New concussion screening tool for young athletes developed in Richmond

Fourteen-year-old Richmond student Blake Charlesworth lives and breathes soccer. He hopes to become a professional player and one day play in goal for FC Barcelona, his favourite club.

He knows that to make his dream a reality he’s going to have to watch the knocks to the head. Although doctors don’t know the long-term effects of multiple concussions on young brains, they do know that by continuing to play without a full recovery could lead to more. And experts fear that could disrupt cognitive development.

As a goalie for Richmond Football Club, Charlesworth has hit his head a few times on the goal post, but he isn’t aware of ever having a concussion. That’s why he was keen to take part in testing first-of-its-kind concussion screening technology for young athletes, developed at the University of B.C.

About 20 young soccer players from Richmond FC volunteered to undergo ectroencephalogram (EEG) scanning at Brighouse Park in Richmond on Saturday. They also sat down after the screening with a doctor for a neuropsychological evaluation for concussion diagnosis.

Vancouver-based EEGlewave uses a computer algorithm that can distinguish between the EEG of a healthy brain and that of a concussed brain.

“My parents said this would be really good for me, so in case I ever do get a concussion I would have something to go on,” said Charlesworth, as analysts measured his head for the brain scanner device.

The company’s plan is to create a product using data from young players as a baseline to help sports physicians diagnose concussion quickly and more accurately.

Using his data as a baseline, doctors and analysts at EEGlewave can later monitor Charlesworth’s brain should he get a knock to the head and determine whether he has a concussion by comparing the new EEG with that of his previously recorded healthy EEG.

Youth players found to have a concussion, however mild, can then take the necessary time off from their the sport to recover instead of continuing and possibly exacerbating the problem.

Charlesworth said he has loved soccer ever since he was five years old, and wants to make sure he stays healthy to play.

“My dad is a big soccer fan, my mum loves soccer too. It is a real family tradition. I’m the only one to want to go far with it so it’s a very big part of my life. I sleep, breathe and eat it.”

Like many young players, Charlesworth isn’t 100-per-cent sure he has never had a concussion. Rein Webber, chair of Richmond FC, said it is very common for coaches and the players to believe everything is OK after a hit to the head and continue playing.

“This is a whole new level of keeping our kids safe,” Webber said about the new brain scanning tool. “We can’t avoid injury but we can help the recovery. And we want to be there to support the players and their families as they go through the recovery process.”

Dr. Naznin Virji-Babul, who co-founded EEGlewave in 2015, said the brains of kids and adolescents don’t stop developing until about their mid-20s.  With this new tool, she said they can study how a concussion affects a developing brain and how to help kids recover.

EEGlewave has already collected baseline data from some Vancouver Whitecaps players, as well as youth in the Seafair Minor Hockey Association in Richmond.

“After the kids have a concussion, we repeat the testing. What we have found is that using our technology we are about 95 per cent accurate in being able to tell that someone has had a change in their brain as a result of the concussion,” said Virji-Babul, an assistant professor at UBC’s department of physical therapy who studies concussions.

If kids keep playing through a concussion, Virji-Babul said there is around a 30-per-cent chance of that child getting another.

“Their brains are still undergoing a lot of change, and we know the major changes are happening in their frontal cortex,” she said. “That’s the part of the brain that controls memory and attention. And it also controls risk-taking behaviour. So these are really important cognitive skills that are being developed.”

A 2013 report by Child Health B.C. found that during a one-year period there were 6,675 concussion-related emergency department visits by children and youth in the Lower Mainland.

 

Tiffany Crawford (Vancouver Sun) Published: September 17, 2016Updated: September 17, 2016 11:24 PMFiled Under:The Province Health Family & ChildShareNew Concussion Screening Tool for Young Athletes Developed in Rich. “New Concussion Screening Tool for Young Athletes Developed in Richmond.”Www.theprovince.com. Province, 17 Sept. 2016. Web. 19 Sept. 2016.


‘Collaborative Care’ May Aid Kids’ Concussion Recovery

Collaborative care, including cognitive behavioral therapy (CBT), was linked with decreased reporting of postconcussive symptoms as well as fewer depressive symptoms among adolescents with persistent symptoms of concussion, a small randomized trial found.
Six months following treatment, a significantly smaller portion of the group that received collaborative care reported having postconcussive symptoms, and a larger portion of the collaborative care group reported a significant reduction in depressive symptoms compared with kids receiving usual care, reported Carolyn A. McCarty, PhD, of Seattle Children’s Hospital, and colleagues, writing in Pediatrics.

In an email to MedPage Today, McCarty said that there are no evidence-based treatments to address prolonged concussive symptoms, which can be particularly problematic for adolescents, who are learning and developing very rapidly.
“Based on our experience using collaborative care and cognitive behavioral therapies to address other health problems, we had reason to believe that these approaches would translate well to address post-concussive symptoms,” she said. “We believe we have developed an effective alternative to watchful waiting that meaningfully impacts quality of life for patients with prolonged concussion.”
This was a small pilot study of 47 patients ages 11-17 years (mean 15.0 years, 65% girls, 75% white), who reported persistent symptoms more than a month after a sports-related concussion. The sample was comprised of 57.5% sports-related concussions and 42.5% recreation-related concussions (such as trampoline park injuries). There was a significantly larger portion of kids sustaining sports-related concussions in the collaborative care group versus those in usual care.
Overall, after the full 6 months of treatment, 13.0% of the collaborative care group continued to report postconcussive symptoms compared with 41.7% of the usual care group (P=0.03). Over three-quarters of the collaborative care group also reported a more than 50% reduction in depressive symptoms after 6 months of treatment compared with 45.8% of the usual care group (P=0.02). However, there were no significant differences between the two groups in anxiety symptoms.
McCarty added that 41% of the sample presented with symptoms of depression, a frequently co-occurring problem among youth with post-concussive symptoms.

