California — SPROC

Transport of Acutely Ill and Injured Children to Institutions of Higher Care from Allied Localities

June 1, 2012 - Dec. 7, 2020

Grant Number

H3AMC24073

Project Overview: 2012-2016: partnering of the North Coast EMS Agency, the UC Davis Medical Center, the United Indian Health Services, and the North Coast Clinics Network to develop a regionalized, standardized health care delivery system for children; integrating evidence-based emergency medical services into the pediatric emergency care system either by transport and/or telemedicine; and increasing access to ongoing education and pediatric quality care to remote, rural, and under-served areas within the state through organized transfer processes and use of telemedicine.
2016-2021: Building upon the successes of a 2012 SPROC grant received by the University of California, TACTICAL. The 2012 project successfully developed a coordinated, regionalized, and culturally sensitive system of care for emergency medical services for children in a rural, underserved, three-county EMS agency, North Coast EMS (NCEMS), in northern California. The project facilitated quality improvement (QI) efforts, comprehensive pediatric coverage thru the use of telemedicine, and the participation and successful recognition of all NCEMS receiving hospital emergency departments (EDs) in a pediatric readiness recognition program known as Emergency Departments Approved for Pediatrics (EDAP). The project team plans to enhance pediatric capabilities by expanding TACTICAL into a second service region in California, the Sierra-Sacramento Valley (S-SVEMS). The targeted regions being addressed by TACTICAL serve rural and under-served communities inadequately prepared to provide high-quality care to seriously ill children. Project goals include: (1) Implement, improve, and sustain continuous pediatric-specific quality improvement in EDs located in rural and underserved communities in both NCEMS and S-SVEMS regions; (2) Improve the ability of EDs in the S-SVEMS region to care for acutely ill and injured children by increasing readiness to evaluate and treat pediatric patients via expansion of telemedicine and EDAP; and (3) Provide pediatric education and training in the management of acutely ill and injured children to prehospital and hospital providers, as well as a monitoring process for care that includes the establishment of a data collection system in the NCEMS and S-SVEMS regions.
Institution: Regents of the University of California
Award Amount: $1,150,000

Contacts

Name	Role(s)	Phone	Email
James Marcin, MD, MPH	Project Director	(916) 734-4726	jpmarcin@ucdavis.edu
Ilana Sigal, MPH	Program Manager	(916) 734-2639	isigal@ucdavis.edu

Products

Title	Format	Description	Published/Revised	Availability
Family Centered Care Packet	Toolkit	Essential documents and supplies for families having children transferred to another facility – i.e. directions to new facility, where to … Family Centered Care Packet Description Essential documents and supplies for families having children transferred to another facility – i.e. directions to new facility, where to go once upon arrival as well as essential hygiene items to assist family members.	2015	Not Available

