A logit model for the effect of telecardiology on acute newborn transfers

The deregionalization of neonatal intensive care in the United States has s hifted the site of care for many newborn infants away from academic medical centers where subspecialty support is available. Objective: To investigate the effect of immediate echocardiogram interpreta tion via telemedicine on rates of neonatal transfer to academic medical cen ters. Methods: A legit model was developed to predict the probability of transfer from two regional level 3 neonatal intensive care units to academic medica l centers. One of these units implemented a telecardiology program and the other acted as a comparison institution with on-site cardiology expertise, The telecardiology intervention began 18 months into the 36-month study per iod. Subjects: infants (n = 2,142) admitted to neonatal intensive care at e ither of the two institutions during calendar years 1994 through 1996. Results: A statistically significant reduction in the rate of transfer to a cademic medical centers was observed. Telecardiology was associated with a 58% reduction of such transfers (p = .001, 95% CI = 30%, 75%). No such redu ction was noted at the comparison institution. It is estimated that approxi mately 30 transfers were eliminated during tile study period, resulting in the elimination of approximately $150,000 in hospital charges, In addition, the infants that were transferred after the adoption of telemedicine were more often transferred to their telemedicine partner institution (p < .02).