scholarly journals Using Telemedicine to Pre-Screen Sports Medicine Patients in the Ambulatory Setting Reduces Wait Times and Maximizes Provider-Patient Interaction

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0041
Author(s):  
Alfred Atanda ◽  
Kathryn Leyden ◽  
Medical Student
Keyword(s):  
Patient Satisfaction ◽  
Knee Pain ◽  
Sports Medicine ◽  
Clinic Visit ◽  
Background Information ◽  
Full Time ◽  
Visit Time ◽  
Medicine Clinic ◽  
Exam Room ◽  
Room Time

Objectives: Gathering of background information during a clinic visit can be time-consuming. Some medical specialties have workflows that pre-screen patients ahead of time to minimize delays. Having background information ahead of time may decrease delays and ensure that the visit is focused on physical examination, diagnosis, and treatment. We have used telemedicine to treat established patients to reduce cost and resource utilization, while maintaining high levels of patient satisfaction. It is conceivable that telemedicine could also be used to pre-screen new patients prior to their in-person clinic visit. The goal of the current study was to evaluate whether utilizing telemedicine to pre-screen new patients to our sports medicine clinic would reduce time in the exam room waiting and being seen, and overall clinic times. Methods: From June 2018 through August 2018, we utilized videoconferencing telemedicine to pre-screen all new patients to a pediatric sports medicine clinic with a chief diagnosis of knee pain. Visits were performed by full-time telemedicine pediatricians who were provided appropriate training and an intake form describing which questions should be asked. All visits utilized the American Well software platform (Boston, USA) and were performed on the patient’s personal device. During the subsequent in-person visit, the overall timing of the visit was recorded including: time checked in, time waiting in waiting room, time waiting in exam room, time spent with provider, and time-checked out, were all recorded. Similar time points were recorded for matched control patients that did not undergo telemedicine pre-screening and were seen in the traditional manner. Inclusion criteria included: being brand new to the practice and unilateral knee pain. Results: There were eight pre-screened patients and ten control patients in this cohort. Compared to controls, pre-screened patients spent less time in the exam room (19 min vs. 31 min), higher percentage of the exam room time with the provider (58% vs. 34%), higher percentage of the overall visit time with the provider (29% vs. 19.5%), and less time for the overall visit (39 min vs. 52 min). Conclusion: Pre-screening patients to obtain background information can decrease exam room waiting time and overall visit time and maximize time during the visit spent with the provider. In addition, it could potentially be used to increase throughput through the clinic and improve patient satisfaction scores.

scholarly journals SESAMOID INJURIES IN PEDIATRIC AND ADOLESCENT ATHLETES PRESENTING TO SPORTS MEDICINE CLINIC

2019 ◽  
Vol 7 (3_suppl) ◽  
pp. 2325967119S0018
Author(s):  
Andrea Stracciolini ◽  
Bridget W. Dahlberg ◽  
Bridget Quinn ◽  
Dai Sugimoto ◽  
Cynthia Stein
Keyword(s):  
Diagnostic Imaging ◽  
Strong Correlation ◽  
Sports Medicine ◽  
Female Athletes ◽  
Return To Sport ◽  
Clinic Visit ◽  
Male Athletes ◽  
Medicine Clinic ◽  
The Mean ◽  
Performing Artist

