Therapy-led model of care for simple, diagnostic-defined pediatric hand fractures can maximize service access and...

Pediatric upper limb fractures place high demand on emergency and specialist medical services.

Allied health professionals (ie, therapists) are increasingly becoming sole providers for care of these conditions; however, evidence for the effectiveness, experiences, and outcomes within the pediatric population is lacking.

This quality improvement study used mixed-methods design, informed by the RE-AIM and Consolidated Framework for Implementation Research.

Six diagnostically defined, simple pediatric hand injuries (ie, soft tissue; minimally displaced or angulated fractures) were redirected at the time of referral to therapy-led care. Quantitative and qualitative data were collected, including consumer codesigned value-based healthcare outcome measures (function, pain, and patient experience); a patient-reported outcome measure (PROMIS Pediatric Upper Extremity Short Form 8a); health service delivery performance measures (eg, time to appointment, cost of staffing); and workforce stakeholder survey (feasibility and acceptability). Descriptive or inferential statistics were applied to quantitative data and content analysis to qualitative data.

The therapy-led clinic absorbed 20% of the overall new occasions of service to the orthopedic medical fracture clinic with a median wait time of 9 days (IQR = 5), seeing 97 new patients. Patient-reported measures were collected for 3 months. Fifty-three percent (n = 30/57) of eligible families completed the value-based healthcare outcome measures at clinical healing (eg, 4-6 weeks post injury), with all measures exceeding expected performance for function, pain, and health service experience. There was a higher virtual care follow-up in therapy-led vs medical care (82% vs 9%, respectively). Workforce stakeholders indicated a high willingness to continue the therapy-led clinic if adequate workforce resourcing was available.

The application of therapist-led care in pediatric acute hand injuries is safe, effective, and of high value. This model, and the effectiveness of using value-based health care and implementation science frameworks in quality improvement, has high potential for scale and spread within other healthcare settings.