{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T01:15:29Z","timestamp":1791335729347,"version":"4.3.1"},"reference-count":49,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2019,10,4]],"date-time":"2019-10-04T00:00:00Z","timestamp":1570147200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"name":"Edward F. and Barbara A. Bell Family"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,1,23]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The standardization of care along disease lines is recommended to improve outcomes and reduce health care costs. The multiple disciplines involved in concussion management often result in fragmented and disparate care. A fundamental gap exists in the effective utilization of rehabilitation services for individuals with concussion.<\/jats:p><\/jats:sec><jats:sec><jats:title>Purpose<\/jats:title><jats:p>The purpose of this project was to (1) characterize changes in health care utilization following implementation of a concussion carepath, and (2) present an economic evaluation of patient charges following carepath implementation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>This was a retrospective cohort study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A review of electronic medical and financial records was conducted of individuals (N\u00a0=\u00a03937), ages 18 to 45 years, with primary diagnosis of concussion who sought care in the outpatient or emergency department settings over a 7-year period (2010\u20132016). Outcomes including encounter length, resource utilization, and charges were compared for each year to determine changes from pre- to post-carepath implementation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>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\u00a0days 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Limitations<\/jats:title><jats:p>Encounter lengths served as a proxy for recovery time.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec>","DOI":"10.1093\/ptj\/pzz141","type":"journal-article","created":{"date-parts":[[2019,10,1]],"date-time":"2019-10-01T19:24:18Z","timestamp":1569957858000},"page":"136-148","source":"Crossref","is-referenced-by-count":15,"title":["A Technology-Enabled Concussion Care Pathway Reduces Costs and Enhances Care"],"prefix":"10.1093","volume":"100","author":[{"given":"Jay L","family":"Alberts","sequence":"first","affiliation":[{"name":"Department of Biomedical Engineering , Cleveland Clinic Foundation, 9500 Euclid Avenue, ND-20, Cleveland, OH 44195 (USA); Center for Neurological Restoration, Cleveland Clinic Foundation; Office of Clinical Transformation, Cleveland Clinic Foundation; and Concussion Center, Cleveland Clinic Foundation"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael T","family":"Modic","sequence":"additional","affiliation":[{"name":"Office of Clinical Transformation , Cleveland Clinic Foundation"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Belinda L","family":"Udeh","sequence":"additional","affiliation":[{"name":"Office of Clinical Transformation , Cleveland Clinic Foundation; and Neurological Institute Center for Outcomes Research, Cleveland Clinic Foundation"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole","family":"Zimmerman","sequence":"additional","affiliation":[{"name":"Office of Clinical Transformation , Cleveland Clinic Foundation"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kay","family":"Cherian","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering , Cleveland Clinic Foundation"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoyang","family":"Lu","sequence":"additional","affiliation":[{"name":"Office of Clinical Transformation , Cleveland Clinic Foundation"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Gray","sequence":"additional","affiliation":[{"name":"Concussion Center , Cleveland Clinic Foundation"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Figler","sequence":"additional","affiliation":[{"name":"Concussion Center , Cleveland Clinic Foundation"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Russman","sequence":"additional","affiliation":[{"name":"Concussion Center , Cleveland Clinic Foundation"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan M","family":"Linder","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering , Cleveland Clinic Foundation; and Concussion Center, Cleveland Clinic Foundation"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2019,10,4]]},"reference":[{"key":"2023011704463143500_ref1","doi-asserted-by":"crossref","first-page":"516","DOI":"10.1377\/hlthaff.2012.0961","article-title":"Redesigning primary care: a strategic vision to improve value by organizing around patients' needs","volume":"32","author":"Porter","year":"2013","journal-title":"Health Aff (Millwood)."},{"key":"2023011704463143500_ref2","doi-asserted-by":"crossref","DOI":"10.3791\/58962","article-title":"Development and implementation of a multi-disciplinary technology enhanced care pathway for youth and adults with concussion","author":"Alberts","year":"2019","journal-title":"J Vis Exp"},{"key":"2023011704463143500_ref3","first-page":"24","article-title":"The strategy that will fix health care","volume":"91","author":"Porter","year":"2013","journal-title":"Harvard Bus Rev."},{"key":"2023011704463143500_ref4","doi-asserted-by":"crossref","first-page":"296","DOI":"10.1287\/opre.9.3.296","article-title":"Scheduling: mathematical basis","volume":"9","author":"Critical-Path Planning","year":"1961","journal-title":"Oper Res."},{"key":"2023011704463143500_ref5","first-page":"104","article-title":"Obliterate. 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