The cost-effectiveness of teleneurology consultations for patients admitted to hospitals without neurologists on site. 1: A retrospective comparisonof the case-mix and management at two rural hospitals

We are currently evaluating the use of telemedicine for improving the care of patients admitted with neurological symptoms to hospitals that do not ha ve specialist neurologists on site. To do this we have been comparing the o utcome of patients admitted to two small hospitals. In one hospital all pat ients with neurological symptoms are seen by a neurologist at a distance us ing an interactive video-link transmitting at 384 kbit/s; in the other pati ents with neurological problems are managed as per usual practices. For the results of this study to be valid, it is essential that the case-mix and p rocess of management for neurological patients are similar at the two hospi tals. We therefore compared the case-mix, process of management, and outcom e for all patients admitted over a four-month period to either hospital who had been coded using ICD-10 as having a final diagnosis of a neurological condition. No appreciable differences were noted between the two hospitals for measures of case-mix or outcome. Likewise, most measures of process wer e similar, although there was a significant difference for the overall leng th of hospital episode between the two hospitals. When patients with prolon ged hospital episodes were excluded, or only patients with a diagnosis of h eadache, epilepsy or transient ischaemic attack were considered (who as a g roup made up the bulk of neurological admissions), the difference in the le ngth of hospital episode was not significant. It should therefore be possib le for us to estimate the effect of telemedicine on the management of patie nts with neurological problems.