Healthy Athletes Update
In Search of Referral Best Practices…
People who witness a Healthy Athletes event are invariably impressed with the health information discovered by athletes during the screenings, but while knowledge of their health status is increased, the health issues generally remain. Improving their health status most likely depends on follow-up care received at a local health care provider once athletes return home. In order to help athletes get this care, Special Olympics Programs in many places have instituted a wide variety of innovative procedures including partnering with local clinics, communicating directly with parents and guardians to make them aware of their athletes’ needs, and even tracking athletes’ conditions to see if they are persistent over time.
“It’s an important part that we have in our Program. It’s our position that if we are going to get this information, it is our responsibility to follow up as best as we can,” says Jon Buzby, Director of Media Relations for Special Olympics Delaware who also serves as the Program’s Healthy Athletes Coordinator.
Since 2002, Buzby has maintained a spreadsheet for all athletes who have received screenings at state Healthy Athletes events in Delaware and been “flagged” as needing immediate follow-up care. While mild myopic vision would not be flagged, glaucoma would be, as an example. Each Games, 30-40 athletes (about 10% of the total number of athletes that are screened) fit that category. While all athletes screened receive a health “report card,” the guardians for those who are flagged also get a letter from Special Olympics Delaware alerting them that there is a problem that requires follow-up.
Due to Delaware’s relative small size and easy geography, Buzby estimates that 50% of the athletes or more come back to Healthy Athletes the next year, and he is able to keep a watchful eye out for any athlete who is flagged for the same issue twice.
Although the system is not perfect (there is no way of knowing what happened to the athletes who do not come back through Healthy Athletes a second time), it represents an ambitious attempt to encourage follow-up care and track the health status of athletes.
Another, more common practice for providing successful referrals is to partner with local clinics, hospitals, and health practitioners’ offices. According to a survey conducted by Special Olympics Healthy Athletes headquarters in late 2008, 49 percent of responding Programs reported partnering with health clinics, 37 percent reported giving athletes a specific doctor or list of doctors to contact; and 29 percent reported giving such a list to parents or guardians. Click here to read the complete results of this survey.
Special Olympics Wisconsin is one such Program. By partnering with Delta Dental, a not-for-profit service corporation that administers and underwrites dental plans for employers throughout Wisconsin, the Program is able to maintain a list of dentists who are willing to take Special Olympics athletes as patients, particularly those receiving medical assistance. Like Special Olympics Delaware, the Program in Wisconsin sends letters to the guardians and agency managers when it determines that an athlete has an immediate need for follow-up care. These letters generally go out within two weeks of an event and include a report card-like document and a list of recommended providers, according to Melissa Schoenbrodt, the Program’s Director of Sports Training and Athlete Wellness.
Starting about two months after an event, the Program also places telephone calls to the athletes’ guardian to inquire whether or not follow-up care has been found. Schoenbrodt estimates about 60% of athletes have received the needed care.
Currently, the Program offers these referral follow-ups only for Special Smiles but plans to expand it to other disciplines.
“One of my goals this year is to send letters to athletes from Opening Eyes who have issues like high eye pressure, or even to get on the phone for athletes with critical issues that need follow-up,” Schoenbrodt said. Another addition for 2009 in Wisconsin is screening for blood pressure in the Health Promotion venue. “I can then pull the information for anyone who has a risky BP and compare it to their medical form and place a call to the guardian.”
Study to Evaluate Program Follow-up, Referral Efforts
Providing effective referrals is one of the most important priorities for Healthy Athletes headquarters in Washington DC as well. Through this study, Healthy Athletes hopes to discover the most effective ways to both increase the amount of information received by parents/guardians and the subsequent care received by athletes. Research has shown that getting the health information from the screening venue and into the hands of a parent or guardian is a challenge but could be one critical factor. A recent study conducted by the University of Kansas found that someone other than the athlete only learned about the screening results 55% of the time, but among those parents or guardians who did learn the results, two-thirds reported pursuing follow-up care.
The question then becomes: what is the best method for communicating the need for follow-up care to whoever is making medical decisions for the athlete in need? Healthy Athletes hopes to find the answer to this question in a research study to be conducted this year.
In a request for proposal (RFP) currently being distributed by the Special Olympics Research and Evaluation department, the project is described and the following goals established:
Identify a set of practices currently conducted by SO Programs that have the potential to enhance adherence by athletes and families to follow-up care recommendations received at Healthy Athletes. This set of practices should reflect diversity in geography, socio-cultural environments, types of national healthcare delivery systems, types of follow-up practices, and types of Healthy Athletes disciplines.
Conduct a formal assessment of this subset of follow-up practices to determine the likelihood of parents/guardians seeing the screening results, the likelihood of parents/guardians understanding the results, and the likelihood of athletes following-up on the referrals.
Package best practices for dissemination to SO Programs.
Identify barriers that remain to athletes getting follow-up care despite these best practices.
Click here to read the entire RFP.
Special Olympics Research hopes to conclude the project by the fall of 2010 and distribute results soon afterwards.