The location of care should be dictated by the needs of the patient and be as convenient as possible. To support this, a regional hub-and-spoke network has been outlined. Each VISN supports at least 1 MS regional program (hub site). The MS regional program team consists of a physician with MS expertise, a nurse, a social worker, and access to specialty care services. These teams lead and coordinate integrated MS care at the local medical center and assist in the care of patients with MS at remote facilities within the VISN.
Facilities without a MS regional program are designated as spoke sites that have a designated MS care coordinator to assist with care at that facility. Spoke sites work with the regional hub to deliver MS care to the local population. Consultations from the closest MS regional center may be provided by telephone, telehealth, or a live visit. The level of MS care for regional centers is influenced by the patient’s MS stage and the location. Different MS care models that incorporate more consultative and telehealth approaches may need to be developed for patients with MS in rural areas with limited access to specialists.