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

A. Theadom; J. Chua; A. Sintmaartensdyk; S. Kara; R. Barnes; R. Macharg; E. Leckey; A. Mirza

doi:10.1071/HC23131

RESEARCH ARTICLE (Open Access)

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

A. Theadom

¹ ^* , J. Chua ¹ , A. Sintmaartensdyk ² , S. Kara ³ ⁴ , R. Barnes ⁵ , R. Macharg ⁶ , E. Leckey ⁵ , A. Mirza ⁷

+ Author Affiliations

- Author Affiliations

¹ School of Clinical Sciences, Faculty of Health and Environmental Science, TBI Network, Auckland University of Technology, AR238, AUT North Campus, Auckland, New Zealand.

² Accident Compensation Corporation, Dunedin, New Zealand.

³ Axis Sports Medicine Specialists, Auckland, New Zealand.

⁴ ProCare, Auckland, New Zealand.

⁵ Pegasus Health, Canterbury, New Zealand.

⁶ WellSouth Primary Health Network, Dunedin, New Zealand.

⁷ Manage My Health, Auckland, New Zealand.

^* Correspondence to: alice.theadom@aut.ac.nz

Handling Editor: Tim Stokes

Journal of Primary Health Care 16(3) 308-314 https://doi.org/10.1071/HC23131

Submitted: 12 October 2023 Accepted: 8 February 2024 Published: 4 March 2024

© 2024 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of The Royal New Zealand College of General Practitioners. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)

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.

Keywords: assessment, clinical decision support, concussion, general practice, mild traumatic brain injury, primary care, screening, TBI.

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