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Quality Improvement in Concussion Management: The Influence of Guideline-Based Education on Community-Practicing Pediatricians
Andrew Reisner, MD1,2,4, Thomas G. Burns, PsyD3, Kim E. Ono, PhD3 , Donna L. Murdaugh, PhD1,2, Laura S. Blackwell, PhD1,2, Larry B. Hall, MBA4, Kimberly M. Speake, BSN, RN, CPN4 , Shabnam Jain, MD2,4, Charlotte Yarrow, RN4, John Bleacher, MD4, Brad C. Weselman, MD2,4, Elizabeth Hogan, BS-HCM4, David L. Marshall, MD4, Antonius DeGrauw, MD2,4, Joshua J. Chern, MD, PhD1,4. 1Department of Neurosurgery, Emory University and Children's Healthcare of Atlanta, Atlanta, GA, USA, 2Department of Pediatrics, Emory University and Children's Healthcare of Atlanta, Atlanta, GA, USA, 3Department of Neuropsychology, Children's Healthcare of Atlanta, Atlanta, GA, USA, 4Children's Healthcare of Atlanta, Atlanta, GA, USA.

Background: Community-based pediatricians report feeling ill-equipped to manage youth concussion. Given the surging demand for pediatricians to provide concussion care, evidence-based educational interventions and decision supports are needed to improve the quality of care for concussion.

Methods: A prospective study examining the practice and quality of care of youth concussion care in the community among 210 pediatricians before and 18 months after initiation an intense, evidence-based concussion education program, initiated at a tertiary children's hospital. Statistical analysis was performed using analyses of variance (ANOVA) tests.

Results: Based on responses from 120 pediatricians participating in the two surveys and intervention (response rate 57.1%), the program had significant positive effects on knowledge of concussions (-0.26 to 0.56 on -3 to +1 scale; p<.001) from pre- to post-intervention, guideline use (0.73 to 1.06 on 0-6 scale; p<.01), and comfort level in managing concussions (3.76 to 4.16 on 1-5 scale; p<.01). Post-education, pediatricians were significantly less likely to refer for CT (1.64 to 1.07; p<.001) and CT/ED (4.73 to 3.97; p<.01).

Conclusions: Adoption of a multifaceted, evidence-based education program translated into a positive modification of practice behavior for concussion management. Community-based pediatricians showed improved use of guidelines, increased comfort level in managing concussions and more effective utilization of community resources with an approximate 35% reduction in referrals for CT and a 20% reduction in referral to both the ED and CT. The relatively rapid acceptance of these pathways may be due to the program's relevance to practice and implementation at the point of care.

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