Improving Primary Care Provider Practices in Youth Concussion Management

Area of Science:

• Pediatrics
• Neurology
• Primary Care Medicine

Background:

• Primary care providers (PCPs) manage pediatric concussions but face time and training limitations.
• This hinders the adoption of evidence-based concussion care best practices.
• Pediatric concussion management requires specific examinations and guideline discussions.

Purpose of the Study:

• To assess the impact of a primary care-based intervention on concussion management.
• To improve the documentation of vestibular oculomotor examinations and return-to-learn/return-to-play (RTL/RTP) guidelines.
• To evaluate the effectiveness of an electronic health record (EHR)-based clinical decision support tool combined with training.

Main Methods:

• An intervention involving an EHR-based SmartSet tool and in-person training was implemented.
• The study analyzed data from 7284 pediatric patients (0-17 years) with initial concussion visits.
• Proportions of visits documenting key practices were compared pre- and post-intervention.

Main Results:

• Documentation of vestibular oculomotor examinations increased from 1.8% to 71.1%.
• Documentation of RTL/RTP guidelines increased from 19.0% to 72.9%.
• 95% of post-intervention examinations were documented using the SmartSet tool.

Conclusions:

• An EHR-based clinical decision support tool, coupled with training, can significantly improve PCP concussion care practices.
• This intervention demonstrates a scalable approach to enhancing pediatric concussion management in primary care settings.
• The SmartSet tool was instrumental in driving the adoption of best practices for concussion care.