFS clinic (Figure). Vascular risk factors were common (85% hypertension, 47% diabetes mellitus, 23% active tobacco use). Ninety-one percent were seen within 30 days from hospital discharge (median 21.5 days [IQR 19.5–26.4]). The NTSP nurse and physician team provided individualized education and developed treatment plans, while also teaching them to recognize the warning signs of stroke. Recommendations to modify critical secondary-prevention and risk-factor reduction regimens were made for 36%, and diagnostic evaluation gaps were also addressed in the clinic (Table). Conclusion: The VA PSFS Clinic provided timely, structured follow-up aligned with AHA/ASA guidelines, outperforming national averages (21.5 vs 35 days). Through tailored education, medication recommendations, and suggestions of additional diagnostic testing, the clinic contributed to closing gaps in post-stroke care in a high-risk population. This telehealth model shows promise for reducing care gaps and may serve as a framework for broader implementation in additional populations.