Parent and Provider Parent and Provider Impressions of Emergency Impressions of Emergency Planning for CSHCN; Midwest Planning for CSHCN; Midwest Emergency Medical Services Emergency Medical Services for Children Information for Children Information System (MEMSCIS.com)System (MEMSCIS.com)

Lee A. Pyles, MD, Kathy Jamrozek, RN, Jessica C. Hannan, RN, Lee A. Pyles, MD, Kathy Jamrozek, RN, Jessica C. Hannan, RN, Margaret Scheid, RN, MSN, Claudia I. Hines, RN, MSNMargaret Scheid, RN, MSN, Claudia I. Hines, RN, MSN

University of Minnesota Children’s Hospital and Departments of University of Minnesota Children’s Hospital and Departments of Pediatrics and Emergency Medicine, Pediatrics and Emergency Medicine, Emergency Medical Services for Children Resource Center of Emergency Medical Services for Children Resource Center of Minnesota, Children’s Hospitals and Clinics of MinnesotaMinnesota, Children’s Hospitals and Clinics of Minnesota

DisclosuresDisclosures

No conflicts of interestNo conflicts of interest No investigational drugs or No investigational drugs or

devicesdevices Research and Presentation Research and Presentation

supported by US DHHS MCHB supported by US DHHS MCHB Grants H34MCC0091 and Grants H34MCC0091 and H34MC02544 MCHB EMS for H34MC02544 MCHB EMS for Children Program.Children Program.

IntroductionIntroduction

Emergency Information Form is a Emergency Information Form is a paper summary of CSHCN clinical paper summary of CSHCN clinical historyhistory– DemographicsDemographics– DiagnosesDiagnoses– ProceduresProcedures– MedicationsMedications– PrecautionsPrecautions– Suggested TreatmentsSuggested Treatments– Baseline VS and Physical ExamBaseline VS and Physical Exam

Introduction Introduction EIF / MEMSCIS Data EIF / MEMSCIS Data ElementsElements

Emergency Information Form is a Emergency Information Form is a paper summary of CSHCN clinical paper summary of CSHCN clinical historyhistory– DemographicsDemographics– DiagnosesDiagnoses– ProceduresProcedures– MedicationsMedications– PrecautionsPrecautions– Suggested TreatmentsSuggested Treatments– Baseline VS and Physical ExamBaseline VS and Physical Exam

American Academy of Pediatrics, Committee on Pediatric American Academy of Pediatrics, Committee on Pediatric Emergency Medicine, Preparedness for Children with Emergency Medicine, Preparedness for Children with Special Health Care Needs.Special Health Care Needs. PediatricsPediatrics 1999;104(4):E53. 1999;104(4):E53.

MEMSCISMEMSCIS

Midwest Emergency Medical Midwest Emergency Medical Services for Children Information Services for Children Information System System www.memscis.comwww.memscis.com

Web-linked database to store Web-linked database to store Emergency Information FormsEmergency Information Forms

Pyles, LA, Hines, C, Patock, M, et al. Development of a Web-Pyles, LA, Hines, C, Patock, M, et al. Development of a Web-based Database to Manage American College of Emergency based Database to Manage American College of Emergency Physicians/ American Academy of Pediatrics Emergency Physicians/ American Academy of Pediatrics Emergency Information Forms. Information Forms. Academic Emergency Medicine Vol 12 Academic Emergency Medicine Vol 12 (3) 1-5. March 2005(3) 1-5. March 2005..

EHREHR ↔↔ PHRPHR

MEMSCIS is a hybrid electronic MEMSCIS is a hybrid electronic health record for providers and health record for providers and personal health record for parents personal health record for parents of Children with Special Health of Children with Special Health Care NeedsCare Needs

Unique FeaturesUnique Features– Advice SectionAdvice Section– Icon system of data attributionIcon system of data attribution

StudyStudy

170 (94 study and 76 control) children 170 (94 study and 76 control) children enrolled in IRB-approved prospective enrolled in IRB-approved prospective randomized controlled trial from 9/26/02 randomized controlled trial from 9/26/02 to 9/11/04 and followed to 2/28/05.to 9/11/04 and followed to 2/28/05.

Inclusion/ExclusionInclusion/Exclusion– Children under age two with significant Children under age two with significant

cardiac diseasecardiac disease– No ASD device, non-neonatal PS dilationNo ASD device, non-neonatal PS dilation– No trachs, ventsNo trachs, vents

SurveySurvey Parents surveyed on yearly basisParents surveyed on yearly basis

– Use of MEMSCISUse of MEMSCIS– Comfort with Emergency SituationComfort with Emergency Situation– Perception of Provider ComfortPerception of Provider Comfort

Ed physician surveyed after ED visitEd physician surveyed after ED visit Surveys graded with yes/no responses and 5 Surveys graded with yes/no responses and 5

point Likert Scale to evaluate responses to survey point Likert Scale to evaluate responses to survey questionsquestions

Content validity reviewed with National Content validity reviewed with National Emergency Medical Services for Children Data Emergency Medical Services for Children Data Analysis Resource Center (NEDARC)Analysis Resource Center (NEDARC)

ResultsResults

Prior to enrollment in the study, 26 of Prior to enrollment in the study, 26 of 105 parents (25%) reported that they 105 parents (25%) reported that they kept a written health history for their kept a written health history for their childchild

91% of parents opted-in for Break-the-91% of parents opted-in for Break-the-Glass accessGlass access

25% of parents performed updates25% of parents performed updates 70% of updates by study nurses70% of updates by study nurses 189 ED visits (0.47 ED visits / pt / year)189 ED visits (0.47 ED visits / pt / year)

