PABI Plan - The Sarah Jane Brain Project

Rural / Tele-health issues during Acute Care
While 86.1% of the population lives within 60 minutes of a Level 1 or Level 2 Trauma Center,
many PA/TBI cases will not be presented in such institutions. The Acute Category of Care must
develop strategies and programs to deal with the initial assessment and treatment of PA/TBI,
including but not limited to Mild TBI since most of those cases will never be presented at a
Level 1 or Level 2 Trauma Center. The use of store-and-forward telehealth for digital images,
video, audio and clinical data can save time and money if used properly. In addition, real-time
telehealth strategies are already being used and those that have been successful should be
expanded to allow instantaneous interaction. Not only video-conferencing but advancements in
technology allow for peripheral devices to be used. These technologies also allow for primary
physicians to receive second opinions from specialists without the families needing to travel any
further than their local healthcare provider. The use of telepharmacy programs has the potential
to improve the quality of pharmaceutical care and decrease medication errors and adverse drug
events in small rural hospitals; however many states have not adopted rules and regulations to
implement some of these newer strategies. Many rural hospitals, especially Critical Access
Hospitals (CAHs), have limited hours of on-site pharmacist coverage. In addition, a significant
number of pharmacists in small rural hospitals are primarily retail pharmacists, who provide parttime
pharmacist consultant services in hospitals and nursing homes in addition to their retail
responsibilities. Telepharmacy arrangements have been proposed as a way for smaller rural
hospitals with limited pharmacist coverage to obtain additional pharmacist resources. However,
because telepharmacy is relatively new, there is little literature in peer-reviewed journals.
Limited information on telepharmacy projects is available in other formats such as articles in
newspapers and trade journals, and grant reports. Additionally, Medicaid/Medicare payments to
rural hospitals and physicians are dramatically less than those to their urban counterparts for
equivalent services. This correlates closely with the fact that more than 470 rural hospitals have
closed in the past 25 years.
Rural / Telehealth issues during Reintegration, Long-term care and Adult Transition
Many of the school and community resources in Rural America are not designed (nor do they
have the proper training) to deal with a child/young adult with PA/TBI, let alone their families.
The Reintegration and Adult Transition Categories of Care must develop and implement
strategies and programs uniquely designed to meet the challenges facing the rural families,
schools, employers and communities dealing with a child/young adult with PA/TBI. Using
telehealth strategies for non-Rural PA/TBI families may also prove beneficial for the family who
is unable to access specialty health-related services because of barriers (i.e., the suburban town
doesn’t have a specialist in a particular area, the child/young adult is too difficult to move
because of his or her fragile or serious medical condition). Telerehabilitation is currently being
utilized in neuropsychology, speech-language pathology, occupational and physical therapy, and
robot-aided rehabilitation; however, very few applications have been adopted for pediatric cases.
Because of the lack of evidence-based research, few health insurers in the U.S. today will
reimburse for telerehabilitation services.
Taking advantage of the use of the Virtual SJBF Center (see Chapter 7) by having access to
advice, services and support through the SJBF Registry along with the advanced use of an
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