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Hernandez MI, Miller EC, Biese KM, Columna L, Andreae S, McGuine TA, Snedden TR, Eberman LE, Bell DR. Secondary School Athletic Trainers' Perceptions of the Influence of Social Determinants of Health and Socioeconomic Status on Clinical Management Decisions. J Athl Train 2024; 59:388-393. [PMID: 37459372 PMCID: PMC11064109 DOI: 10.4085/1062-6050-0445.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
CONTEXT Evidence suggests that lower socioeconomic status (SES) and negative social determinants of health (SDOH) contribute to health care disparities. Due to their accessibility in the high school setting, secondary school athletic trainers (SSATs) may encounter patients who are historically underserved in health care, such as patients with low SES. However, a significant gap in knowledge exists regarding how SDOH and SES may influence SSATs' clinical management decisions. OBJECTIVES To describe SSATs' perceptions of how patient SDOH and SES influence clinical management decisions and to identify barriers to athletic health care. DESIGN Cross-sectional study. SETTING Online survey. PARTICIPANTS OR OTHER PARTICIPANTS National Athletic Trainers' Association SSATs (6.7% response rate). MAIN OUTCOME MEASURE(S) Secondary school athletic trainers were asked about their perceptions of patient SDOH and SES (content validity index = 0.83 for relevancy). The levels of relevance and agreement were answered on a 4-point Likert scale. Data were summarized using means and SDs, frequencies and proportions (%), and median scores. RESULTS A total of 380 SSATs participated (mean years of experience = 14.9 ± 11.7 years). When providing care, most (71.3%) SSATs believed their patients' health or health care access to be the most relevant of the 5 SDOH, whereas the other 4 SDOH were less than 60% relevant. Most SSATs agreed or strongly agreed that patient SES affected both referral (67.4%) and the reliance on conservative treatment before referral (71.2%). Secondary school athletic trainers identified patient or guardian compliance (70.2%) and type of health insurance (61.5%) as barriers to providing care to patients with low SES. CONCLUSIONS Secondary school athletic trainers perceived health or health care access as the most relevant social determinant when providing care to patients with low SES. When SSATs further considered the SES of patients, they identified all SDOH as barriers that they were ill equipped to navigate as they delivered care and engaged in patient referral.
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Affiliation(s)
| | | | - Kevin M Biese
- Kinesiology and Athletic Training, University of Wisconsin-Oshkosh
| | - Luis Columna
- Department of Kinesiology, University of Wisconsin-Madison
| | - Susan Andreae
- Department of Kinesiology, University of Wisconsin-Madison
| | - Timothy A McGuine
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison
| | | | - Lindsey E Eberman
- Neuromechanics, Interventions, and Continuing Education Research (NICER) Laboratory, Indiana State University, Terre Haute
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Nyland J, Antimisiaris D, Mattocks A, Krupp R. The Athletic Trainer as a Public Health Foot Soldier. Sports Health 2023; 15:917-919. [PMID: 37731300 PMCID: PMC10606976 DOI: 10.1177/19417381231203591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023] Open
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Gawrys SP, Wong WJ, Parker LM, Bradshaw JT, Starr EG, Wilde B. Educational intervention promotes injury prevention adherence in club collegiate men's lacrosse athletes. J Osteopath Med 2023; 123:537-541. [PMID: 37498528 DOI: 10.1515/jom-2022-0200] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 06/29/2023] [Indexed: 07/28/2023]
Abstract
CONTEXT Club sports are intercollegiate athletics that are student-led and not university-funded, many of which are without professional credentialing. Collegiate club athletes have an increased rate of injury compared to their NCAA counterparts. Education and implementation of stretching and strength training have demonstrated decreased rates of noncontact injuries. OBJECTIVES Educational intervention was given to club collegiate athletes to determine its effect on injury rates, perceived pain, and compliance toward injury-prevention practices. METHODS Intramural collegiate athletes were educated on injury prevention that focused on targeted stretching. Surveys designed to assess the impact of the education were distributed to three men's club lacrosse teams in Utah at the beginning and end of the season. The questions measured pain and time missed due to noncontact injury. RESULTS Two-tailed unpaired t tests demonstrated p values <0.05 for: overall decreased levels of pain (p<0.0001); increased range of motion (ROM, p<0.0001); increased frequency of stretching the muscle groups psoas (p<0.0001), calves (p=0.0081), and piriformis (p<0.0001); decreased pain levels for the hamstring (p=0.0274); and increased frequency of stretching after practice (p<0.0001). CONCLUSIONS The increased frequency of stretching suggests increased compliance toward injury prevention practices. Decreased self-reported levels of overall pain, and decreased pain in the hamstring, show that the subjects surveyed in the sample reported less pain and increased time stretching at the end of the season compared with the beginning of the season. Educational intervention offers an affordable measure to provide club collegiate athletes with resources to reduce injury rates through athlete compliance to targeted stretches.
