Pediatric Concussion Health Service Utilization and Follow-Up Care: A Population-Based Epidemiological Study Using Administrative Health Data
Date
2021-08-19
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Abstract
Concussion is a common injury among children and youth, although population-level incidence and trends related to service use are not well described in the literature. In addition, while treatment and management decisions are led by best practices and clinical guidelines, there is a paucity of studies exploring the individual and contextual factors that impact health service utilization following concussion in the pediatric patient. Thus, the objective of this thesis was to address these gaps and better understand how children and youth are interacting with the health care system following concussion in Alberta. In this thesis, 14-years of system-level linked administrative health data and a defined episode of care (EOC) were used to describe trends in health care utilization following pediatric concussion in Alberta. An increased incidence of concussion and other mild head injury diagnoses was observed across the province. In addition, a shift in care from emergency department (ED) to outpatient physician office (PO) settings and a higher use of the ED by some segments of the population was observed. Findings suggest some children and youth are more likely to receive care following a concussion. In addition, follow-up care increased over time, demonstrating accordance with clinical guidelines. However, rates remained low, indicating a lack of application by provider or adherence by patient. Findings indicate that the likelihood of receiving follow-up care in Alberta was influenced by both individual and contextual factors. Factors related to need (perceived and evaluated) were most strongly associated with health care utilization. The index visit occurring in PO had the strongest positive association with follow-up care, followed by a history of concussion-related EOC. At the same time, patient predisposing and enabling factors also affected utilization. Younger children and youth, females, and those from areas of lower socioeconomic status (SES) or residing in certain geographical areas were less likely to receive follow-up care. Findings suggest that to improve service delivery and targeted treatment in line with clinical guidelines for all children and youth, policies that focus on equitable access are needed.
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Keywords
concussion, pediatric, administrative health data, clinical guidelines, health service utilization, health system
Citation
Wittevrongel, K. (2021). Pediatric concussion health service utilization and follow-up care: a population-based epidemiological study using administrative health data (Master's thesis, University of Calgary, Calgary, Canada). Retrieved from https://prism.ucalgary.ca.