Regionalized Pediatric Emergency Care in Rural Pennsylvania (OUTREACH)

Primary Outcome Measures:

• 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:

• Incidence of emergency transfers to CHP after an index community ED visit [ Time Frame: 90 days ]
  
• Incidence of emergency transfers to CHP that do not result in a hospital admission [ Time Frame: 90 days ]
  
• Total health care encounters outside the county within three months after an index community ED visit [ Time Frame: 90 days ]
  
• 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
  
  

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.