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Affiliation(s)
- Steven P Gawrys
- Rocky Vista University College of Osteopathic Medicine Southern Utah Campus, Ivins, UT, USA
| | - Westin J Wong
- Rocky Vista University College of Osteopathic Medicine Southern Utah Campus, Ivins, UT, USA
| | - Lawsen M Parker
- Rocky Vista University College of Osteopathic Medicine Southern Utah Campus, Ivins, UT, USA
| | - Justin T Bradshaw
- Rocky Vista University College of Osteopathic Medicine Southern Utah Campus, Ivins, UT, USA
| | - Evan G Starr
- Rocky Vista University College of Osteopathic Medicine Southern Utah Campus, Ivins, UT, USA
| | - Ben Wilde
- Rocky Vista University Montana College of Osteopathic Medicine, Billings, MT, USA
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Drescher MJ, Mills G, Winkelmann ZK, Games KE. Collaborative Mental Health Care in Collegiate Athletics: Behavioral Health Providers' Perceived Role of the Athletic Trainer. J Athl Train 2023; 58:855-864. [PMID: 37071505 PMCID: PMC11215710 DOI: 10.4085/1062-6050-0530.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
CONTEXT Developing effective interprofessional teams is vital to achieving quality care for those dealing with behavioral health concerns. Athletic trainers (ATs) play a vital role, as they are often the first health care providers to interact with student-athletes participating in intercollegiate athletics. However, research regarding how behavioral health providers view the AT's role on interprofessional behavioral health teams is limited. OBJECTIVE To explore behavioral health providers' perceived role of ATs in collaborative behavioral health care. DESIGN Qualitative study. SETTING Individual interviews. PATIENTS OR OTHER PARTICIPANTS Nine behavioral health care providers (women = 6, men = 3; age range = 30-59 years, years in clinical practice = 6-25) from National Collegiate Athletic Association Power 5 schools were interviewed. DATA COLLECTION AND ANALYSIS Participants were contacted via publicly available information on their university websites. Participants engaged in individual, audio-only interviews using a commercially available teleconferencing platform. All interviews were recorded, transcribed, and returned to participants for member checking. A phenomenological approach with inductive coding and multianalyst triangulation was performed to analyze the transcripts for common themes and subthemes. RESULTS CONCLUSIONS Collaborative care models can enhance providers' abilities and maximize support of student-athlete wellness. In this study, we demonstrated that behavioral health providers working within a collaborative care model with ATs had overall positive experiences with such collaboration and that clear role delineation and responsibilities helped to foster high-quality patient care.
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Clifton DR, Nelson DA, Sammy Choi Y, Edgeworth D, Shell D, Deuster PA. Financial Impact of Embedded Injury-Prevention Experts in US Army Initial Entry Training. J Athl Train 2023; 58:511-518. [PMID: 36583956 PMCID: PMC10496456 DOI: 10.4085/1062-6050-0353.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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 198 166 soldiers (age = 20.7 ± 3.2 years, body mass index = 24.4 ± 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 14 094 soldiers without IPE exposure, 2.77% were discharged early for MSK-related reasons. Among 184 072 soldiers with IPE exposure, 1.01% were discharged. Exposure to IPEs was associated with reduced odds of MSK-related early discharge (odds ratio = 0.36, 95% CI = 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.
