Clinical Adherence to Concussion Practice Guidelines

Objective This study aimed to assess common barriers to adherence to the Physical Therapy Concussion/Mild Traumatic Brain Injury Clinical Practice Guidelines (PTCPG) and design an action plan to address these barriers. Setting Single University Health System Participants Electronic medical record (EMR) data were collected over an initial 6-month period and then a follow-up 6-month period after the interventions. The initial period yielded an average of 129 patients with a concussion diagnosis, and the follow-up period yielded an average of 331 patients. Design Through the knowledge-to-action framework, it was identified that providers were often unaware of current practice guidelines, and some had a low comfort level with the diagnosis. Subsequent action items to address these barriers included education sessions, modification of a concussion documentation template to better align with PTCPG recommendations, and the design of a pop-up within the electronic medical records that allowed providers to create a referral to a concussion treatment network. Main Measures Frequency calculations were performed based on whether the outcome measure was performed at any time during a concussion episode of care. Selection of outcome measures was determined by what outcome measures were available for use within the EMR and aligned with the PTCPG recommended system domains. Data was collected from the following providers: physical therapists, occupational therapists, sports medicine physicians and physical medicine & rehab physicians. Results From the initial EMR query to the follow-up, the following increases in use of outcome measures were seen with each outcome measure, Post-Concussion Symptom Scale (PCSS) = 10.0%, Cervical & Thoracic Screen = 6.0%, Vestibular Ocular Motor Screen (VOMS) = 12.6%, Modified Orthostatic Vital Signs (MOVS) = 18.9%, Buffalo Concussion Treadmill Test (BCTT) = 3.5%, Balance Error Scoring System (BESS) = -4.8%, Sensory Organization Test (SOT) = 0.9%. Conclusion The improvement in adherence to recommendations was attributed to a knowledge to action approach that combined education along with structural changes to electronic medical record documentation.