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Increasing Access and Improving the Care Delivered to Abused Children in Rural, Underserved Hospitals with Telemedicine
Project Number: R40 MC 08723-02
Grantee: University of California, Davis
Department/Center: School of Medicine/Pediatrics
Project Date: 09/01/2007
James Marcin, MD, MPH
2516 Stockton Blvd.
Sacramento, CA 95817-2208
Phone: (916) 734-5647
- Perinatal/Infancy (0-12 months)
- Toddlerhood (13-35 months)
- Early Childhood (3-5 years)
- Middle Childhood (6-11 years)
Background: Children living in rural communities experience disproportionately high rates of physical and sexual abuse. Unfortunately, rural hospitals that serve these children typically lack the knowledge and experience to proficiently evaluate and examine these children. Without experienced examiners, abused children do not receive the quality care that they deserve and are at risk of inadequate protection and continued abuse. Additionally, due to a lack of local resources, abused children often undergo costly and emotionally traumatic transfers to urban child abuse referral centers. Specific Aims: The use of telemedicine to provide training and live expert advice to healthcare providers in rural hospitals is an innovative approach to assist these hospitals and the abused children they serve. The specific aim of this project is to test whether a well-defined telemedicine based training and consultation program will improve the quality of care provided to physically and sexually abused children seeking treatment at rural underserved hospitals when compared to matched control hospitals. We will accomplish this by providing the healthcare providers at four hospitals with: 1) monthly training via telemedicine in the recognition, evaluation and treatment of childhood physical and sexual abuse; and 2) 24/7 access to live telemedicine consultations from child abuse experts to assist with the history, examination, and current standard of care, consisting of the same monthly training (where examiners are expected to travel for in-person training) and 24/7 access to telephone consultations from the same child abuse experts. Methods: We aim to objectively quantify the benefits of a telemedicine program by measuring four outcomes: 1) Quality of care (measured by independent, blinded child abuse experts reviewing the State of California's standardized child physical and sexual abuse reporting forms); 2) Diagnostic accuracy (measured using the curernt gold-standard, a blinded panel review of the forensic photographs, drawings and medical records); 3) Remote provider child abuse knowledge (measured using a previously published child abuse written exam); and 4) Child abuse transfer and referral rates. These measures will be compared using a pretest-posttest matched control design, comparing outcomes between the telemedicine and matched control hospitals. Conclusion: We expect to demonstrate that our model, which can be easily disseminated to other locations throughout the United States, will improve access and increase the quality of care provided to physically and sexually abused children. In accordance with MCHB Strategic Research Issues, our program will enhance services and systems to assure quality of care while eliminating health disparities and barriers to health care access for underserved, geographically isolated populations. We expect that the long-term consequences of our project will be the increased use of telemedicine technology to extend pediatric education and consultations to underserved communities thereby reducing disparities in access and increasing quality of health care outcomes.
Listed is descending order by year published.
Marcin JP, Shaikh U, Steinhorn RH. Addressing health disparities in rural communities using telehealth. Pediatr Res. 2016;79:169-176.
Ellenby MS, Marcin JP. The role of telemedicine in pediatric critical care. Crit Care Clin. 2015;31(2):275-290.
McSwain SD, Marcin JP. Telemedicine in the care of children in the hospital setting. Pediatr Ann. 2014;43(2):44-9.
Miyamoto S, Dharmar M, Boyle C, et al. Impact of telemedicine on the quality of forensic sexual abuse examinations in rural communities. Child Abuse Negl. 2014 Sep;38(9):1533-39.
Rural, Telehealth, Violence & Abuse, Access to Health Care, Health Care Quality, Health Disparities