Practice-Based Research Networks, Part II: A Descriptive Analysis of the Athletic Training Practice-Based Research Network in the Secondary School Setting

Abstract

Context Analysis of health care service models requires the collection and evaluation of basic practice characterization data. Practice-based research networks (PBRNs) provide a framework for gathering data useful in characterizing clinical practice. Objective To describe preliminary secondary school setting practice data from the Athletic Training Practice-Based Research Network (AT-PBRN). Design Descriptive study. Setting Secondary school athletic training facilities within the AT-PBRN. Patients or Other Participants Clinicians (n = 22) and their patients (n = 2523) from the AT-PBRN. Main Outcome Measure(s) A Web-based survey was used to obtain data on clinical practice site and clinician characteristics. Patient and practice characteristics were obtained via deidentified electronic medical record data collected between September 1, 2009, and April 1, 2011. Descriptive data regarding the clinician and CPS practice characteristics are reported as percentages and frequencies. Descriptive analysis of patient encounters and practice characteristic data was performed, with the percentages and frequencies of the type of injuries recorded at initial evaluation, type of treatment received at initial evaluation, daily treatment, and daily sign-in procedures. Results The AT-PBRN had secondary school sites in 7 states, and most athletic trainers at those sites (78.2%) had less than 5 years of experience. The secondary school sites within the AT-PBRN documented 2523 patients treated across 3140 encounters. Patients most frequently sought care for a current injury (61.3%), followed by preventive services (24.0%), and new injuries (14.7%). The most common diagnoses were ankle sprain/strain (17.9%), hip sprain/strain (12.5%), concussion (12.0%), and knee pain (2.5%). The most frequent procedures were athletic trainer evaluation (53.9%), hot- or cold-pack application (26.0%), strapping (10.3%), and therapeutic exercise (5.7%). The median number of treatments per injury was 3 (interquartile range = 2, 4; range = 2–19). Conclusions These preliminary data describe services provided by clinicians within the AT-PBRN and demonstrate the usefulness of the PBRN model for obtaining such data.

Methods and Descriptive Epidemiology of Services Provided by Athletic Trainers in High Schools: The National Athletic Treatment, Injury and Outcomes Network Study

“…Our results regarding the most common services provided by ATs varied from previous results of the Athletic Training Practice-Based Research Network (AT-PBRN), 6,7 which also examined the high school student-athlete ). Like the AT-PBRN, our study used electronic medical record systems to collect injury and treatment data.…”

Athletic Training Services During Daily Patient Encounters: A Report From the Athletic Training Practice-Based Research Network

“…The 4 domains of athletic training clinical practice related to injury management are (1) prevention, (2) clinical evaluation and diagnosis, (3) immediate care, and (4) treatment, rehabilitation, and reconditioning. 15 Although previous epidemiologic 16À20 and practice characterization 12,13 research has provided insight into the latter 3 domains, limited information has been available regarding preventive services. Thus, our results are important in highlighting the unique role of ATs as health care providers who provide substantial preventive services to their patients.…”

“…For example, the ''Summary document: appropriate medical coverage for secondary school athletes'' 8 and the ''Interassociation consensus statement on best practices for sports medicine management for secondary schools and colleges ''11 identified components of clinical practice that need to be considered when discussing appropriate athletic health care for interscholastic athletes. These clinical practice components include coverage of high-risk sports, 18,19 treatment and rehabilitation services, 12,13 and injury-and illness-prevention services. 26,27 Together with previous studies that characterized treatment and rehabilitation services in high-risk sports, our findings should help clinicians and administrators make more informed decisions about appropriate coverage at their clinical sites.…”

“…Detailed information regarding the EMR, including standards (eg, Health Insurance Portability and Accountability Act, Safe Harbor Method) and major components of the system, required clinician training related to its use, and procedures for data quality assurance have been previously described. 12,13 For this study, we reviewed records from the daily encounter forms of the EMR. The daily encounter form is used by ATs to document the individual athlete encounters that occur each day; it documents services such as preventive taping and bracing and performance-enhancement activities that might not be captured in other EMR forms, such as the daily treatment note or the full evaluation form.…”

“…Recent researchers 12,13 have begun to characterize patient and treatment characteristics of athletic training practice, yet it is likely that these data are primarily related to time-loss injuries and capture only a small portion of the daily demands on, workload of, and tasks performed by the athletic trainer (AT). The NATA's recently released ''Secondary school value model'' document 14 recommended that ATs supplement formal patient documentation with daily encounter or sign-in forms to record patient visits and services such as ice or heat application or injury-preventive measures (eg, taping) related to nontime-loss injuries.…”