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Boston Children's / CHU Ste-Justine Pediatric Orthopaedic Columbia Mission Trip

Grant Recipient: Mathilde Hupin

Boston Children's Hospital
Presentations & Publications:
Further Funding:
Additional Information:
POSNA Micro Grant Trip Report
Boston Children’s Pediatric Orthopaedic Colombia Mission Trip
  1. Summary
For the last 8 years, our group has organized a pediatric orthopaedic team for a recurring, annual mission trip to Neiva, Colombia with Healing the Children foundation.  Over the past 3 years, we have worked to develop systems to better promote follow-up, monitor outcomes, and begin to study and improve program metrics.  The POSNA Micro Grant was used to further develop these goals through support of team personnel tasked with establishing a 1-year follow-up clinic, including key quality improvement documentation and functional outcome measures.
Overall we had good success in achieving our aims.  We successfully conducted a supervised 1-year follow-up clinic evaluating patients treated in the prior year.  We not only performed clinical evaluations, but also began to collect program metrics including follow-up rates, cost of travel, and PROMIS functional outcome scores as part of our ongoing routine care.  We have also instituted follow-up phone calls and more short-term post-operative follow-up with our local collaborating pediatric orthopaedic surgeon in Colombia.  Having key team members lead each component, with our grant-supported resident managing the effort, was instrumental in ensuring each step was carried out during an otherwise busy, fluid mission trip.
These trip improvements, however, were not without challenge.  Contacting patients for follow-up, both over the phone and for the in-person visit, was more difficult than anticipated.  We learned that phone numbers and sim cards change frequently in our patient population, and had to use local networks of trip staff and local healthcare providers to assist in contacting families.  Even so, in this first year we had an approximately 50% follow-up rate – a great start to our program, but certainly with room for improvement.  We feel that increased communication before surgery regarding contact information, government ID numbers, and follow-up expectations will aid in improving these numbers, as well as eventually financial travel assistance to encourage in-person visits.  Furthermore, with this support, we have increased ownership and involvement of our local partners both during and between trips, which we feel is a good direction for any global surgery venture.
  1. Future Plans
We are using the database, documentation, and systems created through the support of this POSNA Micro Grant to improve the care delivered through our trip to Colombia.  By tracking our patients and outcomes, we will identify areas of logistic problems for our patients, as well as examine clinical outcomes of treatment in this patient population.  As a starting point, we studied the level of health literacy in our population, finding it to be quite low with only 56% demonstrating adequate literacy based on a validated assessment tool in Spanish.  Our abstract for this work has been accepted for presentation at the Bethune Roundtable and GLOCAL global health conferences, and we are preparing a manuscript for submission.  Furthermore, with the establishment through this grant of our 1-year follow-up clinic, we now aim to collect additional records at the subsequent clinic and examine clinical and functional outcomes in our patient population for review and publication.
Moving forward, we have now established a 3-part system for our mission trip that includes a screening clinic for operative and non-operative treatment, a pre-clinic for patients known previously to have been indicated for surgery, an annual follow-up clinic for patient treated in prior years, a 3-month post-operative follow-up clinic by our local surgical partner, and 6-10 month telephone follow-up to identify patients requiring ongoing assistance.  With ongoing support and development, we feel this may be a good model for surgical mission trips, encouraging long-term documentation and follow-up, and hope there may be other groups with similar efforts that we may learn from as we further our own program.
  1. Brief Budget
Roundtrip Airfare  (Boston - Bogota):                       $551.00
Accommodations  ($64 per night, 7 nights):          $449.00
TOTAL:                                                                                  $1 000.00