title: Impact of Co-management at the Primary-Subspecialty Care Interface on Follow-up and Referral Patterns for Patients With Concussion.
abstract: BACKGROUND
  Co-management is a collaborative care model that consists of structured tools to define and document care delivered by 2 or more providers. We evaluated the impact of implementing co-management at the interface between pediatric primary care providers (PCPs) and subspecialists.
  
  
  METHODS
  Participating PCPs (n = 9) were trained on management of concussion using the co-management tools. Co-managed patients with concussion were prospectively enrolled (n = 148) and compared to a retrospective audit of non-co-managed patients (n = 50).
  
  
  RESULTS
  PCPs using co-management demonstrated adherence to the tools. PCPs were significantly more likely to provide follow-up care to patients when using the co-management tools. All participating PCPs reported that co-management enhanced their expertise in caring for patients with concussion.
  
  
  CONCLUSIONS
  Co-management can enhance PCPs' capacity to independently manage the care of patients with concussion. Co-management led to an observed change in practice that merits further exploration in terms of cost, quality, and clinical outcomes.
authors.affiliation: Office for Community Child Health, Connecticut Children's Medical Center, Hartford, CT, USA.
authors.forename: Eminet Abebe
authors.initials: EA
authors.lastname: Feyissa
authors.affiliation: Department of Research, Connecticut Children's Medical Center, Hartford, CT, USA.
authors.forename: Erin
authors.initials: E
authors.lastname: Cornell
authors.affiliation: Boston Children's Hospital, Boston, MA, USA.
authors.forename: Laura
authors.initials: L
authors.lastname: Chandhok
authors.affiliation: Elite Sports Medicine, Connecticut Children's Medical Center, Hartford, CT, USA.
authors.forename: David
authors.initials: D
authors.lastname: Wang
authors.affiliation: Neurology, Seattle Children's Hospital, Seattle, WA, USA.
authors.forename: Cristian
authors.initials: C
authors.lastname: Ionita
authors.affiliation: University of Connecticut School of Medicine, Farmington, CT, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Schwab
authors.affiliation: Elite Sports Medicine, Connecticut Children's Medical Center, Hartford, CT, USA.
authors.forename: Regina
authors.initials: R
authors.lastname: Kostyun
authors.affiliation: ProHealth Physicians Inc, Children's Medical Group, Bloomfield, CT, USA.
authors.forename: Felicia
authors.initials: F
authors.lastname: Wilion
authors.affiliation: Division of Endocrinology, Connecticut Children's Medical Center, Hartford, CT, USA KRubin@connecticutchildrens.org.
authors.forename: Karen
authors.initials: K
authors.lastname: Rubin
mesh_terms: D000293:Adolescent; D001924:Brain Concussion / Q000628:therapy*; D002648:Child; D003299:Cooperative Behavior; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008962:Models, Theoretical; D010348:Patient Care Team; D010372:Pediatrics; D058007:Physicians, Primary Care; D011446:Prospective Studies; D011787:Quality of Health Care
keywords: concussion; medical home; primary care; specialty care