Dataset Information

Health care impact of implementing a clinical pathway for acute care of pediatric concussion: a stepped wedge, cluster randomised trial.

ABSTRACT:

Objectives

To test the effects of actively implementing a clinical pathway for acute care of pediatric concussion on health care utilization and costs.

Methods

Stepped wedge, cluster randomized trial of a clinical pathway, conducted in 5 emergency departments (ED) in Alberta, Canada from February 1 to November 30, 2019. The clinical pathway emphasized standardized assessment of risk for persistent symptoms, provision of consistent information to patients and families, and referral for outpatient follow-up. De-identified administrative data measured 6 outcomes: ED return visits; outpatient follow-up visits; length of ED stay, including total time, time from triage to physician initial assessment, and time from physician initial assessment to disposition; and total physician claims in an episode of care.

Results

A total of 2878 unique patients (1164 female, 1713 male) aged 5-17 years (median 11.00, IQR 8, 14) met case criteria. They completed 3009 visits to the 5 sites and 781 follow-up visits to outpatient care, constituting 2910 episodes of care. Implementation did not alter the likelihood of an ED return visit (OR 0.77, 95% CI 0.39, 1.52), but increased the likelihood of outpatient follow-up visits (OR 1.84, 95% CI 1.19, 2.85). Total length of ED stay was unchanged, but time from physician initial assessment to disposition decreased significantly (mean change - 23.76 min, 95% CI - 37.99, - 9.52). Total physician claims increased significantly at only 1 of 5 sites.

Conclusions

Implementation of a clinical pathway in the ED increased outpatient follow-up and reduced the time from physician initial assessment to disposition, without increasing physician costs. Implementation of a clinical pathway can align acute care of pediatric concussion more closely with existing clinical practice guidelines while making care more efficient.

Trial registration

ClinicalTrials.gov NCT05095012.

SUBMITTER: Yeates KO

PROVIDER: S-EPMC10333406 | biostudies-literature | 2023 Jul

REPOSITORIES: biostudies-literature

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Publications

Health care impact of implementing a clinical pathway for acute care of pediatric concussion: a stepped wedge, cluster randomised trial.

Yeates Keith Owen KO Barlow Karen M KM Wright Bruce B Tang Ken K Barrett Olesya O Berdusco Edward E Black Amanda M AM Clark Brenda B Conradi Alf A Godfrey Heather H Kolstad Ashley T AT Ly Anh A Mikrogianakis Angelo A Purser Ross R Schneider Kathryn K Stang Antonia S AS Zemek Roger R Zwicker Jennifer D JD Johnson David W DW

CJEM 20230623 7

<h4>Objectives</h4>To test the effects of actively implementing a clinical pathway for acute care of pediatric concussion on health care utilization and costs.<h4>Methods</h4>Stepped wedge, cluster randomized trial of a clinical pathway, conducted in 5 emergency departments (ED) in Alberta, Canada from February 1 to November 30, 2019. The clinical pathway emphasized standardized assessment of risk for persistent symptoms, provision of consistent information to patients and families, and referral ...[more]

PMID: 37351798

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Dataset Information

Health care impact of implementing a clinical pathway for acute care of pediatric concussion: a stepped wedge, cluster randomised trial.

Objectives

Methods

Results

Conclusions

Trial registration

Publications

Health care impact of implementing a clinical pathway for acute care of pediatric concussion: a stepped wedge, cluster randomised trial.

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