At 2.5 mo, the patient demonstrated a complete reversal of his tinnitus after 10 physical therapy sessions as noted by his score of 0 on the THI upon discharge. He also demonstrated objective improvements in his cervical motion. This case reflected treatment targeted at cervical and TMJ impairments and notable improvements to tinnitus. Future studies should further explore the direct and indirect treatment of tinnitus by physical therapists through clinical trials.
Tinnitus is distressing and affects the quality of life for many patients. Because primary care physicians may be the entry point for patients seeking help for tinnitus, we urge them to acknowledge this symptom and its potential negative impact on the patient's health and quality of life. Physicians should actively listen to the patient and provide hope and encouragement, but also provide realistic expectations about the course of treatment. The patient must also understand that there may be no singular "cure" for tinnitus and that management may involve multidisciplinary assessment and treatment.
Background
The standardization of care along disease lines is recommended to improve outcomes and reduce healthcare costs. The multiple disciplines involved in concussion management often results in fragmented and disparate care. A fundamental gap exists in the effective utilization of rehabilitation services for individuals with concussion.
Purpose
The purpose of this project was to (1) characterize changes in healthcare utilization following implementation of a concussion carepath, and (2) present an economic evaluation of patient charges following carepath implementation.
Design
This was a retrospective cohort study.
Methods
A review of electronic medical and financial records was conducted of individuals (N = 3937), ages 18-45, with primary diagnosis of concussion who sought care in the outpatient or emergency department settings over a 7-year period (2010-2016). Outcomes including encounter length, resource utilization, and charges were compared for each year to determine changes from pre- to post-carepath implementation.
Results
Concussion volumes increased by 385% from 2010 to 2015. Utilization of physical therapy increased from 9% to 20% while time to referral decreased from 72 to 23 days post-injury. Utilization of emergency medicine and imaging were significantly reduced. Efficient resource utilization led to a 20.7% decrease in median charges (estimated ratio of means (CI) 7.72 (0.53, 0.96)) associated with concussion care.
Limitations
Encounter lengths served as a proxy for recovery time.
Conclusions
The implementation of the concussion carepath was successful in optimizing clinical practice with respect to facilitating continuity of care, appropriate resource utilization, and effective handoffs to physical therapy. The utilization of enabling technology to facilitate the collection of common outcomes across providers was vital to the success of standardizing clinical care without compromising patient outcomes.
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