More than 41 million children, or 55 percent of all children in the United States, live more than 30 minutes away from a pediatric trauma center. The management of pediatric trauma requires medical expertise that is only available at Level I pediatric trauma centers, which are specialized pediatric referral hospitals located in large urban cities. Smaller hospitals lack pediatric trauma expertise and resources to properly care for these children. When a small hospital receives a child with trauma, the standard of care is to conduct a telephone consultation to a pediatric trauma specialist, err on the side of safety, and transfer the child to the regional Level I pediatric trauma center.
A newer model of care, the Virtual Pediatric Trauma Center (VPTC), uses live video, or telemedicine, to bring the expertise of a Level I pediatric trauma center virtually to patients at any hospital emergency department. This model of care has the potential to have a positive impact on parent and family involvement, which may reduce unnecessary and financially burdensome transfers. However, many parents and families have expressed a preference to err on the side of safety and have their injured child transferred to the regional Level I pediatric trauma center.
While the VPTC model is being used more frequently, the advantages and disadvantages of these two systems of care remain unknown, particularly with regard to parent/family-centered outcomes.
To develop this study, the project team convened family and community members familiar with the lack of shared decision making, the uncertainty surrounding definitive care, and the burdens on families undergoing transfers, including the cost of transportation, lodging, and missed work. They also raised concerns about disruptions in family and child care, and the stress of hospitalization in an unfamiliar city. As a result of these convenings, the team developed this project to compare the current standard of care to the VPTC among a diverse group of 10 emergency departments located within rural and underserved hospitals in Northern California.
The team will study the following parent, family, community, and medical provider informed outcomes: to compare the parent/family experience of care and distress at three days and 30 days following a childhood injury requiring an emergency department visit in a nonpediatric trauma center under the current standard model of care and the VPTC model of care; to compare 30-day healthcare utilization between injured children cared for under the current standard model of care and the VPTC model of care; to compare the out-of-pocket costs and financial burdens experienced by parents and families at three days and 30 days following a childhood injury requiring an emergency department visit in a nonpediatric trauma center under the current standard model of care and the VPTC model of care.
The goal is to optimize the patient and family experience and to minimize distress, healthcare utilization, and out-of-pocket costs following the injury of a child. The results of this project will help to optimize communication, confidence, and shared decision making between parents/families and clinical staff from both the transferring and receiving hospitals.
*All proposed projects, including requested budgets and project periods, are approved subject to a programmatic and budget review by PCORI staff and the negotiation of a formal award contract.