Disseminations

Title	Type	Publication/Event	Published/Presented	Identifier	Details
Association between emergency department pediatric readiness and transfer of noninjured children in small rural hospitals	Research Paper/Publication	Journal of Rural Health	2021 Abstract	PMID: 33734494 DOI: 10.1111/jrh.12566	Association between emergency department pediatric readiness and transfer of noninjured children in small rural hospitals Author(s)/Presenter(s) Monica K Lieng, James P Marcin, Ilana S Sigal, Sarah C Haynes, Parul Dayal, Daniel J Tancredi, Marianne Gausche-Hill, Jamie L Mouzoon, Patrick S Romano, Jennifer L Rosenthal Abstract/Description Purpose: Pediatric readiness scores may be a useful measure of a hospital's preparedness to care for children. However, there is limited evidence linking these scores with patient outcomes or other metrics, including the need for interfacility transfer. This study aims to determine the association of pediatric readiness scores with the odds of interfacility transfer among a cohort of noninjured children (< 18 years old) presenting to emergency departments (EDs) in small rural hospitals in the state of California. Methods: Data from the National Pediatric Readiness Project assessment were linked with the California Office of Statewide Health Planning and Development's ED and inpatient databases to conduct a cross-sectional study of pediatric interfacility transfers. Hospitals were manually matched between these data sets. Logistic regression was performed with random intercepts for hospital and adjustment for patient-level confounders. Findings: A total of 54 hospitals and 135,388 encounters met the inclusion criteria. EDs with a high pediatric readiness score (>70) had lower adjusted odds of transfer (aOR: 0.55, 95% CI: 0.33-0.93) than EDs with a low pediatric readiness score (≤ 70). The pediatric readiness section with strongest association with transfer was the "policies, procedures, and protocols" section; EDs in the highest quartile had lower odds of transfer than EDs in the lowest quartile (aOR: 0.54, 95% CI: 0.31-0.91). Conclusions: Pediatric patients presenting to EDs at small rural hospitals with high pediatric readiness scores may be less likely to be transferred. Additional studies are recommended to investigate other pediatric outcomes in relation to hospital ED pediatric readiness. Keywords access to care; emergency medical care; pediatric readiness; quality; utilization of health services View On Pub Med
California SPROC Program TACTICAL Project Update	Presentation	2019 EMSC All Grantee Meeting	2019		California SPROC Program TACTICAL Project Update Author(s)/Presenter(s) James Marcin, MD, MPH Abstract/Description Update on the program https://bit.ly/33KvoKq
Emergency Medical Services Utilization by Children	Research Paper/Publication	Pediatric Emergency Care	2019	DOI: 10.1097/PEC.0000000000001143	Emergency Medical Services Utilization by Children Author(s)/Presenter(s) Dayal, Parul MS; Horeczko, Timothy MD, MSCR; Wraa, Cheryl RN, MSN; Karsteadt, Larry MA; Chapman, Wendy; Bruhnke, Louis MA; Litman, Rebecca BA; Ruttan, Timothy MD; Kuppermann, Nathan MD, MPH; Marcin, James MD, MPH Abstract/Description Objective The aim of this study was to compare demographic and clinical features of children (0–14 years old) who arrived at general emergency departments (EDs) by emergency medical services (EMS) to those who arrived by private vehicles and other means in a rural, 3-county region of northern California. Methods We reviewed 507 ED records of children who arrived at EDs by EMS and those who arrived by other means in 2013. We also analyzed prehospital procedures performed on all children transported to an area hospital by EMS. Results Children arriving by EMS were older (9.0 vs 6.0 years; P < 0.001), more ill (mean Severity Classification Score, 2.9 vs 2.4; P < 0.001), and had longer lengths of stay (3.6 vs 2.1 hours; P < 0.001) compared with children who were transported to the EDs by other means. Children transported by EMS received more subspecialty consultations (18.7% vs 6.9%; P < 0.05) and had more diagnostic testing, including laboratory testing (22.9% vs 10.6%; P < 0.001), radiography (39.7% vs 20.8%; P < 0.001), and computed tomography scans (16.8% vs 2.9%; P < 0.001). Children arriving by EMS were transferred more frequently (8.8% vs 1.6%; P < 0.001) and had higher mean Severity Classification Scores compared with children arriving by other transportation even after adjusting for age and sex (β = 0.48; 95% confidence interval, 0.35–0.61; P < 0.001). Older children received more prehospital procedures compared with younger children, and these were of greater complexity and a wider spectrum. Conclusions Children transported to rural EDs via EMS are more ill and use more medical resources compared with those who arrive to the ED by other means of transportation.
Urban and rural patterns in emergent pediatric transfer: a call for regionalization	Research Paper/Publication	Journal of Rural Health	2014	PMID: 24164349 DOI: 10.1111/jrh.12051	Urban and rural patterns in emergent pediatric transfer: a call for regionalization Author(s)/Presenter(s) Timothy Horeczko, James Marvin, Jeremy Kahn, Robert Sapien Abstract/Description Context: National groups call for the regionalization of health care, to direct patients with high-risk conditions to designated hospitals with greater capabilities. Currently there is limited information detailing the characteristics and specific needs of acutely ill and injured children who require transfer to another institution, especially in underserved rural communities. Purpose: To determine the epidemiology of pediatric transfers from urban and rural emergency departments (EDs). Methods: We analyzed data in the National Hospital Ambulatory Medical Care Survey from 1995 to 2010. Eligible children were <18 years of age seen in a United States ED, and transferred to another hospital after initial evaluation. Findings: Of all 283,232,058 pediatric ED visits, less than 0.5% resulted in a transfer, yielding a population-based estimate of 900,100 transfers nationally during this period. Urban and rural EDs showed similar transfer rates. Children transferred from rural EDs were older and more likely to arrive by emergency medical services than children transferred from urban EDs (12.1 vs 8.2 years of age, P < .01). Children from rural EDs were more than twice as likely to be transferred for a psychiatric indication (43.5% vs 19.5%, P < .01). Conclusions: Emergency pediatric transfers are uncommon in the United States; transfer rates are similar in urban and rural settings. Rural children have additional obstacles to care, especially in access to emergency mental health services. Programs to study and implement regionalization of care should consider diverse patient populations and target improvement in coordination of care, transfer times, and outcomes. Keywords access to care; health disparities; mental health; policy; utilization of health services View On Pub Med