Optimizing Novel Training Re-education and Athletic Care (ON TRAC): Extending the Military Medical Home to the Entry-Level Trainees

The Patient-Centered Medical Home (PCMH) is an effective and comprehensive care center comprising a team-based coordinated health care delivery model. Primarily led by a physician, PA, or NP, the goal is to provide comprehensive and continuous medical care to patients to maximize positive health outcomes. For the enlisting military, health outcomes and basic training attrition are disproportionately affected by poor physical fitness, poor nutrition, and tobacco use. Each of these problematic issues is linked to poor health outcomes throughout and beyond the military service member’s career. Our proposal extends the PCMH model beyond the physical clinic walls to the military portal – the Military Entrance Processing Station (MEPS) – to align with the DoD Total Force Fitness initiative and the Quadruple Aim of Readiness, Population Health, Experience of Care and Per Capita Cost of the MHS. We propose to place four BOC certified Athletic Trainers at Baltimore MEPS who would function as "medical home educators" at the Recruiting Offices. These athletic trainers would “train” recruiters in evidence-based, best-practice guidelines, who would then provide educational programs in fitness, nutrition, and smoking cessation to all incoming potential recruits. These critical topic areas are the primary factors linked to musculoskeletal injury and military readiness across all levels of training, and also predict poor lifetime health outcomes.

This pilot proposal would directly benefit the MHS by addressing the readiness of troops from day one of military contact. Additionally, this proposal would improve population health and per capita cost by allocating specific health professionals to educate and prevent disease in the thousands of pre-Basic Training recruits who process through recruiting stations and the MEPS station each year. The cost of recruiting a new service member is approximately $10,000, while the average cost of initial training is approximately $35,000. Several studies have demonstrated that AT services save money for employers and improve quality of life for patients. Specifically, several studies have demonstrated that for each $1 invested in preventive care, employers gained up to a $7 return on investment. Most military members enter the military through a recruiting and MEPS station and then proceed to basic training. Unfortunately many new recruits suffer unnecessary and preventable musculoskeletal injuries (ankle sprains, knee injuries, low back pain), and fall victim to poor health outcomes due to poor nutritional habits and tobacco use. These behaviors can be changed and Medical Home Educators can make a difference if targeted front-line care and interventions are provided prior to entry. If 10% of injuries to the 180,000 new troops each year could be prevented with these services, costs savings to the MHS would be enormous. Assuming the average AT salary is $60,000, investment in a single AT professional could bring a net annual savings of $420,000 in musculoskeletal injury prevention alone. Additional savings would be realized through health behavior modifications, by avoiding health problems impacting future military service. This would further magnify the per capita cost savings, increase readiness and improve population health.

Athletic Trainers are highly qualified, multi-skilled health care professionals whose certification qualifies them to work in the multiple domains in the proposed pilot - more details on their professional education and health educator qualifications are detailed in the image gallery. Most importantly, ATs specialize in patient education to prevent injury and re-injury, which reduce rehabilitative and other health care costs.

Implementing BOC Certified ATs concentrated around MEPS is a logical way to interact with all military branches. Furthermore, there are few other places where health and success in training are more important, which should lead to a high level of buy-in from recruiters and recruits alike. Tying physical health and injury prevention to healthy behaviors in pre-Basic Training recruits is an innovative way to affect the MHS as a whole and it can easily be implemented within a single MEPS. By providing one AT for each service – Air Force, Army, Marines, Navy – this pilot education and improvement strategy can easily be scaled to meet the specific training and educational demands of each service. Our group, the Center for Health And Military Performance (CHAMP) currently has a working relationship with Baltimore MEPS and publishes best-practice, educational resources through the Human Performance Resource Center (HPRC). The implementation timeline is anticipated to be relatively short and the costs should be low – CHAMP is a DoD Center of Excellence based at the Uniformed Services University and this project utilizes existing assets in the MHS to serve the underserved pre-basic training/trainee population.

Our proposal supports the Quadruple Aim through an innovative approach – extending the Patient-Centered Medical Home concept – to improve the health of the military's most junior warfighters from day one. By capitalizing on the varied professional abilities of Athletic Trainers, we will address several major health issues for military members with a single approach: service-specific Medical Home extenders based at a MEPS station where they provide education and resources for health optimization and positive behavior changes at the Recruiter level. CHAMP's mission is to translate best research practices into programs that improve the health of the military's most junior warfighters – use of Athletic Trainers at the point of contact has been shown to be successful in the civilian sector and now it should be tested in the military to optimize the health and well-being our new recruits at point of entry. If successful, this pilot could be scaled to roll out at additional MEPS across the country – an easy and manageable way to positively affect the health of our future troops.

References: http://www.nytimes.com/2009/01/19/us/19recruits.html?pagewanted=all&_r=0


NATA Document: “Certified Athletic Trainers - An Evaluation of Their Effect on Patient Throughput and Revenue Generation in a Primary Care Sports Medicine Practice”

NATA Document: Executive Summary: Certified Athletic Trainers Deliver ROI in Occupational Work Settings http://www.nata.org/ATCsROIinOccupationalSettings

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