Veterans with SCI/D that live a long distance from the SCI Center and within a closer proximity to a VA Medical Center without an SCI Center, must be cared for by both the SCI Center, and the SCI/D Support Clinic or SCI/D PCT at the closer VA facility. This is commonly referred to as the Hub and Spoke system of care.
Primary care management for Veterans with SCI/D is encouraged from the closest VA Medical Center; this could be a medical center with an SCI Center, SCI Support Clinic or SCI Primary Care team.
Use of a community-based outpatient clinic (CBOC) is discouraged for Veterans with SCI/D. However, for patients who choose to receive their care at a CBOC, the SCI team at the parent VA facility of the CBOC, must assist with the tracking, consultation, and appropriate referrals of the patient for specialty care services.