A supported primary health pathway for mild traumatic brain injury quality improvement report.

IF 1.1 Q4 PRIMARY HEALTH CARE Journal of primary health care Pub Date : 2024-09-01 DOI:10.1071/HC23131
A Theadom, J Chua, A Sintmaartensdyk, S Kara, R Barnes, R Macharg, E Leckey, A Mirza
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Abstract

Introduction Best-practice guidelines recommend that patients are followed-up to check if they have recovered following a mild traumatic brain injury (mTBI) and to refer to concussion services, if needed. However, in New Zealand, rates of follow-up are low and access to concussion services can be delayed. Aim We aimed to improve rates of follow-up and access to concussion services for mTBI patients aged ≥8 years by the implementation of a supported health pathway and test its success. Methods The pathway included a decision support tool, funded follow-up appointments, clinician training and a patient education resource. Sociodemographics, injury details and proportions of patients receiving a follow-up by type and time were extracted from the Accident Compensation Corporation (ACC) database between 18 May 22 and 30 June 23 and compared to national ACC data prior to implementation. Results Data were extracted for 220 patients, with a mean age of 31.5 years, 51.4% female and 21.4% Māori and Pacific. There was an increase in the proportion of patients receiving a follow-up from 36% pre-implementation to 56.8% post-implementation. Sixty-three patients (28.6%) accessed a concussion service post-implementation compared to 10% pre-implementation. Time to concussion service reduced from an average of 55 (s.d. = 65.4) to 37 days (29.5). Discussion Risk factor criteria within the decision support tool need to be weighted to improve specificity of referrals. Timing from injury to medical review in primary care needs to be considered. This quality improvement project provides preliminary evidence for implementation of a supported health care pathway for mTBI.

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轻度脑外伤辅助初级保健路径质量改进报告。
导言:最佳实践指南建议对患者进行随访,以检查他们在轻微创伤性脑损伤(mTBI)后是否已经康复,并在必要时转诊至脑震荡服务机构。然而,在新西兰,随访率很低,脑震荡服务的提供也可能被延迟。目的 我们旨在通过实施辅助健康路径,提高年龄≥8 岁的 mTBI 患者的随访率和脑震荡服务的获得率,并测试其成功率。方法 该路径包括决策支持工具、资助随访预约、临床医生培训和患者教育资源。从事故赔偿公司(ACC)的数据库中提取了 22 年 5 月 18 日至 23 年 6 月 30 日期间的社会人口统计数据、受伤详情以及按类型和时间接受随访的患者比例,并与实施前的全国 ACC 数据进行了比较。结果 提取了220名患者的数据,他们的平均年龄为31.5岁,51.4%为女性,21.4%为毛利人和太平洋岛屿族裔。接受随访的患者比例从实施前的 36% 增加到实施后的 56.8%。63名患者(28.6%)在实施后获得了脑震荡服务,而实施前这一比例为10%。接受脑震荡治疗的时间从平均 55 天(s.d. = 65.4)缩短至 37 天(29.5)。讨论 需要对决策支持工具中的风险因素标准进行加权,以提高转诊的特异性。需要考虑从受伤到初级保健医疗审查的时间。该质量改进项目为实施 mTBI 辅助医疗路径提供了初步证据。
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来源期刊
Journal of primary health care
Journal of primary health care PRIMARY HEALTH CARE-
CiteScore
2.70
自引率
16.70%
发文量
79
审稿时长
28 weeks
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