Regionalized Pediatric Emergency Care in Rural Pennsylvania (OUTREACH)

Study Description

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Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information

Brief Summary:

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

Condition or disease	Intervention/treatment	Phase
Emergencies	Other: Multicomponent intervention	Not Applicable

Detailed Description:

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.

Study Design

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Study Type :	Interventional (Clinical Trial)
Actual Enrollment :	5000 participants
Allocation:	Non-Randomized
Intervention Model:	Single Group Assignment
Masking:	None (Open Label)
Primary Purpose:	Health Services Research
Official Title:	Regionalized Pediatric Emergency Care in Rural Pennsylvania: the Optimizing Utilization and Rural Emergency Access for Children Study
Study Start Date :	June 2012
Actual Primary Completion Date :	June 2016
Actual Study Completion Date :	June 2016

Arms and Interventions

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Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information

Arm	Intervention/treatment
Experimental: Multicomponent intervention; 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; 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.
No Intervention: Control; Hospitals in the control arm will receive usual care.

Outcome Measures

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Primary Outcome Measures :

1. Average distance from home to the nearest facility with specialized pediatric emergency care capabilities [ Time Frame: One-year ]
   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)

Secondary Outcome Measures :

1. Incidence of emergency transfers to CHP after an index community ED visit [ Time Frame: 90 days ]
2. Incidence of emergency transfers to CHP that do not result in a hospital admission [ Time Frame: 90 days ]
3. Total health care encounters outside the county within three months after an index community ED visit [ Time Frame: 90 days ]
4. Mortality after an index community ED visit for specified high-risk conditions (trauma, sepsis, and in the chronic disease population) [ Time Frame: 90 days ]
   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

Eligibility Criteria

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Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information

Ages Eligible for Study:	up to 18 Years (Child, Adult)
Sexes Eligible for Study:	All
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

• Pennsylvania
• Medicaid beneficiary
• Less than or equal to 18 years of age

Exclusion Criteria:

Contacts and Locations

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Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information

Locations

United States, Pennsylvania
University of Pittburgh Medical Center
Pittsburgh, Pennsylvania, United States, 15261

Sponsors and Collaborators

University of Pittsburgh

Health Resources and Services Administration (HRSA)

Investigators

Study Director:	Jeremy M Kahn, MD, MS	University of Pittsburgh

More Information

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Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information

Additional Information:

Study web site 

Publications:

Lorch SA, Myers S, Carr B. The regionalization of pediatric health care. Pediatrics. 2010 Dec;126(6):1182-90. doi: 10.1542/peds.2010-1119. Epub 2010 Nov 1. Review.

Berger E. Growing pains: Report notes pediatric emergencies need greater emphasis. Ann Emerg Med. 2006 Aug;48(2):143-4.

Responsible Party:	Jeremy Kahn, Associate Professor of Critical Care, Medicine and Health Policy & Management, University of Pittsburgh
ClinicalTrials.gov Identifier:	NCT01775033 History of Changes
Obsolete Identifiers:	NCT02306408
Other Study ID Numbers:	H3AMC24076
First Posted:	January 24, 2013
Last Update Posted:	October 27, 2016
Last Verified:	October 2016

Keywords provided by Jeremy Kahn, University of Pittsburgh:

Pediatrics; Emergency medical services; Emergency Treatment; Telemedicine

Additional relevant MeSH terms:

Emergencies; Disease Attributes; Pathologic Processes