Funded Projects

Decreasing Delays in Pediatric ACL Care

Project Year

2023

City & State

Kansas City, Missouri

Program Name

CATCH Planning

Topic

Health Disparities

Program Description

Problem Pediatric anterior cruciate ligament reconstruction (ACLR) annually accounts for 32.4 per 1,000 pediatric orthopedic surgeries. The rate of ACLRs has increased 5.7-fold from 2004 to 2014.1 Pediatric ACL care is often used as a surrogate metric for pediatric sports medicine care. The number of pediatric anterior cruciate ligament (ACL) injuries has annually increased by 2.3%, with significantly increasing delays to surgery.2 Delays from injury to surgery decrease healing potential3 and increase risk of concurrent meniscal pathology,4,5 instability, and pathological laxity.6 Decreasing delays to ACLR is of paramount importance for positive functional outcomes. Furthermore, early ACLR is more cost-effective than delayed ACLR, with increased per-patient cost savings.7 Bram et al. found black and Hispanic pediatric patients to have greater delays from injury to surgery, with resulting disparities in overall functional outcomes.8 Many other social risk factors have been linked to delays in ACL injury management including insurance status,8–13 median household income,10,11 socioeconomic status,14,15 and language barriers.16 At our institution, we found that black pediatric athletes, in comparison to white athletes, have 178% greater delays from injury to initial MRI and 36% greater delays from MRI to surgery, from 2012-2018. From 2021-2022, we found that 30% of ACLR patients had a delay to MRI or surgery. Publicly insured patients had 27% longer delays to surgery than privately insured patients, and black patients had 19% longer delays to surgery. This grant proposal works to answer the following questions: What interventions would benefit the Kansas City metropolitan area in improving pediatric ACL care delivery? What community collaborations can form/improve to improve pediatric access to ACL care? Primary Setting The primary setting for this study will be the Kansas City metropolitan area. Number of Children Affected We estimate a total of 500 pediatric ACL injuries in the Kansas City Metropolitan area. Just at our hospital, we completed 93 total acute ACLRs from 2021-2022. Not all ACL injuries are however operative, and many sites for ACL care exist in our large area. The consequences of delays on functional outcomes are well documented in the literature and of great concern. Project Goal The goal of our project is to develop a set of feasible, collaborative initiatives that improve access to pediatric ACL care. Proposed Intervention 1. Hold community forums within three months of grant funding with each of the following community stakeholders in the Kansas City Metropolitan Area: Physical therapists (PTs), athletic trainers (ATs), high/middle school athletic coaches, medical/surgical sports medicine clinicians. These community forums will interrogate existing deficiencies in pediatric ACL care. Forums will be geared specifically towards interrogating existing ACL care pathways and community partnerships. 2. After qualitative data analysis of the community forums held, a summit meeting will be hosted for all the aforementioned community stakeholders. This meeting will be held within ten months of grant funding. The purpose of this summit meeting will be to 1) discuss the results of our studies and prior community forums; 2) identify feasible, collaborative pilot initiatives that improve access to pediatric ACL care. 3. Form a task force dedicated to improving access to pediatric ACL care. This task force will comprise representatives from each of the aforementioned community stakeholders. A set of 5-10 feasible, collaborative initiatives that arise from objectives #1 -2 will be the long-term implementation aims of the task force. Anticipated Outcomes We anticipate that by the end of the 12-month period, we will have formed a task force to implement a set of community partnership initiatives that feasibly streamline access to pediatric ACL care.

Project Goal

Our project goal is to develop a set of feasible, collaborative initiatives that improve access to pediatric ACL care.

Project Objective 1

In the Kansas City metropolitan area, this project, by three months of funding through community forums, will comprehensively understand deficits in existing care pathways that are responsible for delays in care (defined as >/30 days from injury to MRI or >/90 days from injury to surgery) for pediatric patients with ACL injuries.

Project Objective 2

In the Kansas City metropolitan area, this project, by ten months of funding through a summit meeting, will interrogate existing community partnerships with PTs, ATs, coaches, and medical/surgical sports medicine clinicians to identify feasible initiatives that streamline pediatric ACL care.

Project Objective 3

In the Kansas City metropolitan area, this project, by 12 months of funding, will identify a set of 5-10 feasible initiatives and form a task force that improves access to pediatric ACL care, possibly including, but not limited to, modeling our existing AT Partnership Agreement for other hospitals, transportation vouchers, and streamlined scheduling policies.

AAP District

District VI

Institutional Name

Children's Mercy Hospital

Contact 1

Kevin Latz