URGENT MESSAGE: Increased awareness of concussion risks in organized sports creates an opportunity for urgent care centers to offer concussion education and treatment for student-athletes.

James Nawalaniec is a first-year medical student at the University of Texas Southwestern Medical School in Dallas.

Concussions can be difficult to diagnose and easy to ignore, although they pose a very serious threat to brain health and function—especially if more than one concussion is sustained within a short period of time. Because of their prevalence in sports at all levels (from pee-wee to professional), their detrimental long-term effects, and a general lack of understanding among medical professionals, recently concussions have drawn unprecedented attention from athletic organizations, researchers, and the media. Despite being in the spotlight, there is a dearth of knowledge regarding this condition that endangers anyone at risk of suffering a concussion.

According to the Mayo Clinic Encyclopedia of Diseases and Conditions, “a concussion is a traumatic brain injury that alters the way the brain functions.” Effects are usually temporary, but can include headache and problems with concentration, memory, judgment, balance, and coordination. Concussions are especially common in contact sports like football. Every concussion injures the brain to some extent. Sometimes concussions cause loss of consciousness, but most often they do not—meaning it’s all too easy for the victim to have a concussion and not realize it. Fortunately, most concussive traumatic brain injuries are mild, with patients making a full recovery.

Urgent care operators can benefit from the increased number of families entering their facilities, or who are at least exposed to the center’s name and location. Relationships built with coaches, athletic directors, and trainers can drive incremental volume through preparticipation physicals, as well as care for all types of sports-related injuries. While the initial visit may be limited to athletes, it’s likely these same patients will visit the center again for other urgent care issues and tell their friends and families to do likewise.

What’s This Got to Do with My Urgent Care Business?
There is an opportunity for urgent care centers to offer concussion education and treatment for student-athletes who may not have access to substantive concussion care through their schools and trainers. Urgent care can fill a gap by becoming the community care site for student-athlete concussions, especially considering these injuries typically present to emergency rooms, resulting in exponentially greater cost for care that could be delivered in a lower-acuity setting.

History of Concussion Research
Concussions have been shown to cause mental illnesses and permanent brain damage, especially among professional athletes or when multiple cases go untreated.1 Because concussions have been linked to brain damage, depression, and other serious neurological conditions, they have received increased attention at the high school/middle school level where athletes whose brains are still developing are at risk of suffering a concussion. This has led to an increase in awareness of concussions and their symptoms; consequently, visits to the emergency room and associated costs have increased.2

It is important to understand that football is not the only sport where concussions can occur; indeed, they can take place in any contact sport, including basketball, soccer, lacrosse, wrestling, hockey, and so on.

The implications for urgent care, then, is the emergence of a vast new market of local patients seeking immediate care, usually after hours (when practices and games are happening), but who do not require an ED visit; urgent care centers fulfill this need perfectly and should work to occupy this emerging niche.

The Basics of Concussion Care
Most patients with suspected concussions do not need to be seen in a hospital ED; in fact, 95.4% of concussion patients presenting to an ED are discharged home same day.3 This indicates that concussion care could be completed in an urgent care setting, saving time and money for the patient and promoting increased continuity of care with your primary care physician.

In terms of actual treatment of concussions, the care plan is a multistep process that would ensure follow-up visits. Baseline testing is done on athletes on an individual basis, and if a concussion is suspected later on in the season, the same test must be performed to determine if a concussion was sustained. After diagnosis, treatment plans and follow-ups are required before the player can return to play. Almost all urgent care centers would have the resources in place to perform these steps in concussion care.

Also, advanced emergency care equipment is not required to diagnose most concussions. A CT scan, for example, is used only in severely concussed patients to rule out internal bleeding within the skull, which is rare in concussion cases.4 For the most part, concussions can be diagnosed without expensive imaging.

In short, the majority of urgent care centers are capable of evaluating concussion patients and could stabilize the severe cases, sending them to the ED just as is done for any other urgent care patient presenting with severe, emergent symptoms.

In 2011, a report from the Centers for Disease Control and Prevention (CDC)on traumatic brain injuries (TBIs) related to sports or recreation indicated a sharp rise in cases and ED visits. It revealed that from 2001 to 2009, the estimated number of sports- and recreation-related TBI visits to emergency rooms increased 62%.2 As concussion awareness and caution continues to rise, this number will continue to increase. Urgent care centers should recognize the opportunity here to capture these ED patients, with the incentive of much lower cost and better continuity of care. In order to accomplish this ED diversion, however, urgent care centers must be able to successfully market their cost effectiveness, ability to treat such conditions, and superior patient experience.

Implementing Concussion Care and Potential Delivery Models
There are many avenues the urgent care operators can take to begin offering concussion care. On excellent, cost-effective way is to distribute educational literature to athletes who are at risk, as well as their parents and relevant school personnel. The CDC’s website has multiple brochures for patients and providers that can be ordered in bulk, free of charge. These can be distributed from the center or sent to coaches, athletic directors, trainers, or individual patients (including those who have come in for sports participation physicals in the past) with a letter explaining the center’s equipment and ability to treat concussions.

