13. If post-concussion care is provided within a network of providers, it should:

  • respond to individual patient needs;
  • consist of qualified and experienced interdisciplinary providers including a physician;
  • have a clear care pathway;
  • engage in comprehensive for follow-up practices;
  • not unduly inconvenience patients (i.e. having to go to different settings/locales);
  • use a model of collaborative, shared care so that each practitioner is aware of the treatment of the others and that there is regular communication regarding progress and treatment plan.

The goal of this standard for patients with prolonged symptoms is interdisciplinary care with active medical involvement and collaboration for management of symptoms, guidance on resumption of regular activities and return to school/ work /sports, and regular follow-up with a primary care provider as per the core functions of a concussion clinic. It is recognized that in some areas, there may not be an interdisciplinary concussion clinic within a reasonable distance for patients to attend and receive services as they require.

The necessary key elements of post-concussion care are:

  • responsivity to individual patient needs;
  • vetted interdisciplinary providers including a physician;
  • a clear care pathway;
  • an organized process for follow-up;
  • care that does not unduly inconvenience patients (i.e. having to go to different settings/locales);
  • a model of shared care.

What this standard means:

While the interdisciplinary clinic is the ideal for addressing prolonged symptoms, this standard can still be achieved by:

a)a physician with expertise in concussion management working in collaboration with other interdisciplinary providers that are more proximal to the patient; or

b)use of telemedicine to access additional providers.

Most important is that there be an organized, coordinated network of providers who have established and regular mechanisms of communication and coordination, respecting scopes of practice. From the perspective of patients the care should be seamless, comprehensive, timely and integrated.

Tools and Resources:

Post-Concussion Care Pathway