A new study from Children’s Hospital of Philadelphia (CHOP) and the Centers for Disease Control and Prevention (CDC) has demonstrated the utility and effectiveness of electronic health record (EHR)–based clinical decision support tools to improve clinician behaviors around concussion diagnosis. As reported in the journal Clinical Pediatrics, the provision of the tools, coupled with in–person training led to an 85 percent increase in clinicians documenting a vestibular oculomotor exam and a 129 percent increase in their reporting return–to–learn and return–to–play guidelines discussion with patient families, two recommended concussion management strategies.

During the study period, July 1, 2010, to June 30, 2014, researchers identified and followed 14,527 concussion–related primary care office visits for 7,284 unique patients, mostly between the ages of 5 to 19 years old. EHR–based clinical support tools have the potential to facilitate structured screening and diagnostic assessments, as well as enable systematic documentation across a broad healthcare network.

“Historically, integrating new evidence into provider behavior can take many years. However, we demonstrated a rather robust and quick uptake of several recommended clinical strategies, even ones new to many primary care providers,” says Kristy Arbogast, PhD, lead author and co–director of CHOP’s Center for Injury Research and Prevention. “The EHR platform allowed us to provide clinical practice guidance across our geographically and socio–economically diverse network, and promote systematic implementation and documentation of emerging recommended practices. We want all patients to get ‘CHOP–level care’ no matter where they enter our system.”

The study’s results highlight that in the two years leading up to the intervention, neither management strategy was implemented and documented consistently or systematically. In the pre–intervention period, performance of the vestibular oculomotor exam was documented in the EHR for only 1.8 percent of concussion visits. In contrast, 71 percent of visits in the post–intervention period included evidence of this exam for an overall 129 percent increase from July 2012 to June 2014.

During the pre–intervention period, 19 percent of concussion visits included EHR documentation of sharing return–to–learn and return–to–play guidelines. In contrast, in the post–intervention period these phrases were found in 73 percent of EHRs for a total increase of 85 percent.

The vast majority of exams performed in the post–intervention period (95 percent) were documented within a “Concussion SmartSet” template in CHOP’s electronic health record system, EpicCare®, showing that the template facilitated performance and systematic documentation of the exam components.

Large and small health networks and practices can use the emerging evidence base in concussion to develop their own clinical guidelines and pathways. The Concussion Care for Kids: Minds Matter website from CHOP has resources that are freely available for use.