School-Based Tele-Physiatry Assistance for Rehabilitative and Therapeutic Services (STARS) for Children with Special Health Care Needs Living in Rural and Underserved Communities

为生活在农村和服务欠缺社区的有特殊医疗保健需求的儿童提供基于学校的远程康复和治疗服务 (STARS) 援助

• 批准号: 9982267
• 负责人: James P Marcin
• 金额: $ 38.81万
• 依托单位: UNIVERSITY OF CALIFORNIA AT DAVIS
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-30 至 2022-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9982267
• 关键词: Based; Tele; Physiatry; Assistance; Rehabilitative

Project Abstract Medical Therapy Units (MTUs) are multidisciplinary county clinics that provide comprehensive medical management to children with special health care needs for durable medical equipment, orthotics, and therapy services. Unfortunately for children living in rural and underserved communities, MTU specialty care is often difficult to access because the most qualified specialist physicians to lead these encounters (pediatric physiatrists), are regionalized at large urban centers. As a result, these children are left to receive care in one of three ways: first, some pediatric physiatrists travel long distances to provide care in the local community MTU; second, some county MTUs hire non-specialist providers to provide the care, despite the fact that these providers lack expertise in the care of children with special health care needs; and third, some families and children are left with no other option but to travel long distances to receive care at a regionalized, urban MTU. In order to address the travel burdens and barriers to care, as well as to increase the quality of care provided to these children, we will implement a model of care using telemedicine to deliver pediatric physiatrist medical direction to MTUs located in rural and underserved communities. The objective of this application is to prospectively compare outcomes from our telemedicine-based model of care to two cohorts: patients who receive in-person pediatric physiatrist medical direction (the “gold standard”) and patients who receive medical oversight from non-specialist community providers. First, we hypothesize that when pediatric physiatrists use telemedicine to provide medical direction, parents/guardians of children will be equally satisfied with care received compared to parents/guardians of children who receive in-person care by pediatric physiatrists, and more satisfied than parents/guardians of children who receive care by non-specialist community providers. Second, we hypothesize that when pediatric physiatrists use telemedicine to provide medical direction, children will have equal adherence to an evidence- based hip surveillance program compared to children who receive in-person care by pediatric physiatrists, and better adherence to the hip surveillance program than children who receive care by non-specialist community providers. Third, we hypothesize that when pediatric physiatrists use telemedicine to provide medical direction to children with special health care needs living in rural and underserved communities, there will be significant cost savings compared to when pediatric physiatrists have to travel to distant MTUs and to when care is provided by non-specialist community providers. Our work is significant because we expect that this model of care will result in improved access, increased levels of patient-centeredness, higher quality of care, and will simultaneously reduce overall costs of care. We also expect that this model will be scalable and will be used by similar programs treating children with special health care needs throughout the country. 1

项目摘要 医疗单位(MTU)是提供综合医疗服务的多学科县诊所 对有耐用医疗设备、矫形器和治疗的特殊健康护理需要的儿童的管理 服务。不幸的是，对于生活在农村和缺乏服务的社区的儿童来说，MTU的特殊护理通常是 很难接触到，因为最有资格的专科医生来领导这些接触(儿科 理疗师)，在大的城市中心被区域化。因此，这些儿童被留在一个地方接受照顾 有三种方式：第一，一些儿科理疗师长途跋涉到当地社区提供护理 MTU；第二，一些县MTU聘请非专家提供者提供护理，尽管事实是这些 提供者缺乏照顾有特殊卫生保健需要的儿童的专门知识；第三，一些家庭和 儿童别无选择，只能长途跋涉到地区化的城市MTU接受护理。 为了解决旅行负担和护理障碍，以及提高护理质量 为这些儿童提供服务，我们将实施远程医疗模式，为儿童提供理疗师 向位于农村和服务不足社区的MTU提供医疗指导。此应用程序的目标是 前瞻性地比较我们基于远程医疗的护理模式对两个队列的结果： 接受面对面的儿科理疗师的医疗指导(“黄金标准”)和接受医疗服务的患者 来自非专业社区提供者的监督。 首先，我们假设，当儿科理疗师使用远程医疗提供医疗指导时， 与儿童的父母/监护人相比，儿童的父母/监护人对所接受的护理同样满意 接受儿科理疗师亲自护理的儿童，他们比父母/监护人更满意 接受非专业社区提供者照料的儿童。第二，我们假设当儿科医生 理疗师使用远程医疗提供医疗指导，儿童将对证据有同样的坚持- 基于髋关节监测计划的儿童与接受儿科理疗师亲自护理的儿童进行比较，以及 与接受非专科社区护理的儿童相比，更好地坚持髋关节监测计划 供应商。第三，我们假设当儿科理疗师使用远程医疗提供医疗指导时 对于生活在农村和服务不足社区的有特殊卫生保健需要的儿童来说，将有重大的 与儿科理疗师不得不前往远程MTU和护理时相比，节省了成本 由非专业社区提供商提供。 我们的工作意义重大，因为我们预计这种护理模式将带来更好的机会， 提高了以患者为中心的水平、更高的护理质量，同时将降低 关心。我们还预计，这种模式将是可扩展的，并将用于类似的项目，治疗儿童与 全国各地的特殊医疗保健需求。 1