Improving Primary Care Provider Practices in Youth Concussion Management

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-pers...

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Bibliographic Details
Published in:Clinical pediatrics 2017-08, Vol.56 (9), p.854-865
Main Authors: Arbogast, Kristy B., Curry, Allison E., Metzger, Kristina B., Kessler, Ronni S., Bell, Jeneita M., Haarbauer-Krupa, Juliet, Zonfrillo, Mark R., Breiding, Matthew J., Master, Christina L.
Format: Article
Language:English
Subjects:
Adolescent
Adult
Brain Concussion - diagnosis
Brain Concussion - therapy
Child
Child, Preschool
Concussion
Decision support systems
Decision Support Systems, Clinical
Electronic Health Records
Electronic medical records
Female
Guidelines
Humans
Infant
Male
Physicians
Practice Guidelines as Topic
Practice Patterns, Physicians
Primary care
Primary Health Care - methods
Studies
Vestibular system
Young Adult
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Summary: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.
ISSN:0009-9228
1938-2707
DOI:10.1177/0009922817709555