NRNP 6831 Week 5 Access and Resource Analysis Example

Access and Resource Analysis: A Year of Care for a 7-Year-Old With Cerebral Palsy, 90 Miles From Pediatric Rehabilitation

Student Name

College of Nursing, Walden University

NRNP 6831: Management of Specialized and Complex Populations

Instructor Name

Month Day, Year

Access and Resource Analysis: A Year of Care for a 7-Year-Old With Cerebral Palsy, 90 Miles From Pediatric Rehabilitation

Caleb is a composite 7-year-old boy with spastic diplegic cerebral palsy who uses a manual wheelchair for distance and a walker at home. He lives with his parents and a younger sister in a rural county that has one pediatric practice, no outpatient pediatric therapy clinic, and no accessible public transportation. The nearest pediatric rehabilitation center is 90 miles away. He is covered by Medicaid and is on the waiting list for his state's home and community-based services waiver. This paper lists what a year of his care requires, applies a five-dimension model of access to each need, converts the barriers into what they cost the family, and ranks the gaps.

Everything the Year Requires

The needs come first, before any resource is considered, so the analysis cannot shrink them to fit what happens to be available. Over a year, Caleb needs physical therapy about twice a week and occupational therapy weekly; orthopedic follow-up twice for his hips and feet; neurology follow-up twice; botulinum toxin injections for spasticity about every 3 to 4 months at the rehabilitation center's spasticity clinic; a yearly seating clinic visit and servicing of his wheelchair and walker; respite care so that his parents can rest; and school-based services, including therapy and an aide, under his individualized education program.

Five Dimensions as Columns

Penchansky and Thomas (1981) define access as the fit between patients and the health system across five dimensions: availability, whether the service exists in enough supply; accessibility, whether the patient can physically reach it; accommodation, whether its hours, scheduling, and arrangements fit the patient's life; affordability, what it costs the family; and acceptability, whether the family and the service are comfortable with each other. The model suits a rural case because it separates availability from accessibility. A service can exist in the state and still be unreachable from this county.

Table 1 applies the five dimensions to each need. Each cell records a specific local finding: the barrier, or the resource that meets it.

Table 1

Access Matrix for Caleb's Needs Across Five Dimensions

Resources That Already Exist

Some needs are met by resources the family already has or could use. School-based therapy and an aide are provided under the Individuals with Disabilities Education Act, which requires a free appropriate public education for children with disabilities, including related services such as physical and occupational therapy (Individuals with Disabilities Education Act, 20 U.S.C. § 1400, 2018). His state's Title V program for children and youth with special health care needs, funded under the Maternal and Child Health Services Block Grant (42 U.S.C. § 701, 2018), offers care coordination and can help with some costs Medicaid does not cover. Medicaid itself must assure necessary transportation to covered services (Assurance of Transportation, 42 C.F.R. § 431.53, 2024), which in his state means non-emergency medical transportation. The family had not heard of it. Its vans need 48 hours' notice, and the first one sent could not secure his wheelchair, so its acceptability to them is low for now.

What the Gaps Cost

Converting barriers into one unit makes them comparable. Caleb makes about 10 trips a year to the rehabilitation center: two each for orthopedics and neurology, three for injections, one for seating, and two for equipment repairs. Each trip is a round trip of 180 miles. At about 22 miles per gallon and $3.40 a gallon, that is roughly $28 in fuel per trip and $280 a year. His father, who is paid hourly at $18, loses a full shift each trip, about $144, or $1,440 a year. Injection days need both parents, so his mother also loses 3 days of work. Outpatient therapy, if a slot opened, would add two 80-mile round trips a week. For a family whose income qualifies for Medicaid, these costs are not small, and they fall on the family without appearing on any claim. Rural families of children with special health care needs report more difficulty getting care and greater financial and time burdens than urban families (Skinner & Slifkin, 2007).

Gaps Ranked by Consequence

The gaps are ranked by what they mean for Caleb, not by how hard they are to fix.

First, outpatient therapy. A 6-month wait on top of school-based therapy alone means less work on range of motion and strength at an age when hip and ankle position can worsen, which may later require surgery.

Second, respite. With no respite for 3 years, his parents' exhaustion is the risk that threatens every other part of his care.

Third, specialist distance. The trips are costly, but they happen, and his specialist care is not missed.

Fourth, telehealth. Neurology would see him by video, but the connection at home cannot sustain it.

Fifth, equipment servicing. Repairs are slow, but breakdowns have been rare.

Gaps the Practice Can Narrow

Some of these gaps are within reach of a primary care practice. The practice can offer a room with a reliable connection for telehealth visits with neurology, turning a full-day trip into an hour. It can ask the rehabilitation center to schedule orthopedics, neurology, and seating on the same day, cutting 4 trips a year. It can help the family book non-emergency transportation and confirm in advance that the van can secure a wheelchair. It can ask the school therapist and the outpatient clinic to share goals so that the school sessions carry more of the load while he waits.

Other gaps need policy or funding. The waiver waitlist, the shortage of pediatric therapists in rural counties, and home broadband are beyond the practice's reach. The practice can document these gaps for the state Title V program and the county's health planning group, but it cannot close them alone.

References

Assurance of Transportation, 42 C.F.R. § 431.53 (2024).

Individuals with Disabilities Education Act, 20 U.S.C. § 1400 et seq. (2018).

Maternal and Child Health Services Block Grant, 42 U.S.C. § 701 et seq. (2018).

Penchansky, R., & Thomas, J. W. (1981). The concept of access: Definition and relationship to consumer satisfaction. Medical Care, 19(2), 127-140. https://doi.org/10.1097/00005650-198102000-00001

Skinner, A. C., & Slifkin, R. T. (2007). Rural/urban differences in barriers to and burden of care for children with special health care needs. The Journal of Rural Health, 23(2), 150-157. https://doi.org/10.1111/j.1748-0361.2007.00082.x