Background Sesamoid injuries of the first metatarsal phalangeal joint in athletes occur with sports that place repetitive stress on the plantar aspect of the great toe. Performing artist athletes are particularly at risk for injury given the load placed on the hallucal sesamoid bone often inherent in the activity. Risk factors may include choice of sport, volume of training, sex, bone density, BMI and biomechanical profile of the lower extremity. Hallucal sesamoid evaluation and treatment remains poorly defined in the literature. The aim of this study is to analyze all sesamoid injuries presenting to a sports medicine clinic. The goal of the study is to increase understanding of the injury profile, diagnostic evaluation, treatment regime, and return to sport of athletes with hallucal sesamoid injuries. The long-term goal is to develop evaluation and treatment algorithms that serve to guide clinical decision-making, and improve time to return to sport. Methods A comprehensive retrospective chart review was conducted of athletes presenting to a tertiary level sports medicine clinic located within a pediatric medical center. Electronic medical records were searched using the search term sesamoid. To be included in the study, the injury had to definitively involve the hallucal sesamoid and be related to sports participation. Exclusion criteria included patients with a chronic disease or condition that might affect bone healing or confuse the diagnosis of sesamoid injury, prior history of surgery to the foot, and insufficient management records. Descriptive statistics were used to analyze outcome variables including specific diagnosis, clinical prognoses, diagnostic imaging tools and treatment types. Additionally, a correlation analysis was performed for time from pain onset to first clinic visit, and time to return to participation. Little or no correlation was considered 0.00-0.25, weak correlation was considered 0.25-0.50, moderate correlation was considered 0.50-0.75 and strong correlation was considered 0.75 -1.00. Results 326 athletes with 359 hallucal sesamoid injuries were identified. The mean age of the cohort was 15.8 ± 3.8 years (median: 15.3, 95% CIs: 15.46 – 16.24); 86% (n=309) were female and 14% (n=50) of the injuries were male. The mean BMI of the cohort was 21.28 ± 3.5 mg/kg2. Table 1 presents the sports for the athletes in the cohort. The leading sports included 40% (n=144) dance, 13% (n=48) running, and 13% (n=47) soccer. Activities that top the list for females include dance 44% (n=137) and running 13% (n=39). In comparison, male athletes participated in soccer (20%, n=10), running (18%, n=9), and football (10%, n=5) as well as other diverse sports. The most common injuries across both sexes were sesamoiditis (30%, n=107), followed by sesamoid stress fracture (13%, n=46). Table 2 Where self-reported data on dance/sport practice time was recorded, 31% (n=65) reported practicing 10-15 hours per week. Figure 1 The average reported time between injury or the onset of pain to the first clinic visit was 143 days (median: 42, 95% CIs:116.87-169.15). The mean time between pain onset and first clinic visit was greater for female athletes as compared to male athletes (146 days and 119 days). The average time from first presentation to clinic to returning to participation was 115 days (median: 72, CIs:100.7-129.49). Spearman’s rho demonstrated a strong correlation between time from pain onset to first clinic visit and the time to return to participation in both males (? (rho) = 0.82, p < 0.001) and females (? = 0.79, p < 0.001). Males experienced a shorter duration from the first clinic visit to return to participation (mean: 72 days, median 33), than females (mean: 121 days, median 77). The most common diagnostic imaging modalities used were radiographs (72.14%, n=259) and MRI (56.55%, n=203). In both males and females the most common initial treatments included a combination of: walking boot (51.53%, n= 185), physical therapy (38.72%, n=139), and activity modification (34.82%, n=125). These remained the most popularly prescribed treatments in the second and third treatments as well. Conclusions/significance Female athletes participating in dance and running, and male soccer, running and football athletes lead the list for injury to the hallucal sesamoid. Sesamoiditis and sesamoid stress fracture were the leading diagnoses in this cohort. Athletes who presented to clinical attention sooner also returned to sport/dance sooner when compared to athletes who delayed seeking medical attention. Continued research will serve to support anticipatory guidance and education surrounding hallucal sesamoid clinical presentation and need for timely evaluation and treatment in order to minimize time loss from sport/performing artist activity. [Table: see text][Table: see text][Figure: see text]

Improvement in Total and Face-to-Face Provider Time in a Multidisciplinary Craniofacial Team Clinic: An Interventional Study

2021 ◽  
pp. 105566562110217
Author(s):  
Alexis C. Wood ◽  
C. Alejandra Garcia de Mitchell ◽  
Ruchi Kaushik
Keyword(s):  
Data Collection ◽  
Cleft Palate ◽  
Outcome Measures ◽  
Clinic Visit ◽  
Visit Time ◽  
Time Data ◽  
Interventional Study ◽  
Face To Face ◽  
Before And After ◽  
Total Visit

