School of Clinical Sciences, Faculty of Health and Environmental Science, TBI Network, Auckland University of Technology, AR238, AUT North Campus, Auckland, New Zealand.
Accident Compensation Corporation, Dunedin, New Zealand.
J Prim Health Care. 2024 Sep;16(3):308-314. doi: 10.1071/HC23131.
Introduction Best-practice guidelines recommend that patients are followed-up to check if they have recovered following a mild traumatic brain injury (mTBI) and to refer to concussion services, if needed. However, in New Zealand, rates of follow-up are low and access to concussion services can be delayed. Aim We aimed to improve rates of follow-up and access to concussion services for mTBI patients aged ≥8 years by the implementation of a supported health pathway and test its success. Methods The pathway included a decision support tool, funded follow-up appointments, clinician training and a patient education resource. Sociodemographics, injury details and proportions of patients receiving a follow-up by type and time were extracted from the Accident Compensation Corporation (ACC) database between 18 May 22 and 30 June 23 and compared to national ACC data prior to implementation. Results Data were extracted for 220 patients, with a mean age of 31.5 years, 51.4% female and 21.4% Māori and Pacific. There was an increase in the proportion of patients receiving a follow-up from 36% pre-implementation to 56.8% post-implementation. Sixty-three patients (28.6%) accessed a concussion service post-implementation compared to 10% pre-implementation. Time to concussion service reduced from an average of 55 (s.d. = 65.4) to 37 days (29.5). Discussion Risk factor criteria within the decision support tool need to be weighted to improve specificity of referrals. Timing from injury to medical review in primary care needs to be considered. This quality improvement project provides preliminary evidence for implementation of a supported health care pathway for mTBI.
介绍
最佳实践指南建议对轻度创伤性脑损伤 (mTBI) 患者进行随访，以检查他们是否已康复，并在需要时转至脑震荡服务。然而，在新西兰，随访率较低，脑震荡服务的可及性可能会延迟。
目的
我们旨在通过实施支持性健康途径来提高 mTBI 患者（年龄≥8 岁）的随访率和获得脑震荡服务的机会，并检验其成功。
方法
该途径包括决策支持工具、有资金支持的随访预约、临床医生培训和患者教育资源。从 2022 年 5 月 18 日至 2023 年 6 月 30 日，从事故赔偿公司 (ACC) 数据库中提取社会人口统计学、损伤细节和按类型和时间接受随访的患者比例，并与实施前的国家 ACC 数据进行比较。
结果
共提取了 220 名患者的数据，平均年龄为 31.5 岁，女性占 51.4%，毛利人和太平洋岛民占 21.4%。实施后接受随访的患者比例从实施前的 36%增加到 56.8%。实施后有 63 名患者（28.6%）接受了脑震荡服务，而实施前为 10%。从受伤到初级保健医疗审查的时间从平均 55 天（标准差=65.4）减少到 37 天（29.5）。
讨论
决策支持工具中的风险因素标准需要加权，以提高转诊的特异性。需要考虑从受伤到初级保健医疗审查的时间。这个质量改进项目为 mTBI 实施支持性医疗保健途径提供了初步证据。
