Increasing Primary Care Follow-up after Preparticipation Physical Evaluations

Abstract

Background: Preparticipation physical evaluations (PPEs) strive to prevent injuries and sudden death in athletes. Ideally, the medical home is the best setting for completion. However, many school systems request large PPE screenings for their student-athletes. This quality-improvement project aimed to increase primary care provider (PCP) follow-up for athletes “cleared with recommendation” (CR) or “disqualified” (DQ) during our mass PPEs. Methods: Our team evaluated prior PPE data for athlete clearance and PCP follow-up for CR or DQ athletes. The prominent gaps in our PPEs were resident education, PCP or medical home identification, and communication. Our team implemented interventions during the 2018 PPEs to increase both CR and DQ athlete follow-up at the medical home. Results: Retrospective baseline data revealed that physicians categorized 11% (67/582) of athletes at our PPEs as CR or DQ. Of these athletes, the PCP and specialist follow-up rate was 13% (9/67). Our process changed to enhance athlete follow-up, but the rate only increased slightly to 15% (18/120). Medical home identification improved. Successful interventions included resident education, medical home identification, and increased communication. Conclusions: Despite our interventions, this quality-improvement initiative was unsuccessful in reaching the aim. This project found small achievements in educational opportunities, improved documentation, medial home identification for student-athletes, and lead to local changes in our standard operating procedures. Although our aim was ambitious, 100% athlete follow-up with the PCP or medical home ensures athletic safety and decreases liability for all.

Implementing Modern Technology for Vital Sign Monitoring to Enhance Athletic Training and Sports Performance

“…Promoting and utilizing medical investigation methods to evaluate an athlete's health status should be a worldwide concern with the aim of protecting them from the multiple health issues that they might develop [65] due to the extensive stress that sports performance exerts over their body [66]. Although in some less developed countries, the usefulness of these tests may be partially misunderstood or may generate costs that are difficult to cover [67], their use is very important because it can prevent typical athlete ailments, such as anemia, Brugada syndrome, sudden death, burnout syndrome, fractures and muscle ruptures [68].…”

Failure to Participate in Sports: An Evaluation of Preparticipation Physicals in a Local School District

“…14 PPE forms were completed by a variety of clinicians who may have used varying guidelines for determination of clearance. 14,15 For example, for the cardiovascular examination, some clinicians may have used Eighth Joint National Commission (JNC-8) guidelines instead of American Academy of Pediatrics (AAP) guidelines. 1 The standard for sports medicine physicians are 2 measurements of the systolic blood pressure or diastolic blood pressure greater than the 90th percentile based on age, sex, and height noted by The Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents which is concurrent with the American Academy of Pediatrics guidelines.…”

Sports psychiatric examination in competitive sports

“…In German-speaking countries, the implementation of PPE is essentially based on voluntariness. In the case of voluntariness, there is a risk that athletes unfit for sport remain undetected and -despite medical contraindication -actively participate in sport (37). Standardized algorithms exist for performing PPE (37,56).…”