…To make kids better today and
healthier tomorrow.
9.9.13
Program Development
Children’s
Telemedicine
Program
Children’s
Physician Group
at Children’s
Specialty Services
Subspecial...
Clinical Services Offered
Current Specialties and Number of Physicians:
• Allergy and Immunology (1)
• Autism (1)
• Cardio...
Patient Volume
88
461
823
971
767
0
200
400
600
800
1000
1200
2009 2010 2011 2012 2013
Total/Overall
Number of Patients Se...
CONCUSSION:
The Facts and Controversy
David M Popoli, MD
Pediatric and Adolescent Sports Medicine
Medical Director for Tel...
The Statistics
• 2008 (ED data)
– 60 million youth 5-14 yr in organized sports
– 3.8 million concussions from sport and
re...
Objectives
• Define concussion
• Explain concussion pathway
• Discuss treatment and prevention
• Georgia Return to Play Ac...
Definition
• Consensus Guidelines 2012
• Characteristics
1. Direct or impulsive force
2. Rapid onset
3. Functional
4. Clin...
This is Not a “Bump on the Head”
The Big Picture
What’s Really Happening
Twist/Stretch “Leaks”
Electrical
discharge
Recharge
Mechanical Injury leads to
Assessment – What You’ll Be Told
• Symptoms
• School performance
• Activity tolerance
• Sleep
• Appetite
• Mood
Assessment -- Symptoms
• Loss of Consciousness
• Amnesia, retrograde or anterograde
• Disorientation
• Appearing dazed
• A...
Assessment – What You’ll Be Told
Assessment – What You’ll See
• Mental status
• Coordination/Balance/Walking
• Strength
• Sensation
Technology and Concussion
Management
• Computerized neuropsychological testing
• Telemedicine/telehealth
Computerized Neuropsychological Testing
Computerized Neuropsychological Testing
0
10
20
30
40
50
60
70
80
90
100
Baseline Post Injury
1
Post Injury
2
Post Injury
...
Telemedicine/Telehealth
• Improved clinical reach
• Improved education/awareness
• Convenience
• Cost
• Piece of mind
Current Sites
20
*Map and total does not include Child Advocacy Centers
• Participating with 43 presenting
sites throughou...
Our Community…
21
Research – Abstract accepted by
Pediatric Academic Society
“Resource Savings, Family and
Societal Benefi...
Management
• Physical and cognitive rest
• Academic accommodations
• RTP stages
• Imaging*
• Medication*
Academic Accommodations Algorithm
Georgia Return to Play Act
• All public and private schools which provide youth athletic activities
are required:
– Provid...
Return to Play
Stage Exercise Goal
1 None Recovery
2 Light Aerobic Increase HR
3 Sport-Specific Add movement
4 Non-Contact...
Cumulative Effects
Prevention
• Mouthguards
• Helmets
• Rules/regulations
• Style of play
More Information
• Children’s Healthcare of Atlanta
• Centers for Disease Control and Prevention
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Concussion presentation for gpt dr. popoli’s presentation

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  • 2009: 2 service lines with 2 physiciansCurrently: x service lines with x physiciansFuture: x service lines x physicians
  • Project ECHO – Extension for Community Healthcare Outcomes
  • Concussion presentation for gpt dr. popoli’s presentation

    1. 1. …To make kids better today and healthier tomorrow. 9.9.13
    2. 2. Program Development Children’s Telemedicine Program Children’s Physician Group at Children’s Specialty Services Subspecialis t at Egleston Children’s Physician Group at North Druid Hills Marcus Autism Additional Clinic Space Subspecialis t at Scottish Rite Stephanie Blank Center for Safe and Healthy Children • 501(c)3 – Not for Profit • Network of Partners • Minimal Partnership Fees:  Field-Based Telehealth Liaisons  Support for Credentialing  Scheduling System  Centralized PACS System  24/7 support for network partners  Access to Network Our Program Our Network Partner
    3. 3. Clinical Services Offered Current Specialties and Number of Physicians: • Allergy and Immunology (1) • Autism (1) • Cardiology (1) • Child Protection (3) • Concussion/Neurosurgery (1) • Endocrinology (1) • Fetal ECHO (9) • Gastroenterology (1) • Nephrology (2) • Pulmonology (2) • Sports Medicine/Concussion (1) Coming soon: • Autism (1) • Apnea (1) • Ear, Nose, Throat (1) • Transplant (1) • Neurology-Keto patients only (1) • Pulmonology (1) Telemedicine: Working Together for Better Care
    4. 4. Patient Volume 88 461 823 971 767 0 200 400 600 800 1000 1200 2009 2010 2011 2012 2013 Total/Overall Number of Patients Seen Through October 2013 92 355 524 971 91 231 445 767 0 200 400 600 800 1000 1200 CSHC Specialist Marcus Total 2012 - 2013 Through October 2013 Number of Patients Seen 2013 2012 Number of Patients Since Inception: 3,110
    5. 5. CONCUSSION: The Facts and Controversy David M Popoli, MD Pediatric and Adolescent Sports Medicine Medical Director for Telemedicine
    6. 6. The Statistics • 2008 (ED data) – 60 million youth 5-14 yr in organized sports – 3.8 million concussions from sport and recreation – Underestimated due to under-reporting (1) • 2009-2010 (H.S. Reporting Information Online) – 192 High Schools – 1056 Concussions
    7. 7. Objectives • Define concussion • Explain concussion pathway • Discuss treatment and prevention • Georgia Return to Play Act 2014 • Discuss controversies
    8. 8. Definition • Consensus Guidelines 2012 • Characteristics 1. Direct or impulsive force 2. Rapid onset 3. Functional 4. Clinical symptoms 5. No abnormality on standard imaging
    9. 9. This is Not a “Bump on the Head”
    10. 10. The Big Picture
    11. 11. What’s Really Happening Twist/Stretch “Leaks” Electrical discharge Recharge Mechanical Injury leads to
    12. 12. Assessment – What You’ll Be Told • Symptoms • School performance • Activity tolerance • Sleep • Appetite • Mood
    13. 13. Assessment -- Symptoms • Loss of Consciousness • Amnesia, retrograde or anterograde • Disorientation • Appearing dazed • Acting confused • Forgetting game rules or play assignments • Inability to recall score or opponent • Inappropriate emotionality • Physical incoordination • Imbalance • Seizure • Slow verbal responses • Personality changes • Headache • Headache • Nausea or vomiting • Difficulty balancing • Vision changes • Photophobia • Phonophobia • Feeling “out of it” • Difficulty concentrating • Tinnitus • Drowsiness • Sadness • Hallucinations
    14. 14. Assessment – What You’ll Be Told
    15. 15. Assessment – What You’ll See • Mental status • Coordination/Balance/Walking • Strength • Sensation
    16. 16. Technology and Concussion Management • Computerized neuropsychological testing • Telemedicine/telehealth
    17. 17. Computerized Neuropsychological Testing
    18. 18. Computerized Neuropsychological Testing 0 10 20 30 40 50 60 70 80 90 100 Baseline Post Injury 1 Post Injury 2 Post Injury 3 Verbal Memory Visual Memory Processing Speed Reaction Time 6 Days Post 16 Days Post 23 Days Post Percentile
    19. 19. Telemedicine/Telehealth • Improved clinical reach • Improved education/awareness • Convenience • Cost • Piece of mind
    20. 20. Current Sites 20 *Map and total does not include Child Advocacy Centers • Participating with 43 presenting sites throughout Georgia* • 11 specialties with 23 physicians - Future: 14 specialties 27 physicians • Types of presenting sites - Hospitals - Primary care offices - Schools - Public Health Departments - DFCS offices
    21. 21. Our Community… 21 Research – Abstract accepted by Pediatric Academic Society “Resource Savings, Family and Societal Benefits of a Statewide Pediatric Telemedicine Program”. • Patients served live in 63 of the Georgia’s 159 counties • 40% of all counties •All outside of the MSA • 83% of our patients are covered by Medicaid /CMO’s • Overall cost of miles saved: $171,083 (0.55/mile) 2012 Statistics…Per visit: Median (Round Trip) Range (Round Trip) Miles Saved 333 72-524 Cost of miles saved $177 $39-$273 Hours Saved Traveling 5.8 2.0-9.0 School days *Children greater than 5 y/o 76% of our patients would have missed school to travel to Atlanta Work Days Missed *One adult present >75% of our parents would have missed a full day of work to travel to Atlanta
    22. 22. Management • Physical and cognitive rest • Academic accommodations • RTP stages • Imaging* • Medication*
    23. 23. Academic Accommodations Algorithm
    24. 24. Georgia Return to Play Act • All public and private schools which provide youth athletic activities are required: – Provide information to parents on the nature and risk of concussion and head injuries – Establish a concussion management and return to play policy to include: • An Information sheet prior to the beginning of each athletic season • Youth athlete must be removed from play if exhibiting symptoms • Youth athlete must be cleared by a healthcare provider before return to play • Public recreational programs are also required to provide information to parents on the nature and risk of concussion and head injuries • Georgia Department of Public Health shall endorse one or more concussion recognition education courses to inform Georgia citizens of the nature and risk of concussions in youth athletics • Effective date: January 1, 2014
    25. 25. Return to Play Stage Exercise Goal 1 None Recovery 2 Light Aerobic Increase HR 3 Sport-Specific Add movement 4 Non-Contact Drills Coordination 5 Controlled-Contact Drills Restore Confidence 6 Full Contact Practice Game Ready 7 Competition Play
    26. 26. Cumulative Effects
    27. 27. Prevention • Mouthguards • Helmets • Rules/regulations • Style of play
    28. 28. More Information • Children’s Healthcare of Atlanta • Centers for Disease Control and Prevention
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