“It is important to screen for depression among youth with persistent concussion symptoms,” she said. “Pediatricians should also consider partnering with a behavioral health provider when possible to manage these patients, particularly therapists with experience using cognitive behavioral approaches.”
In total, 23 patients completed the collaborative care model of treatment. Each patient received cognitive behavioral therapy to target symptoms of anxiety and depression. Care management involved coordinating with the patient’s school as the treatment progressed. Patients also had the opportunity to consult with an expert in pediatric psychopharmacology to address any symptoms that did not respond to behavioral therapy.
For the 24 patients who completed the usual care model, they received an initial visit to a sports medicine-trained physician, followed by a referral to an expert in pediatric rehabilitation if symptoms did not resolve in 4-6 weeks. Follow-up was conducted by the referring clinic concussion specialist.
Examining types of healthcare visits, 33% of the usual care group reported visits to a mental health professional, while 8% saw a psychiatrist. Nearly 60% of the usual care group saw their primary care physician, although 21% sought treatment from “another physician.”
A third of the collaborative care group received psycho-pharmacologic counseling, and completed a median number of eight CBT sessions over the 6-month treatment period. Outpatient concussion-related visits were similar between the intervention and control groups (average of 6.2 visits versus 5.8 visits, respectively).

Limitations to the study include the small sample size and demographic makeup, which may limit the generalizability of the findings, and that researchers used the PHQ-9 to evaluate depressive symptoms, which may overlap with concussion symptoms.
McCarty characterized the study as “a great launching point” for more research, such as whether boys recover differently from concussions than girls, as well as a longer follow-up period to observe the patients. She added that further collaboration is needed with schools in terms of managing students who have had a concussion.
“We found that there are often school-related needs and issues to consider in the treatment plan as well, such as determining whether accommodations are needed to promote academic learning in the context of post-concussive symptoms,” said McCarty. “More guidance and education is needed around when and how to support patients as they ‘return to learn.'”
This study was supported by the Seattle Sports Concussion Research Collaborative.

 

Primary Source
Pediatrics
Source Reference: McCarty CA, et al “Collaborative care for adolescents with persistent postconcussive symptoms: A randomized trial” Pediatrics 2016; DOI: 10.1542/

 

 


Parents may be treating their children’s concussions wrong

A new survey surprisingly found that many parents caring for a child’s concussion may inadvertently be making it worse.

Many think if a child gets a concussion, you should wake that child up every few hours at night to make sure they’re okay. Not true.

An estimated 2 million children will be treated in emergency rooms this year for sports-related concussions. A new national survey shows a vast majority of parents follow outdated advice when it comes to caring for concussions and their kids could be paying the price.

Kennedy Dierk, for example, had been playing soccer for 10 years, when, in a split second, everything changed. She bumped heads with another player and got a concussion, although her symptoms didn’t appear right away.

“It just progressively got worse and worse and worse throughout the week,” says Kennedy.

“It was a longer road back than we thought. It was a good 2 to 3 months before the headache dissipated,” says her mom, Dione Dierk.

Kennedy developed post-concussion syndrome, something Dr. Christopher Giza says can happen when the right steps aren’t taken immediately after injury.

“Getting proper advice about how to manage your activity early on reduces the likelihood by 15 to 20 percent of whether or not you develop post-concussion syndrome,” says Dr. Gize.

But a new national survey by UCLA Health reveals many parents don’t always act on professional advice

If a child shows symptoms of a concussion after one week, more than 3 in 4 parents say they’re likely to wake their child up throughout the night. That’s something doctors say only makes matters worse.

“Their headache is going to be worse; their memory’s going to be worse; their mood’s going to be worse. All those things that we monitor for concussion will get worse if we don’t let them sleep,” says Dr. Giza.

The survey also found 84 percent of parents would make kids refrain from any physical activity. But Dr. Giza says if the injury is stable and the activity is safe, kids should exercise after the first few days.

And they should remain social. More than half of parents were likely to take away electronic devices, but that’s not always necessary.

“We want to see them interact with their peers as much as they can. And so that may require some permissiveness in terms of electronic communication,” says Dr. Giza.

Doctors say kids should take it easy in the first few days after injury, but easing them back into their routines as quickly and safely as possible is important. If your child’s concussion symptoms linger for more than two weeks without improving, you may want to see a specialist.

 

 

Centofanti, Deena. “Survey Shows Parents May Be Treating Their Children’s Concussions Wrong.” WJBK. WJBK, 06 Sept. 2016. Web. 09 Sept. 2016.

Section III Athletics endorses Heads Up Football safety program

Section III Athletics endorses Heads Up Football safety program

Heads Up Football is a comprehensive program developed by USA Football to advance player safety in the game of football

Section III Athletics is tackling the ever-present issues of sports concussions and player safety. Beginning this summer, the organization – along with the New York State Public High School Athletic Association and the State Football Committee – is endorsing USA Football’s “Heads Up Football” program.

“Section III is recommending that all varsity coaches (including assistant coaches) complete the Heads Up Football® High School Coach Certification program, which consist of four courses found on NFHSLearn.com (Concussion in Sports, Heat Illness Prevention, Sudden Cardiac Arrest and Equipment Fitting/Blocking/Tackling),” according to a press release.

After completion of all four courses, each coach will receive $1 million in general liability insurance from USA Football.

