Improving Pediatric Concussion Management in the Primary Care Setting.

Abstract

Pediatric concussion is a common condition, yet limited standardization in its evaluation and management within primary care-where most patients initially present-can result in delayed recovery, prolonged symptoms, inconsistent guidance on returning to school and play/sport, and increased disparities in care. We aimed to increase to 70% the proportion of patients with concussion presenting to primary care who (1) completed a standardized concussion symptom scale (PCSS); (2) received educational and instructional materials after the initial visit; and (3) were seen for concussion follow-up within 2 weeks if indicated. At 2 hospital-affiliated primary care clinics, we implemented a multidisciplinary process improvement initiative using Plan-Do-Study-Act cycles within the Model for Improvement framework. Interventions included creating a clinical pathway, integrating the PCSS into the electronic medical record, creating a standardized instruction auto-text, and conducting staff education. We monitored monthly screening, education/instruction, and follow-up rates using statistical process control charts. Measures were stratified by patient language, race/ethnicity, and insurance status. PCSS use increased from 37% to 85% (1348 total visits), distribution of education/instructions increased from 42% to 83%, and follow-up visit completion improved from 47% to 71%. Notably, disparities based on language and insurance status observed at baseline in PCSS use and distribution of written instructions were attenuated. Emergency department use was unchanged. This multifaceted interdisciplinary improvement effort standardized concussion evaluation and management in primary care, improving adherence to best practices and reducing disparities. Future work should investigate the impact of care standardization on clinical outcomes and patient recovery.