Financial Impact of Embedded Injury-Prevention Experts in US Army Initial Entry Training

Abstract

Context: The US Army embedded injury-prevention experts (IPEs), specifically athletic trainers and strength and conditioning coaches, into initial entry training (IET) to limit musculoskeletal (MSK) conditions and their negative consequences. However, little is known about the financial impact of IPEs. Objective: To assess whether IPEs were associated with fewer sunk training costs due to MSK-related early discharges from service. Design: Retrospective cohort study. Setting: Database of US Army soldiers’ administrative, medical, and readiness records. Patients or Other Participants: A total of 198166 soldiers (age ¼ 20.7 6 3.2 years, body mass index ¼ 24.4 6 3.5 kg/m2) who began IET during 2014 to 2017. Main Outcome Measure(s): Early discharge from service was defined as occurring within 6 months of beginning IET. All IET sites employed IPEs from 2011 to 2017, except for 2 sites during April to November 2015. Soldiers who began IET at these 2 sites during these times were categorized as not having IPE exposure. All others were categorized as having IPE exposure. The unadjusted association between IPE access and MSK-related early discharge from service was assessed using logistic regression. Financial impact was assessed by quantifying differences in yearly sunk costs between groups with and those without IPE exposure and subtracting IPE hiring costs. Results: Among 14094 soldiers without IPE exposure, 2.77% were discharged early for MSK-related reasons. Among 184072 soldiers with IPE exposure, 1.01% were discharged. Exposure to IPEs was associated with reduced odds of MSK-related early discharge (odds ratio ¼ 0.36, 95% CI ¼ 0.32, 0.40, P, .001) and a decrease in yearly sunk training costs of $11.19 to $20.00 million. Conclusions: Employing IPEs was associated with reduced sunk costs because of fewer soldiers being discharged from service early for MSK-related reasons. Evidence-based recommendations should be developed for guiding policy on the roles and responsibilities of IPEs in the military to reduce negative outcomes from MSK conditions and generate a positive return on investment.