Heads Up Football® is a “comprehensive program developed by USA Football to advance player safety in the game of football”, the press release said.

The Section III Football Committee recently hosted a pair of in-person trainings for one coach per school to attend the Heads Up Football® PSC Clinic conducted by master trainers. The first training, led by Ken Stoldt, was held on June 21 at East Syracuse-Minoa High School, while the second event was on Tuesday at Sauquoit Valley High School and led by Matt Gallagher.

Officials from Section III met with USA Football in May to learn more about the program and later began setting up for the trainings.

“Roughly 75% of the schools were able to make it. We met with USA Football about a month and a half ago to get (the trainings) organized. … To get everything lined up to do it, we wanted as many people here as we could,” Section III Football co-coordinator Keith Kempney said. “We were very pleased with the high numbers that we had with the short notice.”

Officials from Section III Athletics had previously discussed the advantages offered from USA Football with coaches from Section IV and Section VI, leading to their endorsement of the organization.

“We determined it was better and safer to use these techniques that they practice. It was better and safer, so it’s a win-win,” Kempney said. “It’s not mandated by the state at this time. Section III definitely endorses it, they support it. It’s not mandated, but we’re kind of hoping that the state might come up with mandates, though that’s for down the road. For now, we’ve had tremendous response and feedback from the coaches thus far.”

The released added, “Section III believes that our number one priority is the safety of our student-athletes. Heads Up Football High School helps prioritize the health and safety of our players by offering proper tools and resources that help provide a safer experience for our athletes.”

Section III Athletics Executive Director John Rathburn said the joint efforts with USA Football are vital to the safety of the players.

“I strongly believe that coaching certification is critically important for the safety of the game, and what USA Football teaches us can only enhance the educational training that all of our coaches already have,” Rathburn said. “Let’s give them a place to go where they can learn the game, and parents can have the confidence that our coach have received the proper certification.”

Barbosa, Victor. “Section III Athletics Endorses Heads Up Football Safety Program.” Syracuse.com. Syracuse.com, 29 June 2016. Web. 30 June 2016.


Health Care’s Big Shift

In ads that have appeared online and around New York City, people at rest and at play are bathed in a warm golden light in what appears to be Central Park. There isn’t a hospital in sight, despite the fact that the ads are for Mount Sinai Health System. Instead, they evoke a sense of well-being because the park-goers are supposed to be, quite literally, the picture of health. Mount Sinai’s tagline appears above them in a clear sky: “If our beds are filled, it means we’ve failed.” The ads began appearing in 2015, two years after the Mount Sinai Medical Center merged with Continuum Health Partners to create New York City’s largest nonpublic hospital chain.

The merger and ads speak to the critical issues that now confront the U.S. health care industry. Historically—and still today—health system revenues depended on people getting sick or needing acute care. Much of that care has been delivered in hospitals and developed for a centralized system where beds—filled or empty—mean profit or loss. Now, the model is being flipped as the industry’s center of gravity shifts away from hospitals to community-based settings where primary care providers and outpatient ambulatory clinics focus more on “well care” than “sick care.”

This seismic shift is coming after decades of gradual change punctuated by larger moves forward—such as the Affordable Care Act. Today, the U.S. health care industry is under increasing pressure from the government, employers and patients to not only simultaneously improve and shift care to prevention, but also to dramatically reduce costs. Health care spending has grown faster than the economy for decades with the Center for Sustainable Health Spending reporting that health care’s share of the U.S. gross domestic product rose from about 7 percent in 1970 to approximately 18 percent in 2016. As of January 2016, the U.S. spent more than twice the average of other developed countries on health care, with per capita expenditures totaling $8,713.

Dr. James Jenkins, M.D., and Dr. Eric Thomson, M.D.

These pressures are creating a fundamental tension. While hospitals are still the primary industry player with the size and power to drive widespread evolution, the transformation puts at risk their business model: Fill beds with people who are sick. But forward-thinking health systems are upending old business models while a wide mix of new entrants powered by technology are seizing the moment to introduce new business and care models.

These disrupters are shifting investments from hospitals to outpatient settings, including maintaining or partnering with new ambulatory, retail, specialty and urgent clinics—all of them located outside traditional hospitals. They are also putting in place a number of lower-cost and more consumer-friendly options—coordinated through more evolved, cloud-based networks—that reward collaboration, performance and a focus on cost and quality on the part of management and front-line providers. And finally, some are placing bets on a new investment strategy of building and growing physician networks, as opposed to building more hospitals. They’ve committed to driving cultural change around a new model for how care is delivered that will ultimately look dramatically different and hopefully achieve better results for consumers and providers than that which has been in place for decades.

While hospitals are still the primary industry player with the size and power to drive widespread evolution, the transformation puts at risk their business model.

This creates strategic challenges for the executives now leading industry transformation. Challenging or not, these leaders are focused on overhauling the traditional hospital model to one better designed for today’s health care providers and the patients they serve.

Rethinking the Hospital Business Model

Historically, hospitals have focused their business model on the number of beds they filled—much like hotels or airlines—and the services and products they could sell to the people in those beds. That system depended primarily on insurance companies underwriting the cost of those services, making it easy to layer on more and more services and add more beds to increase revenues. Hospitals currently account for 30 percent of all U.S. health care spending and the average price for general hospital services in the U.S. is much higher than other developed countries.

Policymakers, local governments and progressive hospital executives have known for decades that this traditional model wasn’t sustainable. Thirty years ago, New York state officials considered not approving proposals for any more surgical beds in New York City because there was already an excess of 8,700 hospital beds. Noted authorities on hospital administration, including Warren Greenberg, associate professor of health services administration at George Washington University at the time, urged industry leaders to consider the oversupply of beds as “part of a solution to rising health care costs and not part of the problem.”