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Affiliation(s)
- Daniel R. Clifton
- Consortium for Health and Military Performance, Department of Military & Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD
- Womack Army Medical Center, Fort Bragg, NC
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, MD
| | - D. Alan Nelson
- Consortium for Health and Military Performance, Department of Military & Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD
- Womack Army Medical Center, Fort Bragg, NC
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, MD
| | | | - Daniel Edgeworth
- Consortium for Health and Military Performance, Department of Military & Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD
- Womack Army Medical Center, Fort Bragg, NC
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, MD
| | - Donald Shell
- Health Services Policy and Oversight, Office of the Assistant Secretary of Defense for Health Affairs, Defense Health Headquarters, Falls Church, VA
| | - Patricia A. Deuster
- Consortium for Health and Military Performance, Department of Military & Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD
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Picha KJ, Welch Bacon CE, Bay RC, Lewis JH, Snyder Valier AR. Athletic Trainers' Perceptions of and Experience with Social Determinants of Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20085602. [PMID: 37107884 PMCID: PMC10138865 DOI: 10.3390/ijerph20085602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/11/2023] [Accepted: 04/18/2023] [Indexed: 05/10/2023]
Abstract
The role that social determinants of health (SDHs) play in athletic healthcare is gaining attention, yet little is known about athletic trainers' (ATs) perceptions of and encounters with the impact of SDHs. The purpose of this study was to evaluate ATs' perceptions of various SDHs and their experience treating patients whose health and well-being were influenced by SDHs. This was a cross-sectional, web-based survey completed by 1694 ATs (completion rate = 92.6%; 61.1% female; age = 36.6 ± 10.8 years). The survey consisted of several multipart questions focusing on specific SDHs. Descriptive statistics were used to report frequencies and percentages. Results indicated widespread agreement that SDHs matter to patient health and are of concern in athletic healthcare. The SDHs that ATs most commonly reported encountering included lifestyle choices (n = 1306/1406; 93.0%), social support (n = 1185/1427; 83.0%), income (n = 1167/1502; 77.7%), and access to quality and timely healthcare (n = 1093/1420, 77.0%). The SDHs that ATs least commonly reported having experience with was governmental policy (n = 684/1411; 48%). The perceived importance of SDHs among ATs and their commonly reported experiences managing patient cases in which SDHs negatively influence patients' health and healthcare suggest that efforts to assess these factors are needed so that strategies to address their influence on athletic healthcare can be identified.
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Affiliation(s)
- Kelsey J. Picha
- Department of Interdisciplinary Health Sciences, Arizona School of Health Sciences, A.T. Still University, Mesa, AZ 85206, USA
- Correspondence:
| | - Cailee E. Welch Bacon
- Department of Athletic Training, Arizona School of Health Sciences, A.T. Still University, Mesa, AZ 85206, USA
- Department of Basic Science Education, School of Osteopathic Medicine in Arizona, A.T. Still University, Mesa, AZ 85206, USA
| | - R. Curt Bay
- Department of Interdisciplinary Health Sciences, Arizona School of Health Sciences, A.T. Still University, Mesa, AZ 85206, USA
| | - Joy H. Lewis
- Department of Public Health, School of Osteopathic Medicine in Arizona, A.T. Still University, Mesa, AZ 85206, USA
| | - Alison R. Snyder Valier
- Department of Athletic Training, Arizona School of Health Sciences, A.T. Still University, Mesa, AZ 85206, USA
- Department of Basic Science Education, School of Osteopathic Medicine in Arizona, A.T. Still University, Mesa, AZ 85206, USA
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Bullock GS, Mobley JF, Brooks JM, Rauh MJ, Gil Gilliland R, Kissenberth MJ, Shanley E. Uses of Health Care System Medical Care Services by Athletes After Injury at the High School Level. THE JOURNAL OF SCHOOL HEALTH 2023; 93:5-13. [PMID: 36263850 PMCID: PMC10091823 DOI: 10.1111/josh.13255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 08/03/2022] [Accepted: 09/15/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Health care utilization can vary by age group, geographic location, and socioeconomic status (SES). A paucity of information exists regarding the availability and utilization of medical care by injured scholastic athletes. The purpose of this study was to describe and compare injuries and health care service utilization by school SES over an academic year. METHODS Injury and health care service data was collected from 1 large school district. Percentage of free and reduced lunch (FRPL) for each school was calculated to stratify schools into high (<50% FRPL) and low (≥50.1% FRPL) SES groups. Incidence proportion and relative risk (RR) with 95% confidence intervals (95% CI) were calculated. RESULTS About 1756 injuries were reported among over 7000 participating athletes from 14 high schools. Similar injury incidence proportions were reported between high and low SES schools (RR = 1.10 [1.00-1.20]). Athletes from low SES schools were twice (RR = 2.01 [1.21-3.35]) and over three (RR = 3.42 [1.84-6.55]) times more likely to receive emergency and physical therapy care. SES was not associated with the use of physician, imaging, or surgery services. IMPLICATIONS FOR SCHOOL HEALTH, POLICY, AND EQUITY School medical providers and administrators should have ready and provide a list of trusted outside primary care and specialty providers that have experience in sports medicine. They should also enquire and follow up on which outside provider the high school athlete will seek care when referring out to outside providers. CONCLUSIONS Injury incidence was similar between high and low SES schools. However, athletes from low SES high schools were over 2-fold more likely to use emergency department services. Understanding factors influencing health care services choice and usage by student athletes from different socioeconomic backgrounds may assist sport medicine clinicians in identifying barriers and potential solutions in improving time to health restoration, athlete outcomes, and health care monetary burden.
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Affiliation(s)
- Garrett S. Bullock
- Department of Orthopaedic Surgery & Rehabilitation, Wake Forest School of Medicine, Winston‐Salem, NC; Centre for Sport, Exercise and Osteoarthritis Research Versus ArthritisUniversity of OxfordOxfordUK
| | - John F. Mobley
- University of South Carolina School of MedicineColumbiaSC
| | - John M. Brooks
- South Carolina Center for Effectiveness Research in OrthopaedicsUniversity of South CarolinaColumbiaSC
| | - Mitchel J. Rauh
- College of Health and Human ServicesSand Diego State UniversitySan DiegoCA
| | | | | | - Ellen Shanley
- University of South Carolina Center for Rehabilitation and Reconstruction Sciences, Greenville, SC; ATI Physical TherapyGreenvilleSC
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Wang M, Li L. Research and Implementation of Distributed Computing Management System for College Students' Sports Health Based on Integrated Regional Collaborative Medical Care. Occup Ther Int 2022; 2022:9306200. [PMID: 35655945 PMCID: PMC9132689 DOI: 10.1155/2022/9306200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 04/23/2022] [Accepted: 04/27/2022] [Indexed: 11/23/2022] Open
Abstract
This paper constructs and applies a university student sports health management system through the theory of integrated regional collaborative medical care and distributed computing technology. Firstly, it analyzes the current situation and problems of cross-regional medical care, the root causes, and the corresponding business scenarios, reflecting the development trend of cross-regional medical care, in the light of the current practical needs of cross-regional medical care. In response to the strong demand for cross-regional medical care, this paper gives the overall design of the distributed computing system, for the deployment and architecture of the cross-regional platform; the registration of cross-regional patients, regional platforms, and health events and documents; and data exchange, service integration, and process integration, etc. The corresponding design is given. The research was conducted on several medical institutions to refine the functional requirements for the construction of the regional collaborative medical platform, and the requirements were analyzed to present the research results of the collaborative medical project. Based on this, requirements were made for the preparation of the project construction data center and medical institutions, and the remote consultation and two-way referral modules of the distributed collaborative medical platform were designed, which are processed and analyzed through a system composed of multiple servers. The results are returned to the user, and the design results were tested for functionality, compatibility, security, and other usability tests. The necessity and feasibility of the college physical health test data platform were analyzed. Students have various needs for physical test data management, the necessity of designing the college physical health test data platform, and the feasibility of the college physical health test data platform in terms of technical means, theoretical basis, and social environment.
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Affiliation(s)
- Mian Wang
- School of Science and Technology, Nanchang University, Jiangxi 330006, China
| | - Lijuan Li
- Sports Institute, Nanchang University, Jiangxi 330006, China
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Peterson C, Li T. Evidence for Economic Evaluations of Athletic Trainer Services. J Athl Train 2022; 57:632-639. [PMID: 35142843 DOI: 10.4085/1062-6050-0666.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Literature suggests athletic trainers (ATs) can help address health needs in a more affordable way across a variety of settings. We aimed to assess if AT services are cost-effective when compared to no AT services or services by other health providers. DATA SOURCES We performed a keyword search in 5 databases: Medline (FirstSearch), PubMed, Web of Science, SPORTDiscus, and Google scholar. We also conducted a generic web search to identify any informal sources that may meet the eligibility criteria. STUDY SELECTION We used a comprehensive list of terms to search economic evaluation studies on ATs. We included studies that met all the following criteria: economic evaluation studies on AT services; original studies written in English; and published in the last 10 years(2011-present). we excluded studies that examined either only cost or only benefit of AT services. DATA EXTRACTION We extracted data using a predefined checklist that included major components of economic evaluation. We also extracted data regarding athletic training practice setting. RESULTS We extracted 5 articles in our review, most of which supported the use of AT services as economically viable. The practice settings studied in the articles included two high school settings, two military settings, and a community outreach program that included several practice settings. Only one of the studies used standard economic evaluation methodology and took insurance status into account. CONCLUSION Our review shows that AT services can be a cost-effective option for addressing health care needs. However, the literature remains sparse and there was an overall lack of consistency in outcome measures, analytical methods, and reporting practices, which reduced the comparability across studies. Future studies on this topic should address these limitations, which will provide critical economic evidence to inform decision making on investing in AT services across various settings.
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Affiliation(s)
- Collin Peterson
- Health Policy, College of Public Health and Human Sciences, Oregon State University, Corvallis
| | - Tao Li
- Health Policy, College of Public Health and Human Sciences, Oregon State University, Corvallis
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Lam KC, Marshall AN, Welch Bacon CE, Valovich McLeod TC. Cost and Treatment Characteristics of Sport-Related Knee Injuries Managed by Athletic Trainers: A Report From the Athletic Training Practice-Based Research Network. J Athl Train 2021; 56:922-929. [PMID: 33237998 DOI: 10.4085/1062-6050-0061.20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Knee injuries are common during sport participation. However, little is known about the overall management and estimated direct costs of care associated with these injuries when under the care of athletic trainers. OBJECTIVE To describe the treatment characteristics and direct costs of care for athletic training services provided for patients with knee injuries. DESIGN Descriptive study. SETTING Ninety-five athletic training facilities across 24 states. PATIENTS OR OTHER PARTICIPANTS A total of 117 athletic trainers (females = 56.4%, age = 29.4 ± 8.7 years, years certified = 4.7 ± 6.0, years employed at site = 1.6 ± 4.1). MAIN OUTCOME MEASURE(S) Complete patient cases were identified using International Classification of Disease-10 diagnostic codes between 2009 and 2020. Summary statistics were calculated for patient demographics, treatment characteristics, and direct costs of care. Treatment characteristics included the type of athletic training service, duration, amount (eg, number of visits), and direct costs of care. RESULTS A total of 441 patient cases were included. The most common injuries reported were cruciate ligament sprain (18.1%, n = 80), medial collateral ligament sprain (15.4%, n = 68), and knee pain (14.1%, n = 62). Injuries occurred most frequently during football (35.4%, n = 156), basketball (14.7%, n = 65), and soccer (12.7%, n = 56). A total of 8484 athletic training services were recorded over 4254 visits, with therapeutic exercise (29.8%, n = 2530), hot or cold pack (25.8%, n = 2189), and therapeutic activities (11.2%, n = 954) being the most frequently reported services. The median duration of care was 23 days and number of visits was 8. The median total cost of care was $564 per injury and $73 per visit. CONCLUSIONS Patients with knee injuries demonstrated greater time loss than those with other lower extremity injuries. Thus, it is unsurprising that knee injuries were associated with a longer duration and higher cost of care than other lower extremity injuries such as ankle sprains. Future researchers should examine the effectiveness of common treatment strategies and aim to identify treatments that can reduce costs and improve patient outcomes.
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Affiliation(s)
- Kenneth C Lam
- Department of Interdisciplinary Health Sciences, A.T. Still University, Mesa, AZ
| | - Ashley N Marshall
- Department of Health and Exercise Science, Appalachian State University, Boone, NC
| | - Cailee E Welch Bacon
- Department of Interdisciplinary Health Sciences, A.T. Still University, Mesa, AZ
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Winkelmann ZK, Eberman LE, Games KE. Telemedicine Experiences of Athletic Trainers and Orthopaedic Physicians for Patients With Musculoskