The Agency for Healthcare Research and Quality (AHRQ) has awarded a $2 million grant to the UC Davis Department of Pediatrics to provide five years of financial support for a new telemedicine program for children with disabilities living in remote communities.
The grant will fund the School-Based Tele-Physiatry Assistance for Rehabilitative and Therapeutic Services (STARS) program, which will provide assistance and physiatric care for children with cerebral palsy (CP), spinal cord injuries, spina bifida, and other disabilities. It also will fund research into different models of physiatric care.
“The goal of the STARS program is to broaden our reach,” Loren Davidson, chief of pediatric rehabilitation, said in a press release. “We’re geographically limited based on the distance from the medical center and how many staff we have to send out. We’re trying to bridge the provider gap through telemedicine, trying to reach these underserved communities.”
California children with severe disabilities can receive free care through the California Children’s Services’ Medical Therapy Program. Through the program, clinicians visit children’s schools, examine each child, and determine the best therapeutic strategies to prevent complications and reduce children’s suffering. Clinicians often prescribe physical therapy, medications, or medical devices such as orthotics or wheelchairs.
However, this program is less helpful for kids living in remote or rural communities, as it easier to implement in denser urban areas where more physiatrists are available. Only a limited number of physiatrists with appropriate training are available to travel long distances.
Additionally, a lack of systematic monitoring can prevent comprehensive and adequate care from being provided to these children. The STARS program will test if telemedicine is an effective way to provide physiatric care at a distance.
By installing teleconferencing equipment in schools in San Joaquin, Butte, Mendocino, Lodi, and Fresno counties, Davidson and other physiatrists will remotely guide screening and write prescriptions and referrals. They also will assess if this approach provides better care for more children and prevents complications associated with the conditions.
“One of our goals is to look at hip surveillance screening,” Davidson said. “Kids with cerebral palsy are at high risk for hip dislocation. The best treatment is to identify these problems early, before the hip completely dislocates – an orthopedic surgeon can keep the hip in. But when the doc providing guidance is not a rehab doc, and not affiliated with the pediatric orthopedists conducting surveillance, the screening doesn’t get done.”
The AHRQ grant will also support a research study comparing three care approaches: physiatrists providing care in person, non-physiatrists providing care in person, and physiatrists using telemedicine. The main points of assessment are improvement of quality of care, cost reduction, and increased patient-centeredness.
“The hardest thing to see is different outcomes based on how close patients live to a children’s hospital,” Davidson said. “That should not be a determining factor.”
“The efficiencies gained with telemedicine, the medical direction we can provide – it’s a potential game-changer,” added James Marcin, director of the pediatric telemedicine program at UC Davis.
Physiatry is a field centered on non-surgical physical medicine and rehabilitation that aims to restore functional ability and quality of life to those with physical impairments. The team at UC Davis believes their work can help close gaps in care and improve the quality of life for children with conditions like CP at lower costs.