The project encompasses the development and implementation of an acute care, pediatric concussion clinical pathway at 5 pediatric emergency departments in the province of Alberta (Canada).
Clinical pathways (CPs) do not currently guide the care of children with concussions presenting to acute care settings in Alberta. The Alberta Health Services Maternal Newborn Child \& Youth (MNCY) Strategic Clinical Network established a work group to develop best-practice, evidence-based Clinical Practice Guidelines for the management of concussion that are being translated into specific CPs for different clinical settings. The research has three key objectives: 1. Design an evidence-based, knowledge-user informed, and theory-driven approach to implementation of a clinical pathway for acute care of pediatric concussion. Guided by the Theoretical Domains Framework (TDF), the investigators will assess barriers and facilitators likely to influence uptake of the CP in acute care settings. The results of that assessment will inform implementation strategy design, again guided by the TDF. 2. Evaluate the impact of the implementation of the CP on patient-centered outcomes using a stepped wedge cluster randomised trial. Within the context of a stepped wedge cluster randomised trial, the investigators will assess relevant process and clinical outcomes to determine whether implementation of the CP results in significant uptake of the pathway, as well as higher patient satisfaction and better health outcomes following concussion. 3. Determine whether the implementation and use of a CP for acute care of pediatric concussion is associated with changes in health care utilization and associated costs. Health care utilization and costs associated with care of concussion will be compared before and after the implementation of the CP. Utilization and costs are expected to remain stable or decline following implementation of the CP.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Enrollment
2,878
MD assessment will be partially standardized to assess for patients at higher risk of becoming persistently symptomatic. These patients scoring as 'high risk' will be referred to one of three specialty clinics. High risk is defined as scoring 9 or higher out of 12 on the 5P score.
University of Calgary
Calgary, Alberta, Canada
Process Outcome
Measurement of clinician utilization of the newly implemented clinical pathway. Clinician utilization was represented by proportion of clinician-completed 5P assessments per diagnosed concussion. Data was also collected on the number of high risk referrals made through the clinical pathway and the number of handouts provided by the clinician to patients and families.
Time frame: Through study enrollment (Jan 30 - Nov 30, 2019) 11 months
Clinical Outcome
Time to symptom resolution using weekly ratings by patients and parents of whether patient has returned to pre-injury status. Parents and children were asked asked to complete a numeric scale of 0 to 10 (where 0 is very bad and 10 is back to normal), how do you feel now?
Time frame: Through study enrollment, plus a 6 follow-up period, 15 months
Emergency Department satisfaction
Ratings of care received in the emergency department
Time frame: Through study enrollment (Jan 30 - Nov 30, 2019) 11 months
RECOVER web portal usage
Number of unique website hits per IP address
Time frame: 1 year
Adherence to discharge recommendations
Rate of patient and parent reported adherence to physician discharge instructions
Time frame: Through study enrollment (Jan 30 - Nov 30, 2019) 11 months
Rate of diagnosed concussions
Rate of diagnosed concussions per visit (as noted by billing codes)
Time frame: Through study enrollment (Jan 30 - Nov 30, 2019) 11 months
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Rate of Head CT scans ordered
Rate of CT scans ordered per diagnosed concussion
Time frame: Through study enrollment (Jan 30 - Nov 30, 2019) 11 months
Post-concussive symptom ratings
Child and parent symptoms ratings measured using the Health and Behaviour Inventory. Measured weekly from injury to resolution of symptoms.
Time frame: Through study enrollment (Jan 30 - Nov 30, 2019) 11 months
Quality of life ratings
Child and parent quality of life ratings measured by the Pediatric Quality of Life Inventory
Time frame: 4 weeks post injury