MedStar Health Blog

Concussion therapists like Carissa Colangelo, MS, LAT, have special treatments and specific exercises to help an athlete return to normal after an injury.

Athletic Trainers Play a Key Role in Preventing and Managing Injuries

Carissa Colangelo, MS, LAT, goes to work every day with hopes of making a real difference in the lives of others. Whether she is working with a high school football star who is recovering from a shoulder injury or a man in his 60s who just had knee replacement surgery and wants to get his running shoes back on, her goal is the same.

“I’m here to help people get back to doing what they love,” she says.

Colangelo serves as the coordinator of Athletic Training Services at MedStar National Rehabilitation Network at MedStar Harbor Hospital. She leads a team of athletic trainers who work in collaboration with sports medicine physicians to provide preventive, emergency and rehabilitative medical care. In addition to working side-by-side with the sports medicine physicians at the hospital, the team works with local high school athletes, serving as the “go-to” resource for injury prevention and management for students at six public schools located in Anne Arundel County.

“We’re in the training room to help with stretching, taping, and anything else the athletes need to prepare for practices and games, and then we’re out there on the sidelines to respond immediately in the event an injury occurs,” Colangelo explains. “We can assess the injury on the spot and determine what the best course of action is.”

Depending on the severity of the injury, an athletic trainer may determine a trip to the Emergency department or an urgent care center is what’s needed. Or the trainer may recommend a visit to a primary care physician or orthopaedic specialist, or perhaps even a few sessions of physical therapy. Either way, it’s the job of the athletic trainer to coordinate care and serve as the central point of contact for all providers who will be involved in managing the player’s injury. 

“We call athletic trainers our ‘boots on the ground’ because often, they are there when the injury first happens, they work with the athlete and his or her coach and parents to make medical decisions, they stay involved throughout the entire care process, and eventually oversee that athlete’s return to the field or the game once they have recovered,” adds Colangelo.

Another key focus for athletic trainers is education. They spend time assessing their athletes’ general health and function, with emphasis on the steps that can be taken to prevent injuries. They also talk with athletes, coaches, and parents about issues such as hydration and how to identify the signs and symptoms associated with concussions.

“If a concussion does occur, it may not be necessary to go to the hospital for emergency care, but our athletic trainers can arrange for the athlete to see a physician who specializes in treating concussions,” explains Colangelo.

Because concussions are one of the most common injuries that young athletes face, MedStar Harbor offers a comprehensive concussion program that applies a “whole body” approach to care. Here, athletic trainers and sports medicine physicians collaborate to develop customized treatment and recovery plans for each patient.

“We realize players are eager to get back in the game, but when a concussion occurs, it’s important to listen to your physician and take time to rest and recover,” says Jeffrey Mayer, MD, a sports medicine physician at MedStar Harbor. “Our goal is to get people healthy and back to their prior level of function in a safe and efficient manner.”

Colangelo, who is also a concussion-trained therapist, adds, “There are a variety of tools we can utilize in physical therapy to help alleviate symptoms that can occur as a result of a concussion and get athletes back on the field as soon as possible.”

In 2014, we made a shocking discovery. While analyzing the data for women who came to our hospital for breast cancer treatment between 2006 and 2011, we found that nearly 22 percent of them had stage 3 or 4 breast cancers—nearly double the national average of 10.5 percent.

Most of these women were African-American, and 54 percent of them lived in the District of Columbia. And of these D.C. residents, 40 percent of them lived in Ward 5, our hospital’s neighborhood. But what baffled us the most was that 97 percent of the Ward 5 patients with advanced breast cancer had health insurance.

This was especially surprising to me because of my work at the Cancer Preventorium, where we see people who have no symptoms for regular physical exams and cancer screenings such as mammograms. About 95 percent of the patients I see are Latino, most of whom are poor and without health insurance. They pay out of pocket for these preventive health visits, but do so because they know how important these screenings are.

So why were so many women who had access to preventive healthcare being diagnosed with advanced breast cancer? With help from a generous grant from the Avon Foundation for Women, we started the Get2Breast CARE (Cancer Awareness & Resource Education in Ward 5) program to find out why and to design an intervention to reverse the trend. In September 2017, we published the results of what we’ve learned so far.

Phase 1: What’s keeping women from getting mammograms?

Before we could do anything, we needed to find out why our female neighbors weren’t getting mammograms, the first line of defense against breast cancer. We sent community navigators out to survey 1,092 women in Ward 5.   

The reasons we discovered included:

• Fear: Twenty-seven percent of women were afraid of a possible breast cancer diagnosis and the accompanying side effects and costs of treatment.
• Personal factors: Twenty-eight percent reported that they were too busy taking care of other family members or couldn’t take time off work to get a mammogram.
• Lack of education: Thirteen percent didn’t understand breast cancer risk factors, didn’t know when they should start getting a mammogram or that they needed them at all, or were unaware that their health insurance would cover them.
• Access: Seventeen percent said they would be more likely to get a mammogram if it were more convenient, such as being able to go before or after work, on weekends, or if screening was available closer to home.
• Mammogram misconceptions: The remaining reasons included myths, such as getting a mammogram is painful or that radiation from a mammograms actually could cause cancer.   

Phase 2: Getting the word out about mammograms

Now that we were armed with the knowledge of why women weren’t getting mammograms, we developed educational materials based on that information. And our community navigators headed back out to coordinate outreach activities in the neighborhood. These materials and events focused on dispelling fear and empowering women to overcome personal barriers to receive potentially lifesaving mammograms. 

Our amazing community navigators didn’t all have healthcare backgrounds, but they did have a passion to educate and a deep understanding and insider knowledge of the neighborhood. They knew the best places to reach their female neighbors, such as local businesses, churches and community centers. They also knew who they needed to talk to in order to make the event as successful as possible. For example, if they wanted to reach women from a certain church’s congregation, they knew to talk to the pastor’s wife, not the pastor. 

There’s been some confusion in past years about when and who should get a mammogram. This is due to conflicting guidelines from various health organizations. We urged women in our outreach efforts to follow their doctor’s recommendations based on their unique risk factors. We also shared the American Cancer Society guidelines, which say women at average risk of breast cancer can begin having yearly mammograms at age 40 if they choose, but definitely should begin having them by age 45. At age 55, they can start having mammograms every other year.   

Avon Get2Breast Care Community Navigators (left to right)
Janel Diaz, Lynel S. McFadden and Volunteer Community Navigator Sybil L. Smith

The community navigators gave a short survey before and after every educational event to ensure that women were getting the message. We found a 15 percent increase in the participants who believed that “a mammogram is the safest and most effective test available for finding early breast cancer.” Along with the educational events, we offered to schedule mammograms and to help navigate the process if the test yielded suspicious findings.

What’s next: Expanding the program across the city and including other cancers

I’ve seen firsthand the effect education and awareness can have on cancer prevention. I’ve been privileged since 1989 to host a daily one-hour radio broadcast called “El Consultorio Comunitario” (“The Community Clinic of the Air”), which gives disease prevention and health promotion messages on D.C.-area Spanish-language station Radio America WACA 1540AM, Monday through Friday, and via the Internet. The wide reach of this program likely plays a big role in why we see so many of our Latino neighbors at the Cancer Preventorium, despite the fact they may need to pay two-days’ worth of salary for the exam and screening.

The success of our intervention program in Ward 5 left us wanting to expand it further into the city. The Avon Foundation for Women stepped up again, helping to extend the experience to women in Wards 7 and 8. Nearly 70 percent of all women treated with breast cancer at our hospital come from the three wards in which we’re now working. We’re also excited to be talking with the Department of Health in D.C. about adopting our approach and taking it city-wide. And after finding the same disparity (insured people with advanced colorectal cancer) we started a similar approach to tackle colorectal cancer from the neighborhood.

We hope, through these intervention efforts, to see fewer women in D.C. diagnosed with advanced breast cancer in the future. Instead, we want to see more women for regular mammograms to detect breast cancer early, when the disease is easier to treat.

by Kelly Smith, PhD

As a health services research, I often thought of the patients I worked with as a means to an end – as subjects in my research helping me to achieve greatness. As I worked with patients after open heart surgery, I learned so much from them, from their stories, and their shared experience of health and disease in a fractured healthcare system. I knew that the system needed help and found enlightenment in the field of patient safety.

As a newly minted doctor of philosophy, I embarked on a fellowship in patient safety research at the University of Illinois at Chicago. Here, I learned the power of the patient in a completely different way. They became my partners advocating for health systems change and transforming organizations into learning healthcare systems. I wanted to share a few of those opportunities here with you all.

First, we partnered with patients in developing a program to improve the health systems response to patient harm. This work led to the development of the Seven Pillars model for communication and resolution and in 2013, led to the development of the Communication and Optimal Resolution Program Educational Toolkit (CANDOR) in partnership with the Agency for Healthcare Research and Quality. Our patient partners continue to work with us to change the face of healthcare for patients and families harmed by medical error.

Second, in my first project coming to MedStar Health, our team partnered with patients to design the We Want to Know program –a program aimed at detecting, addressing, and learning from patient perceived breakdowns in care. Our patient partners wanted to "empower" over "educate" and advocated for active outreach rather than simply a passive campaign completely changing our approach! Now into our fourth year, MedStar has implemented WWTK across all ten of its hospitals helping to achieve the patient's voice in healthcare transformation and improvement.

Third, our recent work, partnering with patients and primary care clinicians to develop and field test a Guide to Improving Patient Safety in Primary Care Settings by Engaging Patients and Families has yielded a new approach to translating evidence into practice called – Co-Production! It is through our process of co-production that we have created four interventions for the Agency for Healthcare Research and Quality to improve patient safety in primary care by engaging patients and families.

What has been most rewarding about these experiences is that:

• Together, we have crafted a new normal for patient safety research.
• Together, we have found our common language to discuss difficult and delicate issues.
• Together, we have found our voice!

It is only together as health system leaders and patients as partners can build a safe, reliable, and supportive healthcare system to achieve the quadruple aim. I am so fortunate to work at MedStar Health that puts patients at the heart of its quality and safety journey.