Quality Improvement in Concussion Care: Influence of Guideline-Based Education

Published:February 21, 2017DOI:https://doi.org/10.1016/j.jpeds.2017.01.045

      Objective

      To evaluate the potential impact of a concussion management education program on community-practicing pediatricians.

      Study design

      We prospectively surveyed 210 pediatricians before and 18 months after participation in an evidence-based, concussion education program. Pediatricians were part of a network of 38 clinically integrated practices in metro-Atlanta. Participation was mandatory for at least 1 pediatrician in each practice. We assessed pediatricians' self-reported concussion knowledge, use of guidelines, and comfort level, as well as self-reported referral patterns for computed tomography (CT) and/or emergency department (ED) evaluation of children who sustained concussion.

      Results

      Based on responses from 120 pediatricians participating in the 2 surveys and intervention (response rate, 57.1%), the program had significant positive effects from pre- to postintervention on knowledge of concussions (−0.26 to 0.56 on −3 to +1 scale; P < .001), guideline use (0.73-.06 on 0-6 scale; P < .01), and comfort level in managing concussions (3.76-4.16 on 1-5 scale; P < .01). Posteducation, pediatricians were significantly less likely to self-report referral for CT (1.64-1.07; P < .001) and CT/ED (4.73-3.97; P < .01), but not ED referral alone (3.07-3.09; P = ns).

      Conclusions

      Adoption of a multifaceted, evidence-based, education program translated into a positive modification of self-reported practice behavior for youth concussion case management. Given the surging demand for community-based youth concussion care, this program can serve as a model for improving the quality of pediatric concussion management.

      Keywords

      Abbreviations:

      CHOA ( Children's Healthcare of Atlanta), CT ( Computed tomography), ED ( Emergency department), KHF ( Kids Health First Pediatric Alliance)
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