The University of California at Davis Health System has received a $2 million grant over five years to test a telemedicine program for children with cerebral palsy, spina bifida, spinal cord injuries, and other disabilities. According to the AHRQ database, UC Davis will receive $396,557 for FY 2017. The project is expected to conclude in July 2022.
UC Davis offers free coordinated care to children with disabilities through a state government program called the California Children's Services' Medical Therapy Program. These services include physiatry, a branch of medicine aimed at enhancing and restoring functional ability without surgery. The problem is that although the state helps families with financial challenges receive this care, access challenges still create difficulties for children in rural areas.
"The goal of the STARS [School-Based Tele-Physiatry Assistance for Rehabilitative and Therapeutic Services] program is to broaden our reach," Dr. Loren Davidson, associate clinical professor and chief of pediatric rehabilitation at UC Davis, said in a statement. "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."
Currently, care is provided at Medical Therapy Units, multidisciplinary county clinics where specialists evaluate patients and prescribe therapeutic exercises, medications, or medical devices like wheelchairs and orthotics. Because of the limited number of specialists, children in rural areas are either seen by non-specialists or have to be driven long distances into the city for the evaluation and any follow-up appointments.
"In some faraway counties, they can't even hire a physician. They just tell the family they have to drive," Dr. James Marcin, chief of pediatric critical care medicine and director of the pediatric telemedicine program at UC Davis Children's Hospital, said in a statement. "It's a huge burden on children and their families."
In areas where non-specialists perform the assessment, patients can sometimes receive suboptimal care because the providers don't know what tests to conduct or what to look for.
"One of our goals is to look at hip surveillance screening," Davidson said in a statement, offering one example. "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."
Over the five year grant period, UC Davis will install teleconferencing equipment at schools in five remote counties — San Joaquin, Butte, Mendocino, Lodi, and Fresno. Screenings will be conducted remotely at these schools, and UC Davis will compare patient satisfaction and costs in the telemedicine groups to cost and satisfaction in two other cohorts: in-person screening by specialists and in-person screening by non-specialists.