Increasing Primary Care Follow-up after Preparticipation Physical Evaluations

Abstract

Preparticipation physical evaluations (PPEs) strive to prevent injuries and sudden death in athletes. Ideally, the medical home is the best setting for completion. However, many school systems request large PPE screenings for their student-athletes. This quality-improvement project aimed to increase primary care provider (PCP) follow-up for athletes "cleared with recommendation" (CR) or "disqualified" (DQ) during our mass PPEs.

Methods: Our team evaluated prior PPE data for athlete clearance and PCP follow-up for CR or DQ athletes. The prominent gaps in our PPEs were resident education, PCP or medical home identification, and communication. Our team implemented interventions during the 2018 PPEs to increase both CR and DQ athlete follow-up at the medical home.

Results: Retrospective baseline data revealed that physicians categorized 11% (67/582) of athletes at our PPEs as CR or DQ. Of these athletes, the PCP and specialist follow-up rate was 13% (9/67). Our process changed to enhance athlete follow-up, but the rate only increased slightly to 15% (18/120). Medical home identification improved. Successful interventions included resident education, medical home identification, and increased communication.

Conclusions: Despite our interventions, this quality-improvement initiative was unsuccessful in reaching the aim. This project found small achievements in educational opportunities, improved documentation, medial home identification for student-athletes, and lead to local changes in our standard operating procedures. Although our aim was ambitious, 100% athlete follow-up with the PCP or medical home ensures athletic safety and decreases liability for all.

Fig. 1.

Process map. Patient flow depicted during mass preparticipation physical evaluations. The QI team utilized this process map to identify key drivers and formulate initiatives for the project. A, The process map outlines athlete flow from check-in to checkout. B, The process map denotes potential sources of error marked with a black “x”.

Fig. 2.

Key driver diagram. The key driver diagram demonstrates 3 drivers for this quality-improvement initiative: resident education, primary care provider/medical home identification, and communication.