Feasibility and Acceptability of Mobilizing Community Paramedics to Provide the Standard of Care for Pediatric Concussion: Mobile Integrated Health Programming for Pediatric Patients.

Abstract

Objectives: Community Paramedics (CPs) have not yet been engaged in pediatric concussion management. This study aimed to assess the feasibility and acceptability of building and delivering HeadStrong Community (a Mobile Integrated Health (MIH) program utilizing CPs) to provide pediatric concussion care in the community.

Methods: This was an experimental mixed-methods study. Physicians, CPs, and scientists used the Knowledge-to-Action cycle to co-develop the program in response to the knowledge to practice gap for CPs around recovery and rehabilitation for pediatric concussion. Patients aged 3-17 years who had sustained a concussion were eligible. Patients were recruited through the emergency department. The program consisted of a visiting clinician model where trained CPs assessed, helped manage, and provided anticipatory guidance and education for concussion. Feasibility was assessed by primary outcomes related to MIH agency uptake, CP uptake, patient enrollment, and modified Post-Concussion Symptoms Scale (PCSS) scores (0 = no symptoms, 48 = most severe symptoms). Feasibility was analyzed by description of uptake and enrollment, and pre-post symptom scores. Acceptability was assessed by primary outcomes of patient, parent, and CP satisfaction scores (5-point Likert scale). Qualitative surveys of CPs were also conducted and thematically analyzed.

Results: HeadStrong Community recruited and trained 15 CPs from 2 MIH agencies. Of 156 potentially eligible patients, 19% (30/156) enrolled and completed 28 home visits. PCSS scores improved pre- versus post-visit as reported by patients (pre-visit mean = 15.2 ± 10.4, post-visit mean = 8.8 ± 7.6, p < 0.001) and parents (pre-visit mean = 12.0 ± 8.1, post-visit mean = 7.8 ± 7.6, p < 0.001). High levels of program satisfaction were reported by patients (mean = 4.3 ± 1.2; median = 5(1-5); n = 23), parents (mean = 4.4 ± 0.8; median = 5(2-5); n = 23) and CPs (mean = 4.0 ± 0.7; median = 4(1-5); n = 28). The CPs reported success in learning and implementing new assessments as well as engaging with concerned families, but encountered challenges integrating with the broader health care system, particularly with other specialized concussion care.

Conclusions: The expansion of MIH programming to pediatric concussion patients was feasible and acceptable. HeadStrong Community is a novel and innovative model for management of pediatric concussion and may serve as a template for adaptable MIH programming to address other health care needs. Further research is needed to validate clinical utility and continuously improve the program and model.