Objective: Identify factors contributing to time a family spends in a Multidisciplinary Craniofacial Team Clinic (MDCT) and implement an intervention to reduce this time. Design: Interventional: a restructuring of clinics to serve those patients requiring fewer provider encounters separately. Setting: An American Cleft Palate-Craniofacial Association-accredited MDCT in an academic children’s hospital. Patients/Participants: One hundred sixty-seven patients with craniofacial diagnoses. Interventions: Time data were tabulated over ∼2 years. Following 9 months of data collection, patients requiring fewer provider encounters were scheduled to a separate clinic serving children with craniosynostosis, and data were collected in the same fashion for another 14 months. Main Outcome Measures: Principal outcome measures included total visit time and proportion of the visit spent without a provider in the room before and after clinic restructuring. Results: The average time spent by family in a clinic session was 161.53 minutes, of which 64.3% was spent without a provider in the room. Prior to clinic restructuring, a greater number of provider encounters was inversely associated with percentage of time spent without a provider ( P < .001). Upon identifying this predictor, scheduling patients who needed fewer provider encounters to a Craniosynostosis Clinic session resulted in reduction in absolute and percentage of time spent without a provider ( P < .001). Conclusions: The number of provider encounters is a significant predictor of the proportion of a clinic visit spent without a provider. Clinic restructuring to remove patient visits that comprise fewer provider encounters resulted in a greater percentage of time spent with a provider in an MDCT.

scholarly journals Development and validation of the Sorting non-trauMatIc adoLescent knEe pain (SMILE) tool – a development and initial validation study

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Clara Guldhammer ◽  
Sinead Holden ◽  
Marina Elmelund Sørensen ◽  
Jens Lykkegaard Olesen ◽  
Martin Bach Jensen ◽  
...  
Keyword(s):  
Knee Pain ◽  
Gold Standard ◽  
Sports Medicine ◽  
Kappa Statistic ◽  
Medical Doctors ◽  
Clinical Tests ◽  
Support Tool ◽  
Expert Clinician ◽  
Diagnostic Flowchart ◽  
Development And Validation

Abstract Background Despite the commonality of adolescent knee pain, there are no tools to support medical doctors to correctly diagnose knee pain. This study aimed to develop and evaluate a support tool for diagnosing the most common types of non-traumatic adolescent knee pain. Method A systematic search on Medline identified the literature on clinical tests and diagnoses of adolescent knee pain. The search was supplemented by textbooks and transformed into a diagnostic flowchart based on onset, symptoms, and pain localisation. This tool was revised based on feedback from general practitioners and experts in sports medicine. The tool was evaluated on two separate days with blinded assessors. Overall, 27 participants (aged 10–17 years) with non-traumatic knee pain were included. All participants were diagnosed by medical doctors or medical students, without and with the use of the tool. Diagnoses were compared to a gold standard (expert clinician). An interview to inform optimisations of the tool was performed with the assessors. Percentage agreement with the gold standard, and Kappa statistic for interrater reliability were calculated. Results The final tool improved diagnostic agreement with the gold standard from 22.7% (95% CI 10.3–35.1) to 77.3% (95% CI 64.9–89.7). Inter-rater reliability increased from poor agreement k = − 0.04 (95% CI, − 0.12-0.04) to moderate agreement k = 0.56 (95% CI, 0.40–0.72). Conclusion This simple diagnostic tool is quick to use and may assist doctors in diagnosing non-traumatic knee pain in adolescents.

scholarly journals Consistency of Knee Pain and Risk of Knee Replacement: The Multicenter Osteoarthritis Study

2011 ◽  
Vol 38 (7) ◽  
pp. 1390-1395 ◽  
Author(s):  
BARTON L. WISE ◽  
DAVID T. FELSON ◽  
MARGARET CLANCY ◽  
JINGBO NIU ◽  
TUHINA NEOGI ◽  
...  
Keyword(s):  
Knee Pain ◽  
Knee Replacement ◽  
Clinic Visit ◽  
Pain Severity ◽  
Relative Risks ◽  
Increased Risk ◽  
Symptomatic Knee Osteoarthritis ◽  
Symptomatic Knee ◽  
Risk Of Disease ◽  
Total Knee

