Improving Primary Care Provider Practices in Youth Concussion Management

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.

Figure 1

Monthly rate of performance of the vestibular oculomotor examination during concussion primary care visits (pre- and post-intervention) and proportion of those examinations documented within the SmartSet template.

Figure 2

Monthly rate of provision of return-to-learn/return-to-play (RTL/RTP) guidelines during concussion primary care visits (pre- and post-intervention) and proportion of those guidelines documented within the SmartSet template.