The “sick care” provided by hospitals should be limited to the most serious conditions, such as heart attacks and bone cancer.

Greenberg’s realization of an excess supply of hospital beds as a harbinger of change was well ahead of its time. In the immediate future, established institutions as well as health care startups are embracing the idea that having fewer patients in hospitals would be beneficial to the public. This strategy will bring more profits, not less, to those companies in the future. One of those is the Dallas-based CHRISTUS Health System and its CHRISTUS Physician Group (CPG), one of the 10 largest Catholic health care providers in the U.S. that operates in Texas, Louisiana and New Mexico, and extends internationally into Latin America. CHRISTUS has shifted additional investment and focus toward decentralized access to preventative and urgent care during the past five years.

“We call this ‘Generation 3’ of the physician corporation,” says Peter J. Plantes, M.D., CPG’s CEO and system vice president of physician integration at CHRISTUS Health (the parent corporation for the physician enterprise). In 2011, the company began placing more emphasis on acquiring both primary care and specialty physician practices over building more hospitals with more beds. That’s allowed them to become a more diverse health care company that includes ambulatory and urgent care service units.

To Plantes, the “sick care” provided by hospitals should be limited to the most serious conditions, such as heart attacks and bone cancer. For everything else, even for diseases once treated in hospitals, such as gallbladder removals, a network of physicians can manage care in ambulatory centers. At CPG, these physicians act preventively to help patients stop habits such as smoking, help patients maintain healthy diets and encourage preventative tests such as mammograms. The network includes nurse practitioners, physicians’ assistants and advanced practice registered nurses (APRNs) who work closely with doctors. “The difference is we’ve built an investment that’s now geared toward outreach to the community and motivating patients toward maintaining health, rather than asking the patients to come to the hospital to find care just at the point of sickness,” Plantes says.

Carlos Fernandez Calmet, Medical Assistant

CPG is also reframing how its physicians and other health care providers are paid. The traditional reimbursement model pays doctors a fee for every office visit and test ordered. Instead, CPG works from the “triple aim” concept: reduce costs, improve experiences for patients and focus on improved evidence-based outcomes. This type of value-based care rewards health care providers that hit quality targets while managing costs and keeping patients healthier. Although most reimbursement across the health care system still arrives through the traditional fee-for-service model, many experts see “value-based care” as the future.

Plantes agrees. He estimates that 80 percent of the industry’s focus currently remains on sick care rather health care. He says hospitals need to provide a continuum of care for patients that takes place in communities where people live, not in traditional hospitals. “One of the big things that’s changing here is that society is asking for a better outcome of quality, safety and cost,” he says.

Some of this shift is being driven by a larger industry-wide phenomenon: Patients are taking on more of the financial burden of their medical care. The annual average deductible for employer-sponsored plans is $1,318, according to the Kaiser Family Foundation, a substantial increase from the 2010 average of $917. HealthCare.gov places the median deductible for individuals with health care through the government exchange from $2,000 to $5,000, varying by state.

As of January 2016, the U.S. spent more than twice the average of other developed countries on health care, with per capita expenditures totaling $8,713.

The rise in personal medical costs is turning patients into powerful health care consumers. As they become more aware of those costs, they are “doctor shopping” and using crowd-sourced ratings websites to find health care that fits their needs and financial situation. As consumers, people with medical issues and health concerns think very differently about how and where they spend their money than they did as patients covered by insurance who had little knowledge of the costs associated with their care.

This shift from patient to consumer has also given rise to new places to receive medical care, including receiving flu shots at retail clinics or having surgical procedures once performed only in hospitals now taking place in ambulatory surgical centers (ASCs). Between 2008 and 2012, the number of Medicare-certified ASCs increased by an average annual rate of 1.7 percent. Urgent care centers are opening at a rate of more than 300 new clinics annually, and along with flu shots, they offer perks that are more in tune with consumer lifestyles, including longer hours of operation, free snacks and WiFi. Drugstore chains have also opened clinics inside their stores, and their use by consumers covered by insurance jumped tenfold from 2007 through 2009. By the first quarter of 2015, 84 percent of services administered by one of the large drugstore chain’s in-store clinics were paid for by third parties. An April 2015 study by Manatt Health found that patients with commercial insurance paid about $110 as opposed to $166 for similar services at a doctor’s office.

“At CHRISTUS Health and CPG, we are networking all of those access points to care: outpatient physician offices, urgent care, ambulatory surgery center, ambulatory imaging, free-standing emergency room, free-standing laboratory and imaging centers,” Plantes says. “We have the physician network out there in the community that provides a variety of readily available sites of care.”

A Clean Slate

Even as traditional hospitals like CHRISTUS transform their business models, well-funded companies working from a clean slate are inventing new models and approaches.

In the fall of 2015, Fairfax Family Practice Centers (F.F.P.C.) had reached a tipping point. The practice had 14 different offices with 130 doctors and two dozen medical residents stretched across Northern Virginia. The doctors knew they needed to evolve, but they also knew they didn’t want to join a traditional hospital system. “The way things are going, you need a certain infrastructure in order to be successful,” says Dr. James Jenkins, F.F.P.C.’s Medical Director. “You want to leverage your IT as best you can. You want to be data-driven and evidence-based in terms of your care of patients. It’s a redesign of the system.”

How Hospitals Have Transformed
2009
HITECH Act establishes incentives
for the purchase and “meaningful use” of electronic health records.16
U.S. hospital
occupancy rates at
64 % 17
2010
On March 21, the House of Representatives passes the Senate bill, the Patient Protection and Affordable Care Act (A.C.A.). The A.C.A. mandates that employers provide, and individuals carry, health insurance coverage; establishes state level individual markets for health insurance; and creates the Center for Medicare and Medicaid Innovation (CMMI) to test and pilot innovative delivery models.18
2012
Hospital mergers more than double to 105 in 2012 from 50 in 2009.19
2014
Urgent care now worth an estimated
$14.5 billion
business and Urgent Care Association of America estimates 7,100 urgent care centers exist in the U.S.20
Hospital bed
occupancy rate dips to
61%21
64 %
of newly hired physicians
are employed by hospitals and
health systems, up from
11 %
in 2004.22
2015
On January 26, HHS announces that 30 percent of Medicare payments will be tied to quality or value through alternative payment models like Accountable Care Organizations (ACOs) by the end of 2016 and 50 percent by the end of 2018.23

As Jenkins and his team searched for solutions, they discovered that even though the practice had grown in terms of the number of doctors, more expertise and sophisticated infrastructure were needed to be successful in performance-based programs with payers and employers. Size matters, Jenkins realized, but that didn’t have to mean joining a large hospital company. Instead, F.F.P.C. decided to become affiliated with physicians’ network Privia Medical Group in late 2015. Privia, based in Washington, DC, operates a network of physician practices that includes roughly 1,400 doctors and over 270 locations folded into a single core framework of Privia Medical Group.

“We believe that most physicians in the country want to practice in a way that’s most beneficial to their patients, yet most doctors don’t have the infrastructure that they actually need to be able to provide the kind of care to their patients that they want to be able to provide,” says Privia Health CEO Jeff Butler.

Butler recognized this problem not while working in the U.S, but when he was helping doctors treat HIV and AIDS in rural South Africa. He organized physicians into a network and created technology to encourage patient monitoring, home-based support and preventive care. The result was improved clinical outcomes, and his work there served as the blueprint for Privia.

Butler acknowledges that he had the luxury of creating Privia as U.S. health care was undergoing a profound shift. Instead of having to change an old system to fit a new world, he could intentionally design his organization around the new reality.

Despite an influx of more than $28 billion in federal funding, even the most basic efforts at digitization, improved connectivity and basic data sharing have proven difficult for many health care systems.

Using data drawn from its physicians’ network, Privia creates benchmarks that focus on patient satisfaction, quality of care and controlling costs. That’s not unlike CHRISTUS’s triple-aim goal, but Privia has added a fourth: increasing physician satisfaction. To reach that goal, Privia first had to determine what “high-performing” meant across its network. To do that, it used metrics and analysis drawn from a single shared cloud-based electronic records system—athenahealth. The two companies have worked cooperatively since 2014. athenahealth is used by nearly 80,000 providers in the U.S. and supplies health systems and medical practices with cloud-based services, including for electronic medical records, billing and population health management.

That’s the kind of technological step forward that has eluded many other providers. Despite an influx of more than $28 billion in federal funding, even the most basic efforts at digitization, improved connectivity and basic data sharing have proven difficult for many health care systems. In 2010, just 19 percent of hospitals could share information electronically with physicians practicing beyond their walls. Seventy-three percent of physicians didn’t receive information about patients being discharged from hospitals within two days.

Privia uses technology to create unified, connected information networks that support the physicians and, in the end, support health care consumers. For example, Privia can reach out to retail clinics and urgent care facilities and share data with them. “If a patient shows up at a retail clinic, we know that happened, getting the data back into the EMR so that we can best coordinate care,” Butler says.

He points out that this ability to use data effectively has been at the heart of the company’s success. Many practices that join Privia’s network see more than a 30 percent increase in overall revenue within 90 days. That comes from Privia’s doctors being able to rely on a single source of metrics and a consistent, efficiently managed workflow to set benchmarks that are transparent and replicable across its physician network. Privia also blends data analysis and support staff to improve both efficiency and efficacy. Streamlined trainings help Privia practices align their operations quickly. Each doctor has access to data related to their own performance and importantly lets them compare their patient outcomes and expenditures against those of colleagues in their office, with Privia’s network of doctors and across athenahealth’s entire national network.

Discourse between Privia’s physicians also is crucial. Doctors learn, share best practices and are encouraged to provide feedback in groups called PODS, which stands for Physician Organized Delivery Systems, that meet regularly to discuss performance and practice issues. They gather in large groups first and then in smaller breakout groups of practitioners. Coaching is also available from Privia’s performance specialists or from administrative officers like Sandy Cave, who helps manage data and analytics for Fairfax Family Practice Centers. “We have lots of metrics,” Cave says, who joined the practice 20 years ago as a nurse. “Understanding which ones are the metrics that drive change for us, in the sense of enhancing patient outcomes, is what supports the change in patient outcomes.”

Dr. James Jenkins, M.D.

That understanding is key, Butler says, because it has helped Privia combine scale with an infrastructure built around value, not around buildings or beds. So far, Privia’s model is proving successful in a number of ways. It has received significant venture capital investment, including $400M from a Goldman-Sachs-led investor group in 2014. The model is also paying off for the doctors in its network. Two years ago, Privia formed an Accountable Care Organization (ACO), called the Privia Quality Network (P.Q.N.), and participates in the Medicare Shared Savings Program. In 2014, the first year of their participation, P.Q.N. ranked among the top 15 percent of ACOs in the U.S. Unlike the vast majority of ACOs participating, they beat quality and cost targets, earning $5.7 million dollars in Medicare Shared Savings. Privia then distributed bonuses to physicians for helping it achieve those goals; such bonuses are a key part of how Privia physicians are compensated.

