Conclusions

The overarching goal of our work on the Standards for Post-Concussion Care is to fix “the wild west” that describes the current care landscape for post-concussion. We have done this by setting out standards that should improve life for patients after concussion and help the system be accountable for the care that they should be providing.

Currently post-concussion care can be quite disjointed and challenging to navigate. The goal of the ONF Standards for Concussion Clinics is to help patients navigate and evaluate the process of quality care. There are several frameworks by which integrated post-concussion care can be provided. These include providers who are part of a virtual network of providers, individual providers in an ad hoc network of providers, and clinics with integrated services at one site.

At the Concussion Summit in April 2016, it was recognized that post-concussion care management involves both acute and persistent symptoms. Post-concussion care, regardless of how the concussion was sustained, requires a pathway of care that is appropriately coordinated and integrated across a number of health care professions, as needed. Based on the existing literature, no single healthcare profession ‘owns’ concussion; therefore, the application of the collective competence of multiple healthcare professions can be required from the time of injury through to the process of recovery. The majority of concussions resolve quickly and without the need for interdisciplinary support, but for those patients who experience persistent symptoms it is necessary that they have access to coordinated, interdisciplinary care that adheres to regulated scopes of practice.

The Standards provide direction for the key elements that should be part of post-concussion care and outline a set of referral indicators. Post-concussion care provided by a primary care provider and a concussion clinic or network of providers must encompass a set of core functions that must be provided or be accessible to ensure appropriate care within this broad care framework. These functions can be provided in most cases by more than one healthcare professional operating within a regulated scope of practice. Referral indicators are outlined to ensure that referrals are made to ensure appropriate care.

Given that one of the strongest areas of evidence in concussion management is associated with education, provision for the integration of concussion education for both patients and their families is integrated throughout the post-concussion care pathway. The Standards set out guidelines for the type of education on concussion, services, and treatment that should occur to ensure that unnecessary anxiety and vulnerability does not occur.

In summary, the goal in developing these Standards for post-concussion care was to facilitate the right care, provided at the right time, by the right providers, for individuals who have sustained concussive injuries.