title: Patients following their echoes: the effect of telemedicine on institutional referral patterns.
abstract: Increasing market share by attracting patient referrals has long been cited as a justification for implementing telemedicine.
  
  
  METHODS
  At the onset of this study, there were two level III NICUs in North Carolina that did not have on-site cardiology support. During the study period, both institutions set up telemedicine links to the University of North Carolina Health Care System for the provision of rapid cardiology support.
  
  
  OBJECTIVE
  This paper tests the hypothesis that telemedicine was associated with an increase in the percentage of newborn referrals transferred to UNC instead of the other academic medical centers.
  
  
  RESULTS
  Analysis of a total of 201 transfers over a three and a half year period shows that the percentage of acute transfers to UNC increased from 58 % during the pre-intervention phase to 86 % in the post-intervention phase (p = 0.001). An increase in transfers to UNC was observed from both of the level III centers.
  
  
  CONCLUSIONS
  Telemedicine was an effective tool to attract patient referrals in a competitive tertiary care environment.
authors.affiliation: Department of Health Poicy and Administration, University of North Carolina at Chapel Hill, USA. jedi@unc.edu
authors.forename: M C
authors.initials: MC
authors.lastname: Rendina
mesh_terms: D000046:Academic Medical Centers / Q000191:economics / Q000706:statistics & numerical data; D002309:Cardiology; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D016015:Logistic Models; D008297:Male; D009657:North Carolina; D012017:Referral and Consultation / Q000191:economics / Q000706:statistics & numerical data*; D019114:Remote Consultation; D017216:Telemedicine