title: Quality Improvement in Concussion Care: Influence of Guideline-Based Education.
abstract: To evaluate the potential impact of a concussion management education program on community-practicing pediatricians.
  
  
  
  We prospectively surveyed 210 pediatricians before and 18 months after participation in an evidence-based, concussion education program. Pediatricians were part of a network of 38 clinically integrated practices in metro-Atlanta. Participation was mandatory for at least 1 pediatrician in each practice. We assessed pediatricians' self-reported concussion knowledge, use of guidelines, and comfort level, as well as self-reported referral patterns for computed tomography (CT) and/or emergency department (ED) evaluation of children who sustained concussion.
  
  
  
  Based on responses from 120 pediatricians participating in the 2 surveys and intervention (response rate, 57.1%), the program had significant positive effects from pre- to postintervention on knowledge of concussions (-0.26 to 0.56 on -3 to +1 scale; P < .001), guideline use (0.73-.06 on 0-6 scale; P < .01), and comfort level in managing concussions (3.76-4.16 on 1-5 scale; P < .01). Posteducation, pediatricians were significantly less likely to self-report referral for CT (1.64-1.07; P < .001) and CT/ED (4.73-3.97; P < .01), but not ED referral alone (3.07-3.09; P = ns).
  
  
  
  Adoption of a multifaceted, evidence-based, education program translated into a positive modification of self-reported practice behavior for youth concussion case management. Given the surging demand for community-based youth concussion care, this program can serve as a model for improving the quality of pediatric concussion management.
authors.affiliation: Department of Neurosurgery, Children's Healthcare of Atlanta, Atlanta, GA; Department of Pediatrics, Emory University and Children's Healthcare of Atlanta, Atlanta, GA. Electronic address: Andrew.Reisner@choa.org.
authors.forename: Andrew
authors.initials: A
authors.lastname: Reisner
authors.affiliation: Department of Neuropsychology, Children's Healthcare of Atlanta, Atlanta, GA.
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Burns
authors.affiliation: Department of Neurosurgery, Children's Healthcare of Atlanta, Atlanta, GA.
authors.forename: Larry B
authors.initials: LB
authors.lastname: Hall
authors.affiliation: Department of Pediatrics, Emory University and Children's Healthcare of Atlanta, Atlanta, GA.
authors.forename: Shabnam
authors.initials: S
authors.lastname: Jain
authors.affiliation: Kids Health First Network, Atlanta, GA.
authors.forename: Brad C
authors.initials: BC
authors.lastname: Weselman
authors.affiliation: Department of Pediatrics, Emory University and Children's Healthcare of Atlanta, Atlanta, GA.
authors.forename: Ton J
authors.initials: TJ
authors.lastname: De Grauw
authors.affiliation: Department of Neuropsychology, Children's Healthcare of Atlanta, Atlanta, GA.
authors.forename: Kim E
authors.initials: KE
authors.lastname: Ono
authors.affiliation: Department of Neuropsychology, Children's Healthcare of Atlanta, Atlanta, GA.
authors.forename: Laura S
authors.initials: LS
authors.lastname: Blackwell
authors.affiliation: Department of Neurosurgery, Children's Healthcare of Atlanta, Atlanta, GA.
authors.forename: Joshua J
authors.initials: JJ
authors.lastname: Chern
mesh_terms: D000328:Adult; D000368:Aged; D001924:Brain Concussion / Q000628:therapy*; D002648:Child; D006801:Humans; D008875:Middle Aged; D010372:Pediatrics / Q000193:education*; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D058996:Quality Improvement; D057566:Self Report
keywords: community practice; computed tomography; concussion; continuing education; evidence-based guidelines; pediatrician; primary care provider; quality improvement