In fiscal year 2013, Children's Hospital of Philadelphia (CHOP) clinicians reported 12,500 visits from 4,700 patients diagnosed with concussion within the CHOP Care Network (primary care, specialty care, and the emergency department). This represents a greater than 600% increase in visits for concussion from fiscal year 2009. In 2011, in order to continue to provide a high level of care to CHOP patients, CIRP partnered with CHOP Sports Medicine and Performance Center to coordinate efforts to develop a new model of care for concussion in children. (Abstracted from Pediatric Annals, Sept. 2012)
Minds Matter: Improving Pediatric Concussion Management
The objective of this project was to prevent the long-term consequences associated with mTBI (mild traumatic brain injury), or concussion, in children by developing a comprehensive pediatric concussion management program for CHOP. An initial two-year project was accomplished in several phases:
Phase I (Formative) -
Comprehensively characterized the current state of pediatric mTBI management within the CHOP Care Network, including primary care, emergency care, specialty care, and after-hours services. Read a study abstract on providers' self- reported knowledge, practice and attitudes on concussion; and a study abstract on primary care providers' experience with prescribing cognitive rest.
Phase II (Intervention development) -
Used current evidence and best practices, as summed up in five feature articles and a guest editorial in a special issue of Pediatric Annals in 2012, to develop a clinical practice model for diagnosis, treatment and follow-up management. On the local level, the model was accompanied by appropriate hands-on training for CHOP Care providers on its use. Critical components of the new practice model included EHR diagnostic and management support tools (“smart set” prompts), modifications to the Emergency department clinical pathways and After-hours triaging process.
Several post-implementation analyses of clinical practices have been conducted, including an evaluation that reported the postive impact of the EHR-based intervention on key primary care provider practices.(See study abstract.) One other review of the electronic medical records before- and after-implementation of the revised after-hours call center triage algorithm, which refers patients with a suspected concussion to a primary care provider within 24 hours, showed a significant increase in PCP referrals and increase in concussion diagnoses. ED visits and CT-use visits decreased, but differences were not statistically significant. (See study abstract.)
Phase III (Patient family education) -
Developed an internet-based resource on comprehensive concussion care for parents, healthcare providers, athletic coaching and training staff, and school personnel. Visitors to the website can download educational resources such as video FAQs, infographics, posters and fact sheets.
Phase IV - (Concussion registry development)
Develop the architecture of a prospective clinical database on pediatric mTBI which will be instrumental in informing future clinical, research, and quality improvement initiatives. This phase is in progress: See Concussion Registry Development
Principal Investigators: Kristy Arbogast, PhD, Christina L. Master, MD, Matthew Grady, MD
Funding: Children's Hospital of Philadelphia Department of Pediatrics Chair’s Initiatives