DEVELOPMENT OF A COMPREHENSIVE AND COST-EFFECTIVE PRE-PARTICIPATION EXAMINATION (PPE)

Abstract

1319 Mandatory PPEs are labor intensive and poor predictors of future injury or illness. Our objective was to develop a new PPE for the 850 Stanford University varsity athletes that improved both physician time efficiency and quality of primary and preventive care by addressing health issues not specifically related to clearance for participation. This PPE is based on yearly submission of an athlete completed, detailed, medical history questionnaire that is summarized in a 2 page report for the examining physician. The questionnaire was developed through review of PPEs from 15 other institutions, search of Medline from 1966-97 and discussion with 2 experts from each of 7 main content areas: medical and musculoskeletal history, eating, menstrual and sleep disorders, stress and health risk behaviors. Content validity was assessed by 10 sports medicine experts and 5 epidemiologists. It was then programmed for the World Wide Web (WWW). In 1997-98, 79% of athletes used the WWW and 21% completed a hard copy; >90% of athletes who used the web site found it `easy' or `moderately easy' to access and complete. Mean completion time was 28 min. 28% of first year athletes had not had a complete health exam in ≥3 years and 12% had never had a complete health exam; 23% of all athletes wished to speak to a physician about weight control, nutrition, stress, depression or other health concerns not addressed by the previous PPE. Sixteen physicians administered the 1997-98 PPEs; 14 stated the history report was `useful' or `very useful' in focusing their physical exam and 12 indicated it `significantly improved their opportunity to address primary and preventive care issues'; 13 physicians stated there was a `moderate' or `significant' decrease in time needed for each individual exam compared to previous years. Assessment of this new PPE format shows good athlete compliance, improved efficiency and a strong increase in subjective physician satisfaction with the quality of medical care provided. The data indicate a need for improvement of primary care in this population. The database offers opportunities to study trends, risk factors and results of interventions.