“In two short years, the physicians have gone from a very fragmented, five doctors practicing over here, 15 doctors practicing over there, to having banded together around the idea of improving outcomes and driving value into the system,” Butler says. “We are now in a very significant position of impact in the marketplace where the existing incumbents, the health systems and diagnostic facilities, and ambulatory surgery centers and labs and others now have to pay attention to and actively collaborate with doctors who are truly accountable for the outcomes of their patients.”

But Privia and CHRISTUS will need to be joined by many more organizations willing to overturn their traditional business models before health care will truly reflect the scenario described in Mount Sinai’s ad campaign. Getting there will require strong leadership because it means disrupting and replacing the hospital-centric model for good. Butler himself wonders if there are “going to be enough disruptive entrants into the market that can truly disrupt the marketplace and drive value into it?” The big shift currently underway in health care shows no signs of reversing course or slowing down. Most policy experts believe it’s essential for reining in runaway costs and setting U.S. health care on a sustainable path. Those organizations that fail to respond and adapt quickly will be left behind as health care innovators step up and capitalize on the opportunity with new models that can better serve doctors, patients and ultimately our national economy.

 

WSJ, W. “Paid Program: Health Care’s Big Shift.” Athenahealth. WSJ, 11 June 2016. Web. 13 June 2016.

 


The Greatest Problem in Youth Sports

This coming Saturday we have four basketball games: 8:30, 11:00, 12:30 and 7:00. One game each for our four oldest kids.

2016-01-21-1453396255-5033807-IMG_7253.JPG

To some of y’all, that sounds ridiculous and chaotic. To me, it sounds awesome. I can’t wait. My wife is in the first boat with y’all.

I’m coaching in three of those games and will be the cheerleader dad from the stands in the fourth.

But as much as I enjoy days like this coming Saturday, I have to keep reminding myself of one thing.

It’s the thing that I’d argue is the biggest problem in youth sports. The problem is that we’re making these sports about the adults and not the kids that are playing the youth sports.

Let me caveat my logic (or lack thereof) with a few things:

1. I think it’s perfectly fine for kids to want to win at whatever sport they’re playing, at whatever age. Participation trophies aren’t what you get in the real world, so I’m fine with them being competitive and wanting to win. I like that actually.

2. The youth sports culture is incredibly intoxicating and it takes the best-intentioned people (me included) and turns us into something we’re not proud of. We’ve witnessed threats to players, coaches, referees. Insults to opposing players, even their own children.

3. Studies are showing that multiple sports benefit a child’s athletic ability far more than being specialized in one sport so the pressure from parents and coaches to “pick a sport” at an early age is ridiculous in my opinion.

4. The only sports I played beyond high school were intramurals and sports where you could have a beer in the parking lot afterward, so again, not the expert here.

So let me explain where I see the biggest problem in youth sports being played out. The problem is that we’ve made it about us and not them.

Parents (again, me included when I’m at my worst) have turned this into a social form of competition and entertainment. It packs our calendars and fills our weekends.

But shouldn’t it be about teaching them to enjoy whatever game they’re playing?

We travel from practice to practice, game to game, oftentimes so we can be “proud of” watching little Johnny play a dozen sports. It’s entertainment.

But shouldn’t it be about them learning to compete in healthy ways?

And if we admit the truth, we want Johnny to be better than neighbor boy Jimmy. Even if Johnny and Jimmy are on the same team. Not for Johnny’s benefit but for ours. It’s the ugly side of competition.

But shouldn’t it be about teaching them how to be great teammates?

What if we acknowledged this reality and worked hard at shifting the focus back where it belongs? To the youth who are actually playing the youth sports.

Because it’s not about us, it’s about them.

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It’s Not ‘Just’ a Concussion

In a society where the result of a severe bump on the head is often overlooked, misdiagnosed, and misunderstood, the word “concussion” should NOT be taken lightly. Every concussion is a traumatic brain injury and needs to be taken seriously — as it is the leading cause of death for children and adults ages 1 to 44 in the United States and occurs every 13 seconds.

With the movie “Concussion” staring Will Smith, we are finally starting to talk about it. While the movie is about NFL players and their concussions, I understood every word — every nuance of how these guys felt. I understood their frustration when nobody would listen to them, or take them seriously when their MRIs came back clear.

You don’t have to be in a serious car accident or injured playing sports. Simply slipping on a patch of ice can change your life in the blink of an eye, which is exactly what happened to me. 

It was a very cold February morning when I slipped and fell on a patch of sheer ice while walking down my building’s driveway. I remember my feet flying out from under me, in true Charlie Brown fashion, and I was unable to do anything about it. I can still hear the god-awful “thunk” as my head made contact with the asphalt. My skull had taken the full impact of the fall, knocking me unconscious for a few minutes.

When I came to, I immediately knew something was wrong. The pain in my skull was excruciating, and I was seeing whirly stars out of my left eye. Once back in the safety of my apartment, I attempted to look up emergency rooms on Google. Then I realized I couldn’t read my computer screen — it was a blur because my eyes wouldn’t focus. Calling 911 hadn’t even occurred to me! Because I had clearly knocked myself silly, I decided I would drive myself to the clinic. A decision I look back on and realize it probably wasn’t a good one.

After a thorough exam, my doctor told me that I had suffered a severe concussion, along with major whiplash, C4/5 damage to my spine, and a dislocated sternum. He stated that my concussion symptoms should start getting better in about 6-8 weeks. Before releasing me to go home, I was instructed to cancel all of my appointments for the week, and to avoid all stimulation, including TV, radio, reading, etc. I was to return to the doctor later that evening to ensure I was still doing okay — you know, not dying from a brain bleed or anything.

