A Chair’s Initiative at CHOP

In 2011, in order to continue to provide a high level of care to Children's Hospital of Philadelphia (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 and the CHOP Minds Matter Concussion Program, a comprehensive pediatric concussion management program, began.

Minds Matter Concussion Program at CHOP

The objective of this effort was to ensure that all concussion patients seen within the CHOP network were receiving similar high quality care by developing a clinical practice model, standardizing assessment tools, training providers and providing education to families and other stakeholders regarding what to expect if their child sustains a concussion. An initial two-year project, led by Kristy Arbogast, PhDChristina L. Master, MD, and Matthew Grady, MD and funded by CHOP Department of Pediatrics Chair’s Initiatives, was accomplished in several phases.

Phases of Project

Phase I (Formative) 

This phase comprehensively characterized the current state of pediatric concussion 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) 

This phase was conducted in 2012 and involved developing 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 Network providers on its use. Critical components of the new practice model included electronic health record (her) 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 positive 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) 

During this phase an internet-based resource was developed to explain Minds Matter: Concussion Care at CHOP to 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)

Researchers developed the architecture of a prospective clinical database on pediatric concussion that will be instrumental in informing future clinical, research, and quality improvement initiatives during this final phase of the project. By capturing a standardized and comprehensive data set on every child with concussion, we are forming a valuable resource which can be utilized to answer other important questions about prevention, diagnosis and management of this common injury.