Introduction and Background

The incidence of concussion is reaching epidemic proportions. The Institute for Clinical Evaluative Sciences (ICES) analyzed provincially-collected data and found that there were 148,710 diagnosed concussions in Ontario in 2013.2 It is likely that the number of diagnosed concussions has increased in recent years as awareness of the need for diagnosis after a suspected concussion has increased.

Due to the varied nature of concussion, not all patients with concussion require all types of interventions from all providers; there is not one single course of treatment or recovery. It is necessary that all assessment and treatment be individualized.

The majority of concussions will resolve within weeks, spontaneously, with some relative rest, guidance, follow-up from a primary care provider, and a stepwise return to activity.

For patients who experience persistent symptoms and those at risk of a delayed recovery, it is necessary that they have access to appropriate and timely, coordinated, interdisciplinary and evidence-based care.

The growing epidemic of concussion over recent years, reflected in increased awareness, recognition and diagnosis, has resulted in a high degree of patient and family concern, an overabundance of information that is not always evidence-based, and a proliferation of providers offering to treat concussion. Treatment of post-concussion care has been described as the “wild west”, leading to the need to set the standard for appropriate post-concussion care. Post-concussion care in Ontario is currently provided by a combination of publicly, third party and privately funded services.

The overarching vision of ONF in setting standards in post-concussion care is:

To have the right care, delivered at the right time, by the right provider, across the province.

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System-level problems that the standards address:
  1. Trajectory of post-concussion care: Currently there is no accepted clear post-concussion care pathway and as a result patients often receive services in a haphazard and uncoordinated way. At times health care providers are well meaning but do not follow the elements of appropriate and optimal post-concussion care.
  2. Long waitlists: The wait to receive specialized post-concussion care when symptoms of concussion do not resolve is currently far too long. Patients desperate to find treatment for persisting symptoms can be vulnerable to services that while accessible, may not be appropriate for their needs.
  3. Health care provider knowledge gaps: There are inconsistencies and gaps in provider knowledge about the risk factors that might predispose a patient to have persistent symptoms, the need for interdisciplinary care, evidence-based effective treatments, and appropriateness of providers for specific elements of post-concussion care.
What and who the standards are for:

The development of standards for concussion clinics in particular, but also for concussion care provided by others throughout the post-concussion pathway, is an important and necessary step in ensuring that every Ontarian regardless of age, cause of injury, or place of residence receives the most appropriate post-concussion care.

This information includes the standards and the rationale for why they have been developed. The standards are supported by comprehensive, evidence-based and feasible tools and resources intended to assist health care providers, people living with the effects of concussion, and planning and policy-makers to improve post-concussion care regardless of how the injury was sustained.

These standards can apply to publicly-funded, third-party and privately-funded clinics and post-concussion care in Ontario, since concussion can be sustained from a motor vehicle crash, sports or recreational injury, falls, workplace injury, assault or incident in the community. Post-concussion care is likely to be provided in an integrated way involving public, third party and privately delivered services regardless of how the concussion is sustained.

Long-term objectives of this work:
  1. Develop and implement standards for concussion clinics throughout the province.
  2. Establish collective competence in all elements of post-concussion care supports and facilitate networks for regionalized care.
  3. Build an improved system for management and referrals.
  4. Improve the knowledge of patients and families regarding what they can expect as optimal services.
  5. Develop methods for assessment, coordination and measurement of standards.