Increasing Utilization of the Preparticipation Physical Evaluation.

Area of Science:

• Sports Medicine
• Pediatric Cardiology
• Quality Improvement in Healthcare

Background:

• The American Heart Association and American Academy of Pediatrics recommend preparticipation physical evaluations (PPE) to identify risks of sudden cardiac arrest in student athletes.
• Despite recommendations, PPE utilization remains suboptimal, necessitating strategies to improve its implementation in clinical practice.

Purpose of the Study:

• To identify barriers to preparticipation physical evaluation (PPE) use and enhance its utilization among student athletes.
• To implement and assess the effectiveness of quality improvement (QI) methodologies in increasing the documentation of PPE elements.

Main Methods:

• Analysis of documented PPE elements during well-care visits for patients aged 12-18 years across five primary care practices.
• Implementation of plan-do-study-act (PDSA) cycles within one practice to improve PPE element documentation, followed by expansion of interventions to four additional practices.

Main Results:

• Baseline documentation averaged 3.5 out of 14 PPE elements. Following QI interventions, the initial practice increased addressed elements from 2.5 to 14 over 18 months.
• Complete PPE documentation increased from a median of 10.0% to 70.0% across five practices within 12 months of intervention spread.
• Post-intervention, 75% of patients required cardiology follow-up compared to 14% pre-intervention, indicating improved risk identification.

Conclusions:

• The preparticipation physical evaluation (PPE) is an effective, though underutilized, tool for screening sudden cardiac arrest risk in student athletes.
• Quality improvement (QI) methodology proved instrumental in enhancing PPE utilization within the primary care setting, thereby improving athlete health surveillance.