In terms of care delivery, a center can offer baseline testing through programs like imPACT an all-in-one, computerized concussion evaluation system developed by researchers at the University of Pittsburgh. It offers baseline and postconcussion testing through a database of neurocognitive testing questions.5 Some urgent care centers are already using the system; in San Antonio, for example, a center offers baseline testing for $15 and postinjury testing for $20.6

Once you have a baseline assessment, ensure that the center’s doctors are familiar with concussion care and how to interpret test results so the rest of the case amounts to a straightforward urgent care visit with rechecks.

Promote Your Center’s Capabilities
Another important component to successfully implementing concussion care and driving patients through the door is advertising. Urgent care centers offering concussion care must advertise urgent care as a less expensive, more efficient alternative to the ED. This can be accomplished by emphasizing extended hours and pricing differences so patients understand that the ED is not the only after-hours option for medical care—and certainly not the most cost-effective way to receive immediate medical care.

How should a center advertise its concussion care capabilities? Start with getting involved in your local community; work with schools and sports leagues to provide baseline testing and care for students and athletes. Not only does this accomplish targeted advertising to the specific patients we want to draw in for care, but it also builds the center’s brand among the community, helping in the long term to drive a variety of visit types into the center simply as a result of better consumer awareness.

Finally, design a brochure outlining “concussion basics,” sponsored by your center/company. This could be either a hard copy to distribute to patients and the surrounding community, or an online version for a school or league website. This should include information like:

  • How to tell if you have sustained a concussion
  • What to do if you or your child has sustained a concussion
  • Which sports or activities have high risks of occurrence
  • Risks of concussions going untreated
  • How to prevent concussions from happening

Include in the last panel your center’s address and a small advertisement for pre- and postconcussion testing, diagnosis, and treatment.

Advertise aggressively during the beginning of the school year and the beginning of spring, the two times when middle school/high school sports are beginning and when concussions will be on the rise. Promotion of concussion care is a natural complement to the sports participation physicals many centers already provide.

Partnerships Between Healthcare Providers and Schools
In Seattle, three medical centers partnered to develop the Seattle Sports Concussion Program, offering offer complete concussion care, from baseline testing to treatment plans to return-to-play schedules.7 This partnership arose out of a state law requiring athletes who show signs or symptoms of a concussion to get written approval from a licensed healthcare provider before returning to play. The CDC reports that 43 states and the District of Columbia have passed similar laws, opening a niche that urgent care centers can fill by offering concussion treatment services.
In Colorado, Telluride Medical Center has partnered with Think Head First, a company that provides education and consultation services to healthcare providers and sports programs in the area of concussion management, specifically targeting “teams and schools” for patients. They also offer the imPACT testing software. The program includes coach and parent education, baseline testing and athlete education, postinjury, on-site coach support and remote testing, medical and clinical evaluation and follow-up, and multidisciplinary individual return-to-play plans.8

Finally, Heartland Regional Medical Center in Missouri has partnered with a local school district to provide on-site, twice-yearly baseline testing for any students participating in athletics for that semester. Over 500 athletes were tested in just one year.9 The implications for an urgent care center are great, as this translates into a boost in immediate revenue for the center, but equates to 500 new potential patients who may come to your center for diagnosis and care, having already undergone baseline testing through the organization. This type of community involvement is a great way to build your brand and establish your center as a point of care in the community.

Conclusion
Concussion care is an excellent opportunity for urgent care operators to raise brand awareness in their communities and attract new patients. Urgent care centers in general already have the equipment and capabilities needed to treat the majority of concussed patients, so minimal investment would have to be made into a center to offer this care. Concussion care aligns with strategies to divert patients from the ED to the urgent care center, as most concussed patients go to the ED presently even though the same level of care is easily accomplished and is exponentially cheaper in an urgent care setting.

Incorporating concussion care into the services offered at an urgent care center should, if marketing is effective, lead to an increase in revenue and, considering the low cost associated with it, a boost in profitability.

References

  1. Cole C. Uncovering concussions: how they’re changing our brains and the game. Chicago Health. 2012. Available at: http://chicagohealthonline.com/uncovering-concussions/.
  2. Centers for Disease Control and Prevention. Nonfatal traumatic brain injuries related to sports and recreational activities among persons ≤19 years—United States 2001–2009. MMWR Morb Mortal Wkly Rep. 2011;60(39):1337-1342.
  3. Zhao L, Han W, Steiner C. Sports Related Concussions, 2008. Statistical Brief #114. Agency for Healthcare Research and Quality (US). 2011 May.
  4. WebMD. Brain and Nervous System Health Center. WebMD. Available at: http://www.webmd.com/brain/concussion-directory.
  5. imPACT. The ImPACT Test. ImPACT. Available at: http://www.impacttest.com/about/?The-ImPACT-Test-4.
  6. Impact Urgent Care. Online Baseline Concussion Test. Available at: http://impacturgentcare.com/Baseline_Concussion_testing.htm
  7. UW Medicine. UW Sports Concussion Program. Available at: http://www.uwmedicine.org/services/sports-medicine/concussion.
  8. Kelly BA. Think Head First brings a comprehensive and cutting edge concussion protocol to the med center. Telluride Medical Center: Health and Fitness. November 22, 2012. Available at: http://www.tellurideinside.com/2012/11/telluride-med-center-think-head-first.html.

9. Johansen C. School district holds concussion tests. News-Press. St. Joseph, MO. July 9, 2013.

Concussion in the Urgent Care Center: From the Sideline to Your Bottom Line
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