– 101 Study pt101 Study pt– 88 control pt88 control pt

Parent Survey: Parent Survey: Comfort Level for Comfort Level for Emergency CareEmergency Care

0. 000

1. 000

2. 000

3. 000

4. 000

5. 000

Like

rt S

cale

Baseline Follow-Up

Mean_St udy_Fami l y

Mean_Cont r ol _Fami l y

*

* p < 0. 01 f or change i n st udy vs. basel i ne st udy

Parent Assessment of Parent Assessment of Comfort of Hospital Comfort of Hospital ProvidersProviders

0.000

1.000

2.000

3.000

4.000

5.000

Like

rt S

cale

Baseline Follow-Up

Study_Hosp_Prepared

Control_Hosp_Prepared

^ p = 0.0283 change in study vs. change in control

^

Parent Survey: ED Provider Parent Survey: ED Provider ComfortComfort

0. 000

1. 000

2. 000

3. 000

4. 000

5. 000

Like

rt S

cale

Baseline Follow-Up

St udy_Hosp_I mpr ovement

Cont r ol _Hosp_I mpr ove

* #

* p < 0. 001 change i n st udy vs. basel i ne st udy

# p < 0. 006 change i n st udy vs. change i n cont r ol

Hospital Provider Hospital Provider Comfort Impression Comfort Impression ImprovementImprovement

0

1

2

3

4

5

Like

rt S

cale

Baseline Follow-Up

Control

Study_No_EIF

EIF

* p = 0.002 vs. control, p = 0.09 vs. study-no-EIF

*

Parent Assessment of Parent Assessment of Discomfort of ProvidersDiscomfort of Providers

0. 000

1. 000

2. 000

3. 000

4. 000

5. 000

Basel i ne Fol l ow- Up

Mean_Pr e_Di scomf or t

Mean_St udy_Pr e_Di scomf or t

Mean_Cont r ol _Pr e_Di scomf or t

p = NS f or al l compar i sons

0. 000

1. 000

2. 000

3. 000

4. 000

5. 000

Like

rt S

cale

Baseline Follow-Up

Mean_Hosp_Di scomf or t

Mean_St udy_Hosp_Di sComf or t

Mean_Cont r ol _Hosp_Di scomf or t

p = NS for all comparisons

Parent Survey: Parent Survey: Prehospital Provider Prehospital Provider Comfort LevelComfort Level

0. 000

1. 000

2. 000

3. 000

4. 000

5. 000

Like

rt S

cale

Baseline Follow-Up

Mean_St udy_Pr e_Wel l _Pr epar ed

Mean_Cont r ol _Pr e_Wel l _Pr epar ed

* p < 0.01 for change in study vs. baseline study

*

Parent Survey: Parent Survey: Prehospital Provider Prehospital Provider Comfort LevelComfort Level

0. 000

1. 000

2. 000

3. 000

4. 000

5. 000

Like

rt S

cale

Baseline Follow-Up

Study_Pre_Improvement

Control_Pre_Improvement

* p < 0.01 for change in study vs. study baseline# p = 0.0283 for change in study vs change in control

* #

ED Physician SurveyED Physician Survey Table 5 ED Encounter Physician Survey

Number of Encounters

QUESTION 0 1 2 3 4 5 1.) Do you have a previous emergency experience with this child with special health care needs?

EMERGENCY DEPARTMENT? 8 1 0 0 0 0 2.) Please circle your best response to the following statements. YES NO

I was able to access an EIF for this child.

8 0 *Strongly Agree (SA) Agree Somewhat (AS) No Effect (NE) Disagree Somewhat (DS) Strongly Disagree (SD)

SA

AS NE DS SD

I find that I am more comfortable with a child’s special condition because I have a written health history. 6 3 0 0 0 I find that pre-hospital emergency personnel are more comfortable with a child’s specific condition when they have a written history. 3 5 0 0 0 I find that hospital emergency personnel are more comfortable with a child’s specific condition when they have a written history. 5 3 0 0 0 In general, I find that pre-hospital personnel are well-prepared to care for a child with special healthcare needs. 1 5 0 3 0 In general, I find that hospital personnel are well-prepared to care for a child with special healthcare needs. 4 4 1 0 0

SummarySummary

Survey reliability was supported by Survey reliability was supported by lack of change in pre-post responses in lack of change in pre-post responses in control subjectscontrol subjects

Families who had an EIF reported Families who had an EIF reported improved comfort for emergenciesimproved comfort for emergencies

Families perceived that hospital Families perceived that hospital providers showed an improved comfort providers showed an improved comfort level when it was learned that the level when it was learned that the CSHCN had an EIFCSHCN had an EIF

Summary IISummary II

Families remained neutral when Families remained neutral when questions asked for a negative questions asked for a negative response questionsresponse questions

Families described an improvement of Families described an improvement of their perception of ED provider comfort their perception of ED provider comfort over the course of the study, over the course of the study, if the if the family had been a study participant family had been a study participant but especially if family had used the but especially if family had used the EIF.EIF.

Summary IIISummary III

Families described an Families described an improvement of their perception improvement of their perception of pre-hospital provider comfort of pre-hospital provider comfort over the course of the study, over the course of the study, if if the family had been a study the family had been a study participant.participant.

ConclusionsConclusions

The MEMSCIS program was The MEMSCIS program was associated with development of a associated with development of a favorable impression of families for favorable impression of families for emergency providers.emergency providers.

ED visit improved family ED visit improved family impression only if the EIF was used.impression only if the EIF was used.

Providers responded favorably to Providers responded favorably to the EIF when used.the EIF when used.