GOALS & OBJECTIVES
The goals of this project are 1) to improve the health status of injured and special health care needs children after discharge from inpatient care 2) to improve the coordination of care for these children and their families at and after hospital discharge. This will be accomplished using the following objectives: 1) improved coordination of discharge care for injured and special needs children, 2) development of a longitudinal tracking system to monitor the outcomes of CSHCN from inpatient rehabilitation 3) development and evaluation of a program instituting emergency care plans for CSHCN discharged from the inpatient rehabilitation unit, 4) development, implementation, and evaluation of a new support program entitled: Parent Education and Experience in Rehabilitation (PEER). This program of family support and education will initial target severely injured children and later including children with special health care needs discharged from the inpatient progressive rehabilitation unit for other medical and surgical problems, and 5) development and delivery of a telemedicine lecture series regarding rehabilitation needs of injured children to be delivered to primary care and other physicians throughout the state. The interventions will undergo careful evaluation and be developed into a model program for dissemination throughout EMSC agencies.

METHODOLOGY
This project proposes to build on previous studies in a number of ways by using tracking health status measures validated in previous EMSC funded projects. The PEER program will be based on other well studied support programs and will be developed with patient and parent input in the form of focus groups. The Child Health Questionnaire and Functional Independence Measure will be used in the tracking database to monitor patient status and results will be compared to a historical cohort as a baseline to determine impact. The Emergency Information Form (EIF) developed jointly by the American Academy of Pediatrics and the American Academy of Emergency Physicians will be incorporated into discharge and follow up planning for the CSHCN population at Arkansas Children’s Hospital and the effectiveness of this form will be evaluated. Finally, telemedicine lectures regarding the management of CSHCN, the implementation of the EIF, and other important issues regarding pediatric rehabilitation will be developed and delivered statewide using the UAMS Telemedicine program facilities. All educational and program materials will be made available for broader use by EMSC.

COORDINATION
This study will be conducted in coordination with the State EMS and Maternal and Child Health offices. The Arkansas Department of Human Services Children’s Medical Services office, which administers the CSHCN programming in the state, is also involved in program planning and implementation. Information regarding the status of the project and project findings will be shared with these agencies. Further coordination with the National EMSC offices will result in the dissemination of program materials to other EMSC sites. Dr. Aitken is part of the Arkansas EMSC Partnership Grant team and thus interacts regularly with this program as well as AR EMS.

EVALUATION
The investigator will develop of a project tracking database to ensure the timely completion of the study objectives. The project objectives have been carefully planned to have measurable outcomes, and changes in health status related to the proposed interventions will be measured using specific aspects of the WeeFIM and CHQ compared to a historical cohort of injury patients.

ANNOTATION

KEYWORDS
Unintentional Injury, Children with Special Health Care Needs, Family Centered Care, Telemedicine, Research, Primary Care Provider Education