Quality Improvement in Concussion Care: Influence of Guideline-Based Education

J Pediatr. 2017 May;184:26-31. doi: 10.1016/j.jpeds.2017.01.045. Epub 2017 Feb 21.

Abstract

Objective: To evaluate the potential impact of a concussion management education program on community-practicing pediatricians.

Study design: We prospectively surveyed 210 pediatricians before and 18 months after participation in an evidence-based, concussion education program. Pediatricians were part of a network of 38 clinically integrated practices in metro-Atlanta. Participation was mandatory for at least 1 pediatrician in each practice. We assessed pediatricians' self-reported concussion knowledge, use of guidelines, and comfort level, as well as self-reported referral patterns for computed tomography (CT) and/or emergency department (ED) evaluation of children who sustained concussion.

Results: Based on responses from 120 pediatricians participating in the 2 surveys and intervention (response rate, 57.1%), the program had significant positive effects from pre- to postintervention on knowledge of concussions (-0.26 to 0.56 on -3 to +1 scale; P < .001), guideline use (0.73-.06 on 0-6 scale; P < .01), and comfort level in managing concussions (3.76-4.16 on 1-5 scale; P < .01). Posteducation, pediatricians were significantly less likely to self-report referral for CT (1.64-1.07; P < .001) and CT/ED (4.73-3.97; P < .01), but not ED referral alone (3.07-3.09; P = ns).

Conclusions: Adoption of a multifaceted, evidence-based, education program translated into a positive modification of self-reported practice behavior for youth concussion case management. Given the surging demand for community-based youth concussion care, this program can serve as a model for improving the quality of pediatric concussion management.

Keywords: community practice; computed tomography; concussion; continuing education; evidence-based guidelines; pediatrician; primary care provider; quality improvement.

MeSH terms

  • Adult
  • Aged
  • Brain Concussion / therapy*
  • Child
  • Humans
  • Middle Aged
  • Pediatrics / education*
  • Practice Guidelines as Topic
  • Prospective Studies
  • Quality Improvement*
  • Self Report