As weeks, then months, went on, I was still not feeling any better, and in fact, my symptoms were becoming worse. I was living with a constant fogginess in my head, a perpetual headache, and my short-term memory was practically non-existent. And at times I could not find home from the neighborhood store or my best friend’s house, or remember how to run my microwave. I had trouble finding words when I spoke, I was suffering from dizziness and balance issues, and my vision wasn’t quite right, even though eye exams showed everything was “fine.”

Friends started to drift away, telling me I should “get over it because it was ‘just’ a concussion.” While I was living with this hell inside my head, others thought I should “get over it.” One former friend even said I should be thankful it’s “just a concussion,” and not something far worse, like cancer.

I would eventually come to understand a term I had never heard before: “traumatic brain injury” or TBI for short. Every concussion is a TBI, yet when people hear about TBI, they tend to think of the worst-case scenarios. Because I looked seemingly fine, and could walk and talk, people thought I must be okay. I think some people even went so far as to assume I was faking or exaggerating; yet if they had spent even an hour with me, they would realize I wasn’t the same person I was before my fall.

The stigma of a concussion in our society is that it is “no big deal.” We watch professional athletes get back in the game after taking a major blow to the head, and we expect the same of our youth. We watch actors like Tracy Morgan, who suffered a major TBI after an awful accident involving his tour bus and a semi truck, tell us a year later that he’s 100 percent recovered… which I am grateful to hear he’s doing so well, but I don’t buy the “100 percent recovered” part one bit.

In the movie “Concussion,” we start to garner an understanding that concussions are much more serious than originally thought. We get a glimpse inside the severity of repetitive head trauma, and how it can hide invisibly inside our brains, while wreaking havoc on our lives.

My accident was two years ago, and I am still not completely recovered. I have accepted the reality that I may never be 100 percent the same as I was before, and have adapted coping mechanisms to help me with my short-term memory loss and aphasia (the inability to come up with words, or saying the wrong word). I continue to deal with neuro-fatigue and occasional confusion.

Parents, go see the movie “Concussion,” and if your son or daughter takes a physical hit in sports or other activities — monitor them closely, and then don’t allow them back in the game until they have been cleared by a medical professional. Continue to watch your children at home, and if they don’t seem like themselves, or are exhibiting other unusual symptoms, take them in for reevaluation, and don’t let them continue to play until you’re certain they are 100 percent okay.

We must realize children also hit their heads riding a bike or playing on the playground, and with little ones, starting at age 1, hitting glass doors and walls as they begin to learn how to walk. We can’t keep them and ourselves in a perpetual safety bubble, but we do need to be aware of signs and symptoms. As we learn in the movie, repetitive hits to the head can cause very serious long-term, invisible issues.

Now instead of hearing “it’s ‘just’ a concussion,” I hear “you look great; you must be recovered.“ That’s a whole other story for another day. Until you suffer a life-altering brain injury, you will never be able to understand what the other person is going through, I know I sure didn’t. It is a long, lonely road to recovery.

When I think back to when I was first going through this, I still shake my head at the ignorance of some people. Actually, I have since learned, most people have no idea of the complexities of a TBI. My hope is to help raise awareness about traumatic brain injury, and just how serious a concussion really is. We only get one brain — it’s our job to protect it!!

 

Zellmer, Amy. “It’s Not ‘Just’ a Concussion.” The Huffington Post. TheHuffingtonPost.com, 18 Jan. 2016. Web. 19 Apr. 2016.


Clinics teach, preach safety to coaches

By JASON FRANCHUK

Ken Stoldt traveled from his Buffalo-area home to the eastern side of upstate New York for a couple of lightly attended youth-football clinics. That included a Sunday session at Christian Brothers Academy which had just four participants.

The low turnout was just fine with him — the big-picture signs are what matter. And he likes what is being seen nationally through Heads Up Football player safety clinics.

“A fundamentally sound player is a safer player,” Stoldt said after a six-hour clinic that was actually a makeup session which didn’t include any local coaches. “Over the last three years — concussions and injuries are down across the country. Participation is on the rise again, which is a good thing.”

Stoldt carries the title of master trainer for USA Football, a nonprofit that is the sport’s Indiana-based national governing body. The former high school coach of 20 years now travels the state, preaching the words of a 13-year-old organization which features a significant amount of backing from the NFL and is geared toward pre-high school football. (Albany’s Pop Warner League website, for kids 5-15, includes links to various USA Football pages.)

Stoldt spoke of heat and hydration, as teams are getting into late-summer practices, and also how to handle cardiac arrest.

Of course, the big topic these days is avoiding concussions — a process Stoldt says requires use of proper techniques and the elimination of what he considers to be worn-out myths.

After taking in the clinic, Ralph Falloon, who coaches high school ball in Cold Spring (near Poughkeepsie) said he’s impressed at how much “time and money and effort, is spent to properly train coaches and students.” He adds that so much contact just takes place on actual gamedays.

Stoldt said it’s not USA Football’s intention to take away the physical nature of the sport — but rather to preserve it in a more healthful way. That means drills designed to protect players’ heads and limit the amount of force taken.

The last 45 minutes of the clinic — with the coaches coming from the Poughkeepsie area and Utica — was spent behind the school going over drills. There were also classroom segments and PowerPoint presentations.

With bigger groups — Stoldt said he had 50 attend a session in Albany in the past — those on-field sessions can take about 90 minutes. This clinic lasted two hours less than usual.

Stoldt said he couldn’t estimate how many Section II high school coaches had been through a USA Football session this summer. It is not required. But youth leagues that want a USA Football endorsement must have a rep from each of its teams attend a day-long training session.

Stoldt says he also sees positive growth in his own sliced-down travel schedule: He’s only been out of the state once for a clinic during the past two summers, after heading to Connecticut, Vermont and Michigan before that. There are more quality instructors, he said.

It’s on the day campers to pass along pertinent information to their teams and parents.

Stoldt hopes the conversations help parents.

“Putting their minds at ease” of the game’s relative safety is important. Football, he says is still less concussive than soccer and cheerleading according to national statistics. He also attributes some of the fears to media coverage of the epidemic.

“We’re trying to put some of those myths to rest and let people know that, yes, even though we’re not the leading cause of concussions we’re the ones taking steps to prevent it,” he said.

Stoldt said another issue dissected this year is head-to-head contact along the line of scrimmage, in rush-block situations, which he says can cause as much head trauma as all-out tackling.

Parents tend to be concerned about helmet quality, but there’s a lot more to concussions and prevention than gear.

He spent the day discussing code words like “buzz” (getting feet under control before making a tackle) and “breakdown” (a fundamental starting position).

Stoldt loaded up his truck with equipment and manuals for the final time, headed home to put on his next hat: Section VI football chairman.

“It’s been another good summer,” he said.

Source: Franchuk, Jason. “Clinics Teach, Preach Safety to Coaches.” Times Union. N.p., 17 Aug. 2015. Web. 17 Aug. 2015.


Working Together to Prevent Injuries in Youth Sports

victoria2We’ve all been there: getting hit or knocked down during a game and saying “I’m fine!” instead of taking a seat on the bench and determining whether or not we are really injured. No player wants to let the team down or feel weak for admitting that he or she is hurt and in need of a break, but this mentality can actually hurt a player even more down the line. According to safekids.org, a youth sports injury that results in a visit to the emergency room occurs once every 25 seconds. This adds up to about 3,397 children in the hospital every single day. Safe to say, youth sports injuries are not uncommon and need to be taken seriously. That number would be even higher if more players were willing to admit their pain and take the necessary steps to find out how to heal it, but this would at least prevent further damage or repeated injuries of the same kind from happening. 54 percent of athletes said they have played injured, and 42 percent of athletes have admitted to “hiding or down-playing an injury during a game so they could keep playing”, according to safekids.org. This practice of hiding injuries needs to be curbed so that children stop repeatedly playing on an injury, and putting themselves in even more danger.

At the beginning of the season, players need to be told by the coach to come forward and be honest if they are feeling less than okay and ground rules should be set to agree on how the team will approach injuries. It also becomes the parents’ responsibility to report to the coaches in the event that their child has admitted to feeling pain, or has been diagnosed by a doctor and given specific instructions about how to treat an injury. Similarly, the coach needs to be open with the parent and inform them that their child has been injured during a practice or a game so that the parent can take the necessary steps to keep their child healthy and safe. Considering that 62 percent of organized sports-related injuries occur during practices, according to youthsportssafetyalliance.org, it is clear that many injuries occur when the parent is not around to witness them, making communication necessary.

bundleWhile the responsibility does lie on the player, we cannot always trust that children will take an injury as seriously as they should or that they will be open with both their coach and parent and admit to one. According to safekids.org, less than half of coaches are certified and know how to prevent and recognize sports injuries, while 53 percent have said they’ve felt “pressure from a parent or player to put an athlete back in the game” after an injury. To make the playing field a safer place, coaches need to be certified or, at the very least, aware of the health issues of their players, just as parents need to focus on their children’s health rather than their goal count.

What all of this comes down to is communication. The gaps between players and parents, players and coaches, and parents and coaches leave room for more harm. A player who tells his parents that his ankle hurt during the last practice and gets a note from the doctor that he should skip gym class should not be playing in their soccer game the next day. The player might not want to tell their coach about this for fear of being benched, but the parent should recognize the importance of resting for their child’s safety and keep the coach informed. Similarly, if a player was complaining of dizziness during practice and had to sit out, the coach should report this to the parent so that they can go to a doctor or keep an eye out for their child. If a coach or a parent doesn’t know there is something wrong with the child, then they have no way of fixing the problem. Where communication stops is where injuries can go from bad to worse. The more aware that parents and coaches are about a player’s injuries, the more help and support they can give. When players, parents, and coaches work together, athletes are kept safer and the team becomes stronger as a whole.

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Safety Tag Works with HEADstrong Foundation

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PHILADELPHIA (June 16, 2015) – Safety Tag has made the exciting decision to begin working with HEADstrong Foundation and Lacrosse Club in order to assist in raising awareness and funds for people who have been affected by cancer.

Safety Tag is dedicated to improving the health, safety and security of youth athletes. The company works to enable more effective and transparent communication between coaches, players, and parents using their safety platform designed to give coaches instant access to player safety information. In the event of an emergency, a coach has player
specific medical information and emergency action plans right at their fingertips. Safety Tag values the importance of keeping players safe and healthy, and aligns themself with HEADstrong’s mission to improve the quality of life for those who have been affected by cancer. After Nicholas Colleluori was diagnosed with a fatal blood cancer, he created the HEADstrong foundation to help others affected by the disease and used his lacrosse background to carry out his mission. HEADstrong raises money and awareness for their cause through their Lacrosse Club and through other organized athletic events, and has already raised over five million dollars since 2006. With a similar focus on health and wellness, Safety Tag is happy to team up with HEADstrong and donate their safety platform and support to a foundation that they believe has an inspiring and impactful message.

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