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Cerebral Palsy Hip Surveillance: A Virtual Clinic Model

Hunter New England Local Health District
Project Added:
23 August 2016
Last updated:
6 September 2016

Cerebral Palsy Hip Surveillance: A Virtual Clinic Model

Summary

Kaleidoscope Paediatric Rehabilitation Service (KPRS) established a comprehensive hip surveillance program for children and young people living with cerebral palsy (CP) in the Northern Child Health Network (NCHN), including those from regional, rural and remote communities.

This project was presented at the Rural Innovations Changing Healthcare Forum 2016.

View a presentation from the forum.

Aim

To establish a coordinated hip surveillance service for children and young people living with CP in the NCHN using a virtual clinic model, with 50% (approximately 200) of these children and young people engaged in the program by December 2014.

Benefits

  • Maximises local resources and reduces unnecessary face-to-face appointments.
  • Reduces costs to the family and healthcare system.
    Promotes early detection and treatment of hip disease in children with CP.
  • Eliminates the need for invasive hip salvage surgery.
  • Prevents further disability, joint deformity, functional decline and pain.
  • Reduces the burden of care on families and minimises travel and time off work.
  • Improves the child’s mobility, health outcomes, participation and quality of life.
  • Improves collaboration between families, clinicians, allied health teams, radiology and orthopaedic services.

Background

There are approximately 500 children and young people with CP in the NCHN. Children with CP are at greater risk of hip displacement and dislocation, with consequences including pain, disability, joint deformity, functional decline, reduced quality of life and a potential need for hip salvage surgery.

Hip dislocation is preventable through early detection and regular hip surveillance, which is the process of identifying and monitoring the critical early indicators of progressive hip displacement, through clinical assessment and radiology review.

Approximately half of all children with CP in the NCHN live in regional and rural communities. Prior to the project, children with CP did not have access to a coordinated hip surveillance program, which increased their risk of hip dislocation and displacement.

Implementation

  • A new virtual clinic model was developed and used to establish the KPRS CP Hip Surveillance Service. It operates as follows:
    • referrals are accepted from general practitioners, paediatricians and allied health teams
    • x-ray services are provided in the child’s local community
    • results are available online
    • migration percentages are measured and reviewed by paediatric rehabilitation specialists and physiotherapists at the CP Hip Surveillance Service in Newcastle
    • follow-up care is provided according to Australian Hip Surveillance Guidelines for Children with Cerebral Palsy 2014
    • recommendations for treatment are provided to families and referrers
    • children who have an issue highlighted in their x-ray are required to attend a face-to-face clinic.
  • Information packages were sent to families and carers of children with CP living in regional and rural communities, to educate them on the new service.

Project status

  • Sustained - the initiative has been implemented and is sustained in standard business.

Key dates

  • Project start: January 2012
  • Innovation support scholarship: 2012
  • Project work related to scholarship: 2013-2014
  • Ongoing service provision and evaluation: 2015
  • Project completed: June 2015

Implementation site

  • Kaleidoscope Paediatric Rehabilitation Service, Newcastle

KPRS coordinates communication and clinical care with all relevant services involved with the child and family. This occurs across the NCHN, which is one of three Child Health Networks in NSW and is shown in pink below.

map of children's health networks NSW

Partnerships

  • The Cerebral Palsy Alliance
  • Private and public radiology services in the NCHN
  • Private and public orthopaedic services in the NCHN
  • General practitioners in the NCHN
  • Medical and allied health staff in the NCHN
  • Private paediatricians in the NCHN

Results

  • There were a total of 227 children with CP in NCHN who engaged in the KPRS CP Hip Surveillance Service between January 2012 and December 2015.
    • 170 received ongoing hip surveillance using the virtual clinic model, with 57 discharged from the service during this time. Reasons for discharge include reaching skeletal maturity, orthopaedic bony surgery and achieving consistently normal migration percentages.
    • 42 children were referred to paediatric orthopaedics for review.
  • The following objectives will strengthen the project moving forward:
    • increased awareness of CP hip surveillance
    • increased referrals to the KPRS CP Hip Surveillance Service
    • increased access to online x-ray systems from private providers, to significantly reduce the need for hard copy x-rays to be sent by post
    • increased accessibility of x-rays from private providers
    • collaboration with data managers to improve data coding
    • a review of processes for gathering formal feedback from consumers and other stakeholders
    • collaboration with other services, to apply the virtual clinic model in other areas of Australia.
  • The project achieved its objectives, establishing a KPRS CP Hip Surveillance Service and engaging more than 50% of children and young people with CP in the NCHN.

Lessons learnt

It is important to gather consumer feedback prior to and following implementation of the project, to measure changes in their experience.

Further reading

  • Dobson F, Boyd RN, Parrott J et al. Hip surveillance in children with cerebral palsy: Impact on the surgical management of spastic hip disease. Journal of Bone and Joint Surgery 2002; 84-B: 720-726.
  • Hagglund G, Andersson S, Duppe H et al. Prevention of dislocation of the hip in children with cerebral palsy. Journal of Bone and Joint Surgery 2005; 87-B: 95-101
  • Kentish M, Wynter M, Snape N et al. Five-year outcome of statewide hip surveillance of children and adolescents with cerebral palsy. Journal of Pediatric Rehabilitation Medicine 2011; 4(3): 205-217.
  • NSW Kids and Families. Healthy, Safe and Well: A strategic health plan for children, young people and families 2014-2024. North Sydney: NSW Kids and Families; 2014.
  • NSW Ministry of Health. NSW State Health Plan: Towards 2021. North Sydney: NSW Ministry of Health; 2014.
  • Soo B, Howard JJ, Boyd RN et al. Hip Displacement in cerebral palsy. Journal of Bone and Joint Surgery 2006; 88A(1): 121-129.
  • Wynter M, Gibson N, Kentish M et al. Consensus Statement on Hip Surveillance for Children with Cerebral Palsy: Australian Standards of Care. Journal of Paediatric Rehabilitation Medicine 2011; 4(3): 183-195.

Related resources

Contact

Karen Height
Service Manager, Kaleidoscope Paediatric Rehabilitation Service
Community Partnerships and Integration Service
Children Young People and Families Service
Hunter New England Local Health District
Phone: 02 4925 7979
karen.height@hnehealth.nsw.gov.au

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