Regionalized Pediatric Emergency Care in Rural Pennsylvania

Study Overview
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Brief Summary
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The overall goal of this project is to develop and evaluate an organized, regional system of pediatric emergency care in rural western Pennsylvania.

Detailed Description
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The OUTREACH project will develop, implement and evaluate an organized system of regional pediatric emergency care in rural western Pennsylvania. Toward that end the investigators have developed three broad goals: (1) to define the key barriers and potential solutions to regionalized pediatric emergency care through community stakeholder engagement; (2) to implement a regionalized system of pediatric emergency care using education, community outreach and telemedicine; and (3) evaluate the impact of the system on health care access and outcomes for rural children. The investigators will implement the intervention in a sample of rural hospitals in Pennsylvania using a staggered roll-out design, and compare outcomes of children seen in these hospitals to similar matched hospitals in the state, using Pennsylvania state Medicaid data to evaluate the impact of the intervention.

Official Title
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Regionalized Pediatric Emergency Care in Rural Pennsylvania: the Optimizing Utilization and Rural Emergency Access for Children Study

Conditions
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Emergencies

Intervention / Treatment
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* Other: Multicomponent intervention


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Pennsylvania Medicaid beneficiary Less than or equal to 18 years of age Exclusion Criteria: None

Ages Eligible for Study
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Maximum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Non-Randomized
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Multicomponent intervention<br>Hospitals in the experimental arm will receive a four-component intervention that integrates local education, community outreach, telemedicine and protocolized triage and transport | Other: Multicomponent intervention<br>* Develop, implement and evaluate an organized system of regional pediatric emergency care in rural Western Pennsylvania using four pillars: education, community, protocolized triage and transport, and telemedicine.<br>|
| No Intervention: Control<br>Hospitals in the control arm will receive usual care. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Average distance from home to the nearest facility with specialized pediatric emergency care capabilities | This population-based outcome will act as a measure of access and relates to HRSA Maternal Child Health Bureau performance measure AHS-8 and AHS-9 (access to pre-hospital EMS and wait times) | One-year | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Incidence of emergency transfers to CHP after an index community ED visit |  | 90 days | 
| Incidence of emergency transfers to CHP that do not result in a hospital admission |  | 90 days | 
| Total health care encounters outside the county within three months after an index community ED visit |  | 90 days | 
| Mortality after an index community ED visit for specified high-risk conditions (trauma, sepsis, and in the chronic disease population) | These outcomes will address our goal to increase child health and related to the HRSA Maternal Child Health Bureau performance measures MICH-1,2 and 3 | 90 days | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Pediatrics, Emergency medical services, Emergency Treatment, Telemedicine