Improving Primary Care Provider Practices in Youth Concussion Management

Clinical Pediatrics
Kristy B ArbogastChristina L Master

Abstract

Primary care providers are increasingly providing youth concussion care but report insufficient time and training, limiting adoption of best practices. We implemented a primary care-based intervention including an electronic health record-based clinical decision support tool ("SmartSet") and in-person training. We evaluated consequent improvement in 2 key concussion management practices: (1) performance of a vestibular oculomotor examination and (2) discussion of return-to-learn/return-to-play (RTL/RTP) guidelines. Data were included from 7284 primary care patients aged 0 to 17 years with initial concussion visits between July 2010 and June 2014. We compared proportions of visits pre- and post-intervention in which the examination was performed or RTL/RTP guidelines provided. Examinations and RTL/RTP were documented for 1.8% and 19.0% of visits pre-intervention, respectively, compared with 71.1% and 72.9% post-intervention. A total of 95% of post-intervention examinations were documented within the SmartSet. An electronic clinical decision support tool, plus in-person training, may be key to changing primary care provider behavior around concussion care.

References

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Citations

Jan 9, 2019·Journal of Neurotrauma·Keith Owen YeatesUNKNOWN Pediatric Emergency Research Canada (PERC) Predicting Persistent Postconcussive Problems in Pediatrics (5P) Concussion Team
Sep 17, 2019·Medicine and Science in Sports and Exercise·Daniel J CorwinChristina L Master
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Sep 28, 2018·Frontiers in Pediatrics·Meeryo C ChoeTamara M Haegerich
Jul 22, 2020·Current Sports Medicine Reports·Weston T NorthamKevin A Carneiro
Jul 5, 2018·Annals of Internal Medicine·Christina L MasterMatthew F Grady
May 20, 2020·Pediatric Quality & Safety·Tara KaushalVijay Srinivasan
Jan 17, 2021·Injury Prevention : Journal of the International Society for Child and Adolescent Injury Prevention·Kelly SarmientoDavid Wright
Jun 9, 2020·The Journal of Pediatrics·Christina L MasterKristy B Arbogast
May 19, 2019·The Journal of Pediatrics·Allison E CurryChristina L Master
Oct 29, 2020·The Journal of Rural Health : Official Journal of the American Rural Health Association and the National Rural Health Care Association·Jill DaughertyAlana Knudson
Jun 27, 2021·Annals of Epidemiology·Kawai O TanabeChristopher P Holstege
Jun 29, 2021·Pediatric Emergency Care·Daniel J CorwinMark R Zonfrillo
Sep 7, 2021·Brain Injury : [BI]·Sarah DerbyshireDeborah L Snell
Sep 16, 2021·The Physician and Sportsmedicine·Patricia R RobyKristy B Arbogast
Oct 8, 2021·Child Neuropsychology : a Journal on Normal and Abnormal Development in Childhood and Adolescence·Danielle M RansomBeth S Slomine

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Software Mentioned

SAS
SmartSet

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