title: Healthcare continuity from hospital to territory in Lombardy: TELEMACO project.
abstract: To verify implementation and use of TELEMACO (TELEMedicina Ai piccoli COmunilombardi; http://www.telemaco.regione.lombardia.it/), which provides specialized continuity of care with innovative healthcare services in remote areas of the Lombardy region of Italy; to design a network in the territory for sharing of continuityof- care programs; and to allow the relevant health authorities to collect cost data to establish a model for sustainable pricing for implementing these services.
  
  
  
  TELEMACO provides home-based telemanagement services for patients with chronic heart failure and chronic obstructive pulmonary disease (COPD), as well as second-opinion teleconsultations in cardiology, dermatology, diabetology, and pulmonology for general practitioners and second-opinion teleconsultations on digital images in cases of traumatic brain injury and stroke. A total of 2 service centers, 10 cardiology and pneumology departments, 30 specialists, 176 general practitioners, 40 nurses, 2 emergency departments, and 2 consultant hospitals were involved.
  
  
  
  A total of 166 patients with chronic heart failure and 474 patients with COPD were enrolled. There were 4830, 51, and 44 second-opinion teleconsultations for cardiologic, dermatologic, and diabetic conditions, respectively. There were 147 second-opinion teleconsultations on digital images, 68 for stroke, and 79 for traumatic brain injury. Implementation of TELEMACO introduced innovations in working methods and provided evidence to the health authorities for allocating funds for such services.
  
  
  
  TELEMACO provided evidence that there is a growing need for home management of patients using telemedicine, a common and efficacious approach that can ensure care continuity, especially in chronic diseases.
authors.affiliation: Fondazione Salvatore Maugeri, IRCCS, Telemedicine Service, Lumezzane (Brescia), Italy. palmira.bernocchi@fsm.it
authors.forename: Palmira
authors.initials: P
authors.lastname: Bernocchi
authors.forename: Simonetta
authors.initials: S
authors.lastname: Scalvini
authors.forename: Caterina
authors.initials: C
authors.lastname: Tridico
authors.forename: Gabriella
authors.initials: G
authors.lastname: Borghi
authors.forename: Paolo
authors.initials: P
authors.lastname: Zanaboni
authors.forename: Cristina
authors.initials: C
authors.lastname: Masella
authors.forename: Fulvio
authors.initials: F
authors.lastname: Glisenti
authors.forename: Maurizio
authors.initials: M
authors.lastname: Marzegalli
mesh_terms: D000208:Acute Disease; D000368:Aged; D002908:Chronic Disease; D003266:Continuity of Patient Care / Q000458:organization & administration* / Q000706:statistics & numerical data; D005260:Female; D058005:General Practitioners; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006333:Heart Failure; D006801:Humans; D007558:Italy; D008297:Male; D008511:Medicine; D016730:Program Development; D015397:Program Evaluation; D029424:Pulmonary Disease, Chronic Obstructive; D012017:Referral and Consultation; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D017216:Telemedicine / Q000379:methods* / Q000458:organization & administration