School-Based Tele-Physiatry Assistance for Rehabilitative and Therapeutic Services for Children with Special Health Care Needs Living in Rural and Underserved Communities

Throughout the country, individual States have programs focused on providing multidisciplinary care to children with special health care needs (CSHCN). In California, this program is called the Medical Therapy Program, where coordinated care is delivered at school-based clinics, called Medical Therapy Units (MTUs). These programs provide free services to qualifying children of all income levels, promoting independence, supporting a child’s mobility and ambulation needs, and addressing self-help skills. In California, the interdisciplinary team is comprised of a specialist physician (a pediatric physiatrist), a physical therapist, an occupational therapist, a nurse, and a social worker. Examples of qualifying conditions include cerebral palsy, spina bifida, muscular dystrophy, rheumatoid arthritis, and spinal cord injuries.

For those living in rural and underserved communities, this care can be difficult to access given that pediatric physiatrists who are integral to this care are typically regionalized at large urban centers. As a result, these children are left to receive care when a pediatric physiatrist is able to travel to their community, from non-specialist providers who may not be qualified to provide this care, or by travelling long distances to receive care at an urban MTU. Providing such care via telemedicine has the potential to vastly increase the reach of these specialists. This project will implement the School-Based Tele-Physiatry Assistance for Rehabilitative and Therapeutic Services (STARS) program to deliver this care via telemedicine in MTUs in underserved areas.

The specific aims of the project are as follows:

• Assess the effect of providing pediatric physiatrist medical direction using telemedicine on patient- and parent and guardian-centeredness.
• Assess the effect of providing pediatric physiatrist medical direction using telemedicine on quality and adherence to evidence-based protocols. 
• Determine the economic efficiency of providing pediatric physiatrist medical direction using telemedicine. 

Investigators will implement a prospective cohort study and compare the outcomes from the STARS model to the outcomes of two control populations: patients who receive in-person pediatric physiatrist medical care, and patients who receive this care from non-pediatric specialists. The project will evaluate parent and guardian satisfaction via surveys, and perform comprehensive cost analyses. In addition, they will assess quality using an evidence-based hip surveillance program measurement tool for children with cerebral palsy. Spastic hip displacement is the second most common deformity seen in children with cerebral palsy, and the long-term effects can be debilitating. Studies have demonstrated that aggressive early monitoring through a hip surveillance program can help reduce the likelihood of hip displacement and its sequelae.

STARS has the potential to increase efficiency, reduce overall healthcare costs, and improve care coordination so that children will receive necessary referrals that may result in increased functionality and less disability.