Objective.To examine whether the consistency or persistence of knee pain, in addition to its severity, predicts incident total knee replacement (TKR).Methods.The Multicenter Osteoarthritis Study (MOST) is a longitudinal study of persons aged 50 to 79 years with symptomatic knee osteoarthritis or at high risk of disease. Subjects were queried about the presence of knee pain on most days of the previous 30 days (i.e., frequent knee pain; FKP) at 2 timepoints: a telephone screen followed by a clinic visit (median separation 4 weeks). We defined a knee as having “consistent pain” if the subject answered positively to the FKP question at both timepoints, “inconsistent pain” if FKP was positive at only one timepoint, or as “no FKP” if negative at both. We examined the association between consistent FKP and risk of TKR using multiple binomial regression with generalized estimating equations.Results.In 3026 persons (mean age 63 yrs, mean body mass index 30.4), 2979 knees (50%) had no FKP at baseline, 1279 knees (21.5%) had inconsistent FKP, and 1696 knees (28.5%) had consistent FKP. Risk of TKR over 30 months was 0.8%, 2.6%, and 8.8% for knees with no, inconsistent, and consistent FKP, respectively. Relative risks of TKR over 30 months were 1.2 (95% CI 0.6–2.3) and 2.3 (95% CI 1.2–4.4) for knees with inconsistent and consistent FKP, compared with those without FKP. This association was consistent across each level of pain severity on the Western Ontario and McMaster Universities Osteoarthritis Index.Conclusion.Consistency of frequent knee pain is associated with an increased risk of TKR independently of knee pain severity.

How to Set Up a Sports Medicine Clinic

1985 ◽  
Vol 13 (6) ◽  
pp. 168-176
Author(s):  
Heyward L. Nash
Keyword(s):  
Sports Medicine ◽  
Medicine Clinic ◽  
Set Up

scholarly journals SELF-REPORTED PHYSICAL ACTIVITY IN SPECIALIZED AND UNSPECIALIZED YOUTH

2020 ◽  
Vol 8 (4_suppl3) ◽  
pp. 2325967120S0021
Author(s):  
Julie A. Young ◽  
Amy E Valasek ◽  
James Onate
Keyword(s):  
Physical Activity ◽  
Sports Medicine ◽  
Vigorous Physical Activity ◽  
Activity Patterns ◽  
Daily Basis ◽  
Recreational Activities ◽  
Physical Activity Patterns ◽  
Medicine Clinic ◽  
Risk Of Injury

The benefits of physical activity cross all domains of health. Unfortunately, many children are not meeting the current American College of Sports Medicine recommendations of 60 minutes of moderate to vigorous physical activity (MVPA) 7 days a week. This is especially deleterious since physical activity patterns during childhood may carryover to adulthood. Research has also shown that participating in one sport may increase the risk of injury. The purpose of this study was to examine self-reported exercise levels in children reporting to a tertiary sports medicine clinic over a three year period. Subjects were asked “How many minutes of moderate to vigorous physical activity per day?” and “How many days per week do you participate in moderate to vigorous physical activity”. Minutes per week of MVPA was calculated. Age, sex, and current sports and recreational activities were recorded. There were 7427 unique patients (53% female) with an average age of 13.8±2.6. The average minutes per day of exercise was reported as 85.6±44.4, average days per week was 4.4±1.6 and minutes per week was 410.8±266.9. Females reported less minutes per day (83.5 vs. 87.8, p<.001), less days per week (4.2 vs 4.7, p<.001) and less minutes per week (384.1 vs 440.2, p<.001) than males. On average, females reported 56 minutes less activity per week than their male counterparts. There were 3618 participants who only reported one activity and were categorized as specialized in a single physical activity. Those that specialized in a single activity were significantly older (14.1 vs 13.4, p<.001). There were no significant differences between reported minutes per day between specialized and unspecialized athletes (85.8 vs 85.2, p=.57). Those who specialized in one activity reported more days per week (4.6 vs 4.2. p<.001) and more minutes per week (423.8 vs 397.0, p=.001) than unspecialized athletes. Research has consistently shown that females are less active than males. Those who specialized in one activity participated in more minutes per week of activity, mainly through participating in more days of physical activity. Children should be encouraged to participate in a variety of activities on a daily basis to ensure they receive the benefits of physical activity.

scholarly journals Comparison of Patient Satisfaction Between Virtual Visits During the COVID-19 Pandemic and In-person Visits Pre-pandemic

2020 ◽  
pp. 000348942097776
Author(s):  
Kyohei Itamura ◽  
Dennis M. Tang ◽  
Thomas S. Higgins ◽  
Franklin L. Rimell ◽  
Elisa A. Illing ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Interpersonal Communication ◽  
Healthcare Providers ◽  
The United States ◽  
Clinic Visit ◽  
Chi Square ◽  
Level Of Evidence ◽  
Virtual Visits ◽  
Chi Square Test ◽  
Student’S T

Objective: To compare the patient experience of a virtual otolaryngology clinic visit to an in-person visit, especially with its significantly increased implementation during the COVID-19 pandemic. Methods: Patient satisfaction (PS) metrics from the Clinician and Group Consumer Assessment of Healthcare Providers and Systems survey were queried from March 1, 2020 to May 1, 2020 for telehealth visits and January 1, 2020 to March 1, 2020 for in-person visits. Overlapping and comparable questions were analyzed using Mann-Whitney U test, Chi-square test for independence, and Student’s t-test. Results: There were 1284 partial or complete PS surveys from in-person visits and 221 partial or complete virtual PS surveys. There were statistically significantly worse virtual visit evaluations of provider listening, conveyance of information, likelihood to recommend, and overall provider ratings compared to in-person visits. Conclusion: Telehealth has become the new norm for most healthcare providers in the United States. This study demonstrates some of the initial shortcomings of telehealth in an otolaryngology practice and identifies challenges with interpersonal communication that may need to be addressed as telehealth becomes increasingly prevalent. Level of Evidence: Three.

scholarly journals Is Telemedicine Suited for Lower Extremity Pathologies? An Analysis of Non-Urgent Follow-Up in a Foot and Ankle Practice

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0034
Author(s):  
Wesley J. Manz ◽  
Rahul Goel ◽  
Omolola Fakunle ◽  
Sameh A. Labib ◽  
Jason T. Bariteau
Keyword(s):  
Patient Satisfaction ◽  
Clinic Visit ◽  
Continuous Data ◽  
Clinical Approach ◽  
Foot And Ankle ◽  
Office Visits ◽  
Chi Square ◽  
Fracture Care ◽  
Patient Reported ◽  
The Difference

Category: Other; Ankle; Hindfoot; Midfoot/Forefoot Introduction/Purpose: A lack of access to care is predictably associated with negative outcomes in foot and ankle surgery. Despite recent advances in telecommunication technologies, the field of orthopaedics has been slow to adopt these resources in offsetting barriers to care. The COVID-19 pandemic has forced departments to change their clinical approach, lending unprecedented opportunity to better understand how telehealth may bridge this care gap in foot and ankle practices. The purpose of this study was to assess patient-reported outcomes of telemedicine encounters, including comfort and patient satisfaction. Our hypothesis was that patients would be significantly less satisfied with telemedicine when compared to in-office appointments for all non-emergent visit types. Methods: Retrospective analysis of patients seen via telemedicine between April 13, 2020, to June 19, 2020, by one surgeon in the Emory Orthopedics Foot and Ankle department was conducted. Patients were contacted by one of the study authors via telephone to complete a questionnaire; satisfaction and other visit characteristics were assessed with a modified Likert scale from 1 to 5. Patients were designated as either ‘New’ or ‘Established’ based on whether or not they had completed an in-office clinic visit within the last year. Anatomy and pathology of disorder were determined by chief complaint and billing code. Patient demographics were recorded, and data were analyzed using paired and independent t-tests for parametric continuous data, Fisher’s exact and chi-square tests for non-continuous data. Results: 338 eligible patients were contacted via telephone, with 216 (63.9%) completing the telemedicine questionnaire. The patient cohort had an average age of 50.6 (19-84) years old and was 73.6% female (n=159). Overall mean satisfaction for telemedicine visits (4.69) was significantly lower than in-office visits (4.86) (p<0.001). In a subgroup analysis of patient satisfaction, patients seeking fracture care had significantly higher telemedicine satisfaction when compared to those receiving non-fracture care (4.90 vs. 4.64, p=0.001). Telemedicine satisfaction was also significantly greater in patients traveling more than 50 miles from their home to clinic (4.96 vs. 4.67, p<0.001). Patients with median household income less than the Georgia state median ($55,679) were more satisfied with their telemedicine visits than those with greater income, though the difference was non-significant. Conclusion: our data suggest those with significantly hindered mobility such as increased distance from clinic, lower socioeconomic status, and those seeking care for fractures had higher telemedicine satisfaction than their peers. Further study is needed to detail the precise and safe use of telemedicine in practice, but these data illuminate the high ceiling telemedicine offers in expanding patient care. Our hope is that this study aids as a supportive rationale for the continued use of telehealth visits past the period of the pandemic and encourages a more nuanced view of what visit types may be best-suited for telehealthcare

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