Improving Primary Care Provider Practices in Youth Concussion Management

Clin Pediatr (Phila). 2017 Aug;56(9):854-865. doi: 10.1177/0009922817709555. Epub 2017 May 19.

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.

Keywords: clinical decision support; electronic health record; primary care; traumatic brain injury.

MeSH terms

  • Adolescent
  • Adult
  • Brain Concussion / diagnosis*
  • Brain Concussion / therapy*
  • Child
  • Child, Preschool
  • Decision Support Systems, Clinical*
  • Electronic Health Records
  • Female
  • Humans
  • Infant
  • Male
  • Practice Guidelines as Topic
  • Practice Patterns, Physicians'*
  • Primary Health Care / methods*
  • Young Adult