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Parent and Provider Impressions of Emergency Planning for CSHCN; Midwest Emergency Medical Services for Children Information System (MEMSCIS.com). Lee A. Pyles, MD, Kathy Jamrozek, RN, Jessica C. Hannan, RN, Margaret Scheid, RN, MSN, Claudia I. Hines, RN, MSN

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  1. Parent and Provider Impressions of Emergency Planning for CSHCN; Midwest Emergency Medical Services for Children Information System (MEMSCIS.com) Lee A. Pyles, MD, Kathy Jamrozek, RN, Jessica C. Hannan, RN, Margaret Scheid, RN, MSN, Claudia I. Hines, RN, MSN University of Minnesota Children’s Hospital and Departments of Pediatrics and Emergency Medicine, Emergency Medical Services for Children Resource Center of Minnesota, Children’s Hospitals and Clinics of Minnesota

  2. Disclosures • No conflicts of interest • No investigational drugs or devices • Research and Presentation supported by US DHHS MCHB Grants H34MCC0091 and H34MC02544 MCHB EMS for Children Program.

  3. Introduction • Emergency Information Form is a paper summary of CSHCN clinical history • Demographics • Diagnoses • Procedures • Medications • Precautions • Suggested Treatments • Baseline VS and Physical Exam

  4. Introduction EIF / MEMSCIS Data Elements • Emergency Information Form is a paper summary of CSHCN clinical history • Demographics • Diagnoses • Procedures • Medications • Precautions • Suggested Treatments • Baseline VS and Physical Exam • American Academy of Pediatrics, Committee on Pediatric Emergency Medicine, Preparedness for Children with Special Health Care Needs.Pediatrics 1999;104(4):E53.

  5. MEMSCIS • Midwest Emergency Medical Services for Children Information System www.memscis.com • Web-linked database to store Emergency Information Forms • Pyles, LA, Hines, C, Patock, M, et al. Development of a Web-based Database to Manage American College of Emergency Physicians/ American Academy of Pediatrics Emergency Information Forms. Academic Emergency Medicine Vol 12 (3) 1-5. March 2005.

  6. EHR↔PHR • MEMSCIS is a hybrid electronic health record for providers and personal health record for parents of Children with Special Health Care Needs • Unique Features • Advice Section • Icon system of data attribution

  7. Study • 170 (94 study and 76 control) children enrolled in IRB-approved prospective randomized controlled trial from 9/26/02 to 9/11/04 and followed to 2/28/05. • Inclusion/Exclusion • Children under age two with significant cardiac disease • No ASD device, non-neonatal PS dilation • No trachs, vents

  8. Survey • Parents surveyed on yearly basis • Use of MEMSCIS • Comfort with Emergency Situation • Perception of Provider Comfort • Ed physician surveyed after ED visit • Surveys graded with yes/no responses and 5 point Likert Scale to evaluate responses to survey questions • Content validity reviewed with National Emergency Medical Services for Children Data Analysis Resource Center (NEDARC)

  9. Results • Prior to enrollment in the study, 26 of 105 parents (25%) reported that they kept a written health history for their child • 91% of parents opted-in for Break-the-Glass access • 25% of parents performed updates • 70% of updates by study nurses • 189 ED visits (0.47 ED visits / pt / year) • 101 Study pt • 88 control pt

  10. Parent Survey: Comfort Level for Emergency Care

  11. 5.000 ^ Study_Hosp_Prepared 4.000 Control_Hosp_Prepared 3.000 Likert Scale 2.000 1.000 0.000 Baseline Follow-Up ^ p = 0.0283 change in study vs. change in control Parent Assessment of Comfort of Hospital Providers

  12. Parent Survey: ED Provider Comfort

  13. Hospital Provider Comfort Impression Improvement

  14. Parent Assessment of Discomfort of Providers

  15. Parent Survey: Prehospital Provider Comfort Level

  16. Parent Survey: Prehospital Provider Comfort Level

  17. ED Physician Survey

  18. Summary • Survey reliability was supported by lack of change in pre-post responses in control subjects • Families who had an EIF reported improved comfort for emergencies • Families perceived that hospital providers showed an improved comfort level when it was learned that the CSHCN had an EIF

  19. Summary II • Families remained neutral when questions asked for a negative response questions • Families described an improvement of their perception of ED provider comfort over the course of the study, if the family had been a study participant but especially if family had used the EIF.

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

  21. Conclusions • The MEMSCIS program was associated with development of a favorable impression of families for emergency providers. • ED visit improved family impression only if the EIF was used. • Providers responded favorably to the EIF when used.

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