An Orthopedic Performance Improvement Initiative at a Small Military Treatment Facility.

OBJECTIVES: The scientific literature demonstrates a cost-benefit associated with early access to physical therapy. The purpose of this case study is to report the results of an orthopedic performance improvement initiative (OPII) at a small military treatment facility (approximately 4.5K active duty beneficiaries). The OPII was introduced to (1) limit variation by ensuring that all active duty orthopedic consults were audited ensuring proper timing of appropriate services and (2) establish contractual agreement for shared resources with the U.S. Naval Jacksonville Orthopedic Department. METHODS: OPII was accomplished through consensus development and strong leadership support. All orthopedic referrals (n = 260) were audited for 6 months. Appropriate recommendations were provided to either continue with orthopedic care or to redirect to a physical therapy first approach. RESULTS: Orthopedic referrals decreased 27% with concomitant 32% increase in physical therapy referrals producing overall savings of $462K (33%). Meanwhile, surgical throughput improved 45%. Seventy percent of the savings were attributed to improved utilization translating to a relative value unit savings per beneficiary of $17.64 (23.7%). CONCLUSION: Our results support the value of a conservative physical therapy first approach for musculoskeletal conditions and shared mil-to-mil resourcing agreements. Success requires an iterative audit/feedback process balanced with stakeholder consensus.

Physical Screening Predictors for Success in Completing Air Force Phase II Air Liaison Officer Aptitude Assessment.

OBJECTIVES: Air Liaison Officer Aptitude Assessment (AAA) attrition is often associated with a lack of candidate physical preparation. The Functional Movement Screen, Tactical Fitness Assessment, and fitness metrics were collected (n = 29 candidates) to determine what physical factors could predict a candidate s success in completing AAA. METHODS: Between-group comparisons were made between candidates completing AAA versus those who did not (p < 0.05). Upper 50% thresholds were established for all variables with R2 < 0.8 and the data were converted to a binary form (0 = did not attain threshold, 1 = attained threshold). Odds-ratios, pre/post-test probabilities and positive likelihood ratios were computed and logistic regression applied to explain model variance. RESULTS: The following variables provided the most predictive value for AAA completion: Pull-ups (p = 0.01), Sit-ups (p = 0.002), Relative Powerball Toss (p = 0.017), and Pull-ups × Sit-ups interaction (p = 0.016). CONCLUSION: Minimum recommended guidelines for AAA screening are Pull-ups (10 maximum), Sit-ups (76/2 minutes), and a Relative Powerball Toss of 0.6980 ft × lb/BW. Associated benefits could be higher graduation rates, and a cost-savings associated from temporary duty and possible injury care for nonselected candidates. Recommended guidelines should be validated in future class cycles.