Financial Impact of Embedded Injury Prevention Experts in U.S. Army Initial Entry Training

Abstract

Context: The U.S. 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: Assess whether IPEs are associated with fewer sunk training costs due to MSK-related early discharges from service. Design: Retrospective cohort study. Setting: Analysis of a longitudinal database of U.S. Army soldiers' administrative, medical, and readiness records. Patients or Other Participants: 198,166 soldiers (age=20.7±3.2 years; body mass index=24.4±3.5 kg/m2) who began IET during 2014–2017. Main Outcome Measure(s): Early discharge from service was defined as occurring within six months of beginning IET. All IET sites employed IPEs from 2011–2017, except for two sites during April 2015–November 2015. Soldiers who began IET at these two sites during these times were categorized as not having IPE exposure. All others were categorized as having IPE exposure. 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 without IPE exposure, and subtracting IPE hiring costs. Results: Among 14,094 soldiers without IPE exposure, 2.77% were discharged early due to MSK-related reasons. Among 184,072 soldiers with IPE exposure, 1.01% were discharged. IPE exposure was associated with reduced odds of MSK-related early discharge (odds ratio=0.36, 95% confidence interval=0.32–0.40, p<0.001). IPE exposure was associated with a decrease in yearly sunk training costs of $11.19–$20.00 million. Conclusions: Employing IPEs is associated with reduced sunk costs due to fewer soldiers being discharged from service early for MSK-related reasons. Evidence-based recommendations should be developed to guide policy on the roles and responsibilities of IPEs in the military to reduce negative outcomes from MSK conditions and generate positive return on investment.