This document summarizes a webinar on bringing basic orthopedic and concussion care to pediatric medical homes. It introduces the course directors and schedule for the learning community webinars and sessions. It then discusses the current and new concussion process maps. The webinar covered case scenarios on foot and ankle injuries and the appropriate stepped care approaches. It also provided information on splinting and casting materials available through a partner supplier. The document concludes with reminders about follow-up coursework and evaluations.

1. Bringing Basic Orthopedic and Concussion
Care to the Pediatric Medical Home:
PPOC/CHICO Learning Community
& Integration Program
© 2014 Pediatric Physicians’ Organization at Children’s (PPOC). For permission please contact ppoc@childrens.harvard.edu
Webinar Session #3
October 29, 2015

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We have no financial relationships with
commercial entities producing, marketing, re-
selling, or distributing health care goods or
services consumed by, or used on, patients
relevant to the content we are planning,
developing, presenting, or evaluating.
Disclosure
© 2014 Pediatric Physicians’ Organization at Children’s (PPOC). For permission please contact ppoc@childrens.harvard.edu

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Barry Zallen, MD
Chief Medical Officer
Children’s Hospital Integrated Care Organization
barry.zallen@childrens.harvard.edu
Louis Vernacchio, MD, MSc
Pediatrician, Longwood Pediatrics
Director of Research and Analysis
Pediatric Physicians’ Organization at Children’s
Louis.vernacchio@childrens.harvard.edu
© 2014 Pediatric Physicians’ Organization at Children’s (PPOC). For permission please contact ppoc@childrens.harvard.edu
Madeleine Kuhn, MPH
Program Coordinator
Children’s Hospital Integrated Care Organization
Madeleine.kuhn@childrens.harvard.edu
Course Directors

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Learning Community Schedule
Webinars
7:30am – 8:30am
Date Content
Thursday, June 11, 2015 Concussion
Wednesday, September 9, 2015 Foot and Ankle
*Wednesday, December 16, 2015 Hand and Wrist
Wednesday, February 24, 2016 Everything Knee
Date
Wednesday, July 15, 2015
Thursday, August 13, 2015
Thursday, October 29, 2015
Thursday, March 24, 2016
Wednesday, April 27, 2016
Didactic Webinars
7:30am – 9:00am
© 2014 Pediatric Physicians’ Organization at Children’s (PPOC). For permission please contact ppoc@childrens.harvard.edu
In-Person Sessions
7:00am – 9:00am, BCH Waltham
Date Content
Wednesday, January 20, 2016 Practical Session
Wednesday, May 25, 2016 Practical Session
* This Didactic will start at 7 instead of 7:30.

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Agenda 1. Welcome and Review
2. Concussion Process Map Presenters
3. Case Discussions
4. Materials for Casting and Splinting
5. Coursework, next session, and Wrap-Up

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Blackboard: We Have a New Home
Page!

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Current Concussion Process Flow

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New Concussion Process Flow

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Current Process Map

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New Process Map

11. Foot and Ankle
Case Scenarios

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Case Scenario 1
– 14 yo girl turns L ankle
during basketball game
yesterday
Exam:
– Able to bear weight for
several steps

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Stepped Care Approach – Foot and Ankle
© 2014 Pediatric Physicians’ Organization at Children’s (PPOC). For permission please contact ppoc@childrens.harvard.edu

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Stepped Care Approach – Foot and Ankle
© 2014 Pediatric Physicians’ Organization at Children’s (PPOC). For permission please contact ppoc@childrens.harvard.edu

15. 14© 2014 Pediatric Physicians’ Organization at Children’s (PPOC). For permission please contact ppoc@childrens.harvard.edu
Document on Blackboard, in Follow-up Email and in previous Reminder
Email

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Case Scenario 2
• 19 yo young man injures L
ankle in football game earlier
today; unsure of exact
mechanism but ankle buckled
underneath him as he was
tackled
• Exam:
– Able to bear weight for
several steps but painful
– Swelling and tenderness
of both medial and lateral
ankle

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Stepped Care Approach – Foot and Ankle
© 2014 Pediatric Physicians’ Organization at Children’s (PPOC). For permission please contact ppoc@childrens.harvard.edu

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Stepped Care Approach – Foot and Ankle
© 2014 Pediatric Physicians’ Organization at Children’s (PPOC). For permission please contact ppoc@childrens.harvard.edu

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Case Scenario 3
• 11 yo boy kicked in L
ankle during soccer game
today
• Exam:
– Unable to bear weight
Area of
tenderness

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Stepped Care Approach – Foot and Ankle
© 2014 Pediatric Physicians’ Organization at Children’s (PPOC). For permission please contact ppoc@childrens.harvard.edu

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Stepped Care Approach – Foot and Ankle
© 2014 Pediatric Physicians’ Organization at Children’s (PPOC). For permission please contact ppoc@childrens.harvard.edu

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Case Scenario 4
• 12 yo boy dropped heavy
object on R foot
yesterday, injured 2nd toe
• Exam:
– Able to bear weight but
pain with step-off

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Stepped Care Approach – Foot and Ankle
© 2014 Pediatric Physicians’ Organization at Children’s (PPOC). For permission please contact ppoc@childrens.harvard.edu

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Stepped Care Approach – Foot and Ankle
© 2014 Pediatric Physicians’ Organization at Children’s (PPOC). For permission please contact ppoc@childrens.harvard.edu

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Orthopedic Advice and Urgent Access
© 2014 Pediatric Physicians’ Organization at Children’s (PPOC). For permission please contact ppoc@childrens.harvard.edu
Answered live between 7:00AM and 5:00PM, Monday through Friday
Appointments will be made in Boston or a BCH satellite
based upon the patient’s location, day of week and urgency

26. Splinting and Casting
Materials

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Splinting and Casting Billing information
© 2014 Pediatric Physicians’ Organization at Children’s (PPOC). For permission please contact ppoc@childrens.harvard.edu
Item Billing Code
Ankle Stirrup L-4350
Lace-Up Ankle Brace L-1906
Short Walking Boot L-4396
Tall Walking Boot L-4360 (Air) & L-4386

28. Clinically Preferred Products. Patient-focused Service.
Surgi-Care, Inc.
Products & Services Overview

29. DME Solutions – Stock and Bill
Recommended Product List:
Crutches
Canes
Ankle Stirrup
Lace-up Ankle Braces
Short and Tall Walking Boots
l
Wrist Braces
Wrist Braces with Thumb Spica
Arm Sling
Knee Immobilizer
Hinged Knee Braces

30. Your Surgi-Care Contact
To Contact Surgi-Care:
Jason Seymour
Sales Representative
Cell: 781-706-1004
Email: jseymour@surgi-careinc.com

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Learning Community Schedule
Webinars
7:30am – 8:30am
Date Content
Thursday, June 11, 2015 Concussion
Wednesday, September 9, 2015 Foot and Ankle
Wednesday, December 16, 2015 Hand and Wrist
Wednesday, February 24, 2016 Everything Knee
Date
Wednesday, July 15, 2015
Thursday, August 13, 2015
Thursday, October 29, 2015
Thursday, March 24, 2016
Wednesday, April 27, 2016
Didactic Webinars
7:30am – 9:00am
© 2014 Pediatric Physicians’ Organization at Children’s (PPOC). For permission please contact ppoc@childrens.harvard.edu
In-Person Sessions
7:00am – 9:00am, BCH Waltham
Date Content
Wednesday, January 20, 2016 Practical Session
Wednesday, May 25, 2016 Practical Session

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Follow-Up Email Checklist & Course material
© 2014 Pediatric Physicians’ Organization at Children’s (PPOC). For permission please contact ppoc@childrens.harvard.edu
Items in Follow-up Email Description
Coursework Finishing Coursework from Concussion
Process Mapping, Case Reviews, Qstream
Attachments Ankle handout, Foot and Ankle Algorithm,
Webinar Slides
Links Satisfaction Survey
Coursework Due Description
Concussion Process
Mapping
October 29th, 2015
for CME credit
Directions and course worksheet found in
email or on Blackboard under What’s Due.
For assistance email Madeleine Kuhn at
madeleine.kuhn@childrens.harvard.edu
Continuous
coursework
Qstream
Questions
Concussion Challenge

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Your Feedback Helps Us Succeed!
Please take a moment to fill out the session evaluation
Survey and provide us with your feedback so that we
can continue to improve and meet your expectations!
© 2014 Pediatric Physicians’ Organization at Children’s (PPOC). For permission please contact ppoc@childrens.harvard.edu

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Thank You!
© 2014 Pediatric Physicians’ Organization at Children’s (PPOC). For permission please contact ppoc@childrens.harvard.edu