Sports Medicine Research: In the Lab & In the Field: Proof is in the Report: Empowering ATs can Reduce Costs and Improve Care of Scholastic Injuries (Sports Med Res)

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Monday, December 17, 2018

Proof is in the Report: Empowering ATs can Reduce Costs and Improve Care of Scholastic Injuries

Athletic Trainers’ Effect on Population Health: Improving Access to and Quality of Care

Shanley E, Thigpen CA, Chapman CG, Thorpe J, Gilliland RG, & Sease WF.  J Athl Train.  2018; E-pub ahead of print November 7, 2018. DOI:10.4085/1062-6050-219-17

Take Home Message: A quality improvement process that places the scholastic athletic trainer as a central figure in preventing and managing injuries is associated with reduced injuries and costs.  

Approximately half of high school students participated in athletics during the 2015-16 academic year.  Secondary school athletic trainers are uniquely positioned and play critical roles in the prevention and management of injuries among scholastic athletes.  To ensure optimal care and health status for all athletes it is critical use approaches like quality improvement approaches. These authors described the creation, implementation, and initial results of a quality improvement approach that aimed at improving health of scholastic athletes in a county in the United States. They investigated 6 years of electronic medical records for all schools within a county to gather pertinent information (e.g., injury rates per athletic exposures, services rendered, referrals, costs) to analyze trends and inform decisions.  The six years included one year prior to the start of the quality improvement program (2011-2012). The quality improvement approach involved several steps that were primarily managed by athletic trainers:
1.     documenting the magnitude and number of injuries      
2.     documenting risk factors for injury
3.     defining interventions for at-risk athletes
4.     assessing the quality improvement process before and after implementation.
5.     reporting results to stakeholders (e.g., athletic trainers, athletic directors, coaches, parents) and the cycle would be repeated.
Over 6 academic years, almost 50,000 students participated in at least 1 sport. Males experienced most of the injuries with the highest frequency in football.  In the year prior to the program, 58 injuries occurred per 100 athletes; however, by the last year of the study only 36 injuries occurred per 100 athletes. The authors reported that targeted prevention programming was successful at reducing insurance premiums by half over the 6-year period despite participation remaining the same.  Furthermore, claims and financial losses decreased over time. The implementation of a preventative functional warm-up program as well as a specialized baseball conditioning program was effective at reducing musculoskeletal strains and upper extremity injuries, respectively.  To promote successful outcomes post anterior cruciate ligament reconstruction, recommendations were made to only consider return to play 7 months post-surgery based on retrospective interdisciplinary review of 60 injuries. Lastly, these authors attributed reduced medical costs to athletic trainers appropriately triaging injuries and referring to appropriate providers.    

This quality improvement project is very informative for a clinician because it provides a framework for athletic trainers to be able to document and demonstrate their effectiveness as health care providers.  The authors also showed the impact that scholastic athletic trainers may have on the community through injury prevention and management, which ultimately resulted in reduced insurance costs for a school district. Proving the value/worth of athletic trainers in these models is critical as we advocate for things like higher salaries and possible third-party reimbursement initiatives.  It would have been interesting to see metrics about the athletic trainers; such as average salaries, years-experience, number of athletes per athletic trainer, or years at current institution.  It seemed to be an ideal situation that all athletic trainers within the county used the same electronic medical record system for data aggregation; however, it is well known that documentation of health care services can drastically vary between professionals.  I also think that it would be nice to see how the costs of services rendered within the scholastic athletic training facilities compared to medical costs in other settings.  For example, did this approach lead to athletic trainers handling more rehabilitation sessions in the school setting versus referring to a physical therapy clinic. Overall, it is refreshing to see a data-informed health care approach to decision-making and reporting on the efficacy of these programs/initiatives. While these findings are not externally generalizable to other organizations or schools, the authors provide a valuable framework to consider as we seek strategies to improve the overall health status of student athletes in our communities.

Questions for Discussion: What are your current strategies to show the value and worth of your position to your employer? What barriers do you see to implementing a similar quality improvement program within your setting? 

Written by: Nicole Cattano
Reviewed by: Jeffrey Driban

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