Practical Policies to Prevent Injury & Manage Acute Care

July 29, 2013

Every child and young adult deserves access to high quality health care. As we say at CHOP: For every child, the right care at the right time and place. Having insurance is often a first step to getting care, but we need to go further and ensure that the care is delivered by clinicians who are skilled in meeting the unique needs of children and young adults.

In a recent study from CIRP@CHOP, we examined the potential impact on the healthcare system associated with increases in the number of young people with health insurance. We found a potential for more than 730,000 additional medically-attended injuries annually, or a 6.1 percent increase, if all currently uninsured children and young adults (ages 0-26) become insured and if these newly insured youth access medical care in ways similar to those who already have insurance. (See press release for more detail on research findings.)

As states implement policies to expand access to health insurance in response to the Affordable Care Act, health systems need to prepare for this potential increase in medically-attended injuries, ensuring that clinicians are skilled in delivering pediatric and adolescent trauma care. In particular, health systems and states should considering reviewing their Emergency Medical Services for Children training and continuing education, trauma triage protocols and community and patient prevention counseling and services. Medical schools might consider review of relevant course content for students and fellows on the diagnosis and treatment of concussions, musculoskeletal injury, sports medicine and open wound care – some of the most common injuries that require medical attention. Community resources such as Poison Control Centers and call centers should be expanded to avoid the need for costly clinical care. Medical command protocols, triage, and treatment of non-life-threatening injuries should be reviewed to minimize costly transports to trauma centers to those that are medically indicated.

Employers, insurers and public payors need to take notice as well. A significant portion of the increase will come from currently uninsured young adults (18- to 26-year-olds), who will now be able to remain on their parents' insurance until age 26 or find affordable care through exchanges. Investing in proven off-the-job injury prevention strategies will help to defray costs in the longer term. It costs less to prevent an injury than to treat it.

I would point all the above to the Centers for Disease Control and Prevention’s National Action Plan for Childhood Injury Prevention where they can find appropriate models and proven strategies that can be implemented in their communities.

Here are a few practical policy strategies to consider:

  • Allow safety devices such as helmets and car seats to be considered durable medical equipment
  • Reimburse for alcohol screening and brief interventions in hospital settings
  • Incentivize employers to expand injury prevention strategies to include off-the-job injuries for employees and dependents
  • Preserve programs such as the Emergency Medical Services for Children and the Children’s Hospitals Graduate Medical Education Programs, so that people can access high quality pediatric care
  • Reduce barriers to creating public-private partnerships for implementation of injury prevention programs that share responsibility among consumers, payors and providers