The Virtual Concussion Care Model That’s Improving Access and Outcomes
With concussions, the time to definitive care matters. The faster a patient can receive care from a specialty concussion clinic, the more likely it is that they’ll recover earlier and have a better outcome.
But, nationwide, many patients can’t access concussion care quickly. It’s common for patients to have their initial in-person evaluation an extended period of time after the injury. Time to definitive care is generally longer for underserved groups.
That’s why neuropsychologist Scott Burkhart, Psy.D., and his team at Children’s Health℠ Andrews Institute for Orthopaedics & Sports Medicine launched one of the nation’s first virtual concussion care models that engages patients virtually through the entire continuum of care.
“We’re constantly researching and developing new ways to help patients recover and heal from concussions as quickly as possible,” Dr. Burkhart says. “A big piece of that is ensuring our patients can access the concussion care they need, when they need it. With our virtual care model, we can provide access for a lot more people, while achieving the same or better recovery times and patient outcomes as our in-person care.”
Refining Our In-Person Concussion Care Model
In 2017, the team began their mission to develop a virtual concussion care model by refining their screening methodology at in-person visits.
“We started by gathering extensive data on our concussion patients,” Dr. Burkhart says, “There’s yet to be an adopted care model for concussion treatment, so our idea was to use this initial research to refine our methodology for in-person visits and then adapt that successful model for our virtual care.”
Concussion screening includes tests that gauge ocular function, vestibular function, cognitive function and reaction time. Based on how a patient responds to those tests, the treatment plan typically includes a rest approach, which means taking time off from sports and limiting specific academic activities, and a rehabilitative approach with therapeutic exercises.
“We analyzed about 1,000 concussion patients, and we learned a lot about what matters at the time of their initial evaluation in terms of their recovery,” says Dr. Burkhart. “We were able to see correlations between specific symptoms and recovery time so we could better define the treatment plan to achieve the best outcomes. We could be more targeted on the number of days patients need to refrain from some activities, which therapeutic exercises they need at each point in their recovery and when they need follow-up visits.”
The next natural step was to adapt their in-person model to provide virtual access through the entire continuum of care.
Adapting for Virtual Care
In 2019, Children’s Health Andrews Institute launched a virtual concussion care model that engages patients virtually from the initial evaluation through the recovery period.
Many aspects of the in-person care model transferred directly to virtual, like the standard clinical interview that asks preliminary questions about patient history and the concussion, while other steps of the clinical process needed to be slightly adjusted.
For example, some screening tests require the patient to have materials on hand, like a ruler, pen and paper, in order to complete the test virtually. Before the initial virtual visit, the patient receives an email instructing them to have those materials available, preparing them for the tests they’ll be asked to do and providing them with tips to ensure a stable internet connection and clear video conferencing.
“Our process for this upfront patient education has evolved in the past two years,” Dr. Burkhart says. “We know that we can’t send a ton of information and expect that they’re going to read it all before the appointment, so we keep it clear and concise, and patients are responsive to that and come prepared.”
Occasionally, a patient will join a video call, and their full face isn’t visible in the camera or there isn’t a clear picture. When that happens, the provider takes a few minutes at the beginning of the call to walk them through any necessary adjustments. Then the provider goes through the virtual visit, evaluating the patient almost exactly like an in-person visit.
“We’re taking notes throughout the assessment, just like we would in person, and we can certainly look at motor function and everything we need from a neurological standpoint through the camera,” Dr. Burkhart says.
After the screening, the provider gives a personalized treatment plan. The provider demonstrates any rehabilitative exercises virtually, and the patient receives an email that outlines the protocols to follow and next steps for follow-up visits.
Faster Access to Care Leads to Faster Recovery
In June 2021, the team conducted a preliminary study to compare the outcomes of virtual patients to in-person patients in the past two years. The initial data is promising.
Virtual patients are recovering a median of 15 days after the first visit compared to 16 days for in-person patients. Virtual patients are also requiring 1-2 visits on average while in-person patients typically require 2-3.
Today, a patient can call to schedule an appointment at our clinic – whether it be in-person or virtual – and within 15 minutes, they’ll have an appointment to be seen the same day or next day. Dr. Burkhart and his team think that this quick access to care is the key contributing factor to better outcomes with virtual visits.
“We think virtual patients are recovering slightly faster with fewer visits because they have faster access to care when they need it,” Dr. Burkhart says. “They don’t have to wait for a parent to take off work so they can come to an appointment, and they don’t feel obligated to book a follow-up appointment on their way out of an in-person visit just to have it on the calendar. Virtual patients can book their follow-up visits based on the symptoms and outcomes they’re experiencing in their recovery. ”
Changing Concussion Care Today and Tomorrow
When it comes to using technology to improve access and deliver better concussion patient outcomes, Dr. Burkhart says the team at Children’s Health Andrews Institute has just scratched the surface.
“We have more research underway and technology in development to break down access barriers even further and leverage machine learning to more precisely predict outcomes,” Dr. Burkhart says. “This is only the start of a virtual care model that’s transforming concussion care. We aim to not only use this research and technology to better serve pediatrics, but our adult patients as well.”
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