Implementing An interdisciplinary Concussion Clinic : Application of Best Practice
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Résumé
Background: Concussion/Mild traumatic brain injury (mTBI) is a significant cause of morbidity and mortality, with many survivors dealing with persisting difficulties for years post-injury. One Canadian study examining both hospital-treated cases as well as those presenting to a family physician calculated the incidence of mTBI in Ontario to lie between 493 and 653/100,000 (Rhy, 2009). Approximately 66% of patients with mild concussion will recover in approximately 2-4 weeks with follow up from their GP or primary care giver. About 33% will experience more persistent symptoms requiring further assessment and support. Of that group, another 50% of may experience persisting symptoms beyond 3 months. The consequences for these individuals may include physical, cognitive, emotional and behavioural symptoms resulting in reduced functional ability, heightened emotional distress, and delayed return to work or school. These patients require more specialized management to assist in the returning to their pre injury activities. Intervention: Due to an identified gap in service in the South Central Ontario region, a comprehensive, interdisciplinary outpatient clinic was established for the assessment, diagnosis and treatment (including disposition to the appropriate follow-up resource), of patients with mild head injury/concussion. The features of the clinic and the model of care are consistent with the Ontario Neurotrauma Foundation (ONF) Standards of Post-Concussion Care (2017). The interdisciplinary care model is unique in that assessments are done collaboratively, leveraging the specific expertise of each discipline (neurology, physiatry, neuropsychology, nursing and others) in making an accurate diagnosis and determining a plan of care. Further, because this clinic is located at a regional center, consultations/referrals to neurosurgeons and trauma specialists are more easily facilitated when needed. Outcomes: Currently, the clinic operates 1 day/week. In the first 4 months of operation, 288 referrals have been received with approximately 16-20 patients seen daily. Wait time to be seen post injury has been reduced from several weeks to 3-5 days. Expected patient outcomes include: shorter/more effective recovery, hospital avoidance, less long term symptoms/sequelae, quicker reintegration into the community, less lost time at work; increased productivity. Health system outcomes include: decreased demand on ED and other acute care resources, increased skill capacity in the community as follow-up teaching and referral is completed, improved utilization of existing community resources to support patients in their recovery journey.
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Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,005 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,002 | 0,000 |
| Bibliométrie | 0,021 | 0,011 |
| Études des sciences et des technologies | 0,002 | 0,002 |
| Communication savante | 0,005 | 0,043 |
| Science ouverte | 0,016 | 0,046 |
| Intégrité de la recherche | 0,001 | 0,003 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,020 | 0,018 |
Scores machine (provisoires)
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Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
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