The Impact of a Unique Military Treatment Facility-Based Sports Medicine Model on Readiness in the Army- Military Medicine

s suttles, r boeth, m frazier, m garrison b isaacson

Objective: Describe an innovative Sports Medicine clinic design implemented in an outpatient Physical Therapy (PT) clinic within a Military Treatment Facility (MTF) for both referral and direct access (DA) entry portal pathways, and to investigate the modifying effect of medical system initial entry pathway for musculoskeletal injury (MSI) on time from injury to begin care for outcomes of duration of care, recurrence of MSI care for the same condition out to 2 years from discharge after initial care, and physical profile status at time of initial discharge.

Design: Quasi-experimental prospective longitudinal cohort study of active duty Army Soldiers in a MTF who sought care for an initial MSI over a 2-year period.

Materials and Methods: Four hundred eighty-eight individuals were classified by the pathway they entered the Military Health System through: early access pt (EAPT) referral pathway EAPT (n = 290), or DA (n = 198) pathway. The primary analysis considered the relationship between time from injury to treatment, care duration, and effect modification via pathway. Linear regression models were used. Secondary analysis investigated the relationship between injury recurrence and time from injury to treatment, and effect modification of care pathway. Logistic regression models predicted whether at least one recurrence event occurred within 3 to 24 months after discharge from initial care. Another analysis considered return to duty outcomes relative to pathway group. Logistic regression models predicted full return to duty relative to return to duty with physical limitation, whether temporary or permanent.

Results: Forty-one percent of Soldiers reporting for initial MSI care entered the health system through the DA pathway versus 59% in the EAPT pathway. Longer time from injury to treatment initiation was weakly associated with longer duration of care when considered alone (coefficient: 0.05, P = .01). When pathway was introduced into the model, only pathway showed a significant effect (coefficient: 9.6, P = .01), indicating longer duration of care was associated with the EAPT pathway. There was a significant effect of time from injury to treatment initiation on recurrence prevalence. For each additional day between injury and treatment initiation, recurrence likelihood was 30% higher (odds ratio [OR]: 1.0003, P = .01). When pathway was introduced, it again emerged as the only significant predictor, superseding the time from injury to treatment initiation as well as the interaction between the 2 (OR: 1.95, P = .02). Recurrence was 95% higher for those who went through the EAPT pathway relative to the DA pathway. Early access physical therapy patients were 224% more likely to return to duty with limitation than DA patients (OR: 3.24, P < .01).

Conclusions: Within an MTF it is possible to design MSI clinical operations to emulate a Sports Medicine training room model that includes expedited referral processes as well as DA care which allows for more patient encounters and dramatically decreases time from injury to initiation of MSI treatment than the traditional clinic model. Within this model, the expedited referral pathway was associated with longer duration of care, increased recurrence, and increased likelihood that Soldiers would be discharged with continued physical limitations.

Sean Suttles, Riley R Boeth, Mathew Frazier, Michael Garrison, Brad Isaacson, The Impact of a Unique Military Treatment Facility-Based Sports Medicine Model on Readiness in the Army: A Prospective Longitudinal Analysis Comparing 2 Military Health System Entry Portal Pathways on the Duration of Healthcare Management and the Incidence of Recurrence Within 24 Months, Military Medicine, 2025;, usaf423, https://doi.org/10.1093/milmed/usaf423