Pennsylvania — SPROC

Pennsylvania Regionalized System of Care in Western PA

June 1, 2012 - May 31, 2016

Grant Number

H3AMC24076

Project Overview

This project focused on developing and implementing a regionalized system of pediatric emergency care in rural western Pennsylvania. Primary foci of this project included: (1) building upon existing collaborations of rural community health providers and a major pediatric academic referral center to formalize transfer processes; and (2) integrating telemedicine in the emergency departments in participating hospitals to assure that children in the proposed rural communities had access to essential pediatric resources when needed.

Institution

University of Pittsburgh, Office of Research, Office of the Provost

Main Contact

Jeremy Kahn, MD, MS

Award Amount

$400,000

Contacts

Name	Role(s)	Phone	Email
Jeremy Kahn, MD, MS	Principal Investigator

Disseminations

Title	Type	Publication/Event	Published/Presented	Identifier	Details
Clinician Attitudes Toward Adoption of Pediatric Emergency Telemedicine in Rural Hospitals	Research Paper/Publication	Pediatric Emergency Care	2017	PMID: 26785087 DOI: 10.1097/pec.0000000000000583	Clinician Attitudes Toward Adoption of Pediatric Emergency Telemedicine in Rural Hospitals Author(s)/Presenter(s) Ray, Kristin N. MD, MS; Felmet, Kathryn A. MD; Hamilton, Melinda F. MD, MSc; Kuza, Courtney C. MPH; Saladino, Richard A. MD; Schultz, Brian R. MD; Watson, R. Scott MD, MPH; Kahn, Jeremy M. MD, MS Abstract/Description Objective: Although there is growing evidence regarding the utility of telemedicine in providing care for acutely ill children in underserved settings, adoption of pediatric emergency telemedicine remains limited, and little data exist to inform implementation efforts. Among clinician stakeholders, we examined attitudes regarding pediatric emergency telemedicine, including barriers to adoption in rural settings and potential strategies to overcome these barriers. Methods: Using a sequential mixed-methods approach, we first performed semistructured interviews with clinician stakeholders using thematic content analysis to generate a conceptual model for pediatric emergency telemedicine adoption. Based on this model, we then developed and fielded a survey to further examine attitudes regarding barriers to adoption and strategies to improve adoption. Results: Factors influencing adoption of pediatric emergency telemedicine were identified and categorized into 3 domains: contextual factors (such as regional geography, hospital culture, and individual experience), perceived usefulness of pediatric emergency telemedicine, and perceived ease of use of pediatric emergency telemedicine. Within the domains of perceived usefulness and perceived ease of use, belief in the relative advantage of telemedicine was the most pronounced difference between telemedicine proponents and nonproponents. Strategies identified to improve adoption of telemedicine included patient-specific education, clinical protocols for use, decreasing response times, and simplifying the technology. Conclusions: More effective adoption of pediatric emergency telemedicine among clinicians will require addressing perceived usefulness and perceived ease of use in the context of local factors. Future studies should examine the impact of specific identified strategies on adoption of pediatric emergency telemedicine and patient outcomes in rural settings. View On Pub Med
Clinician Attitudes Towards Adoption of Pediatric Emergency Telemedicine in Rural Hospitals	Presentation	Annual American Telemedicine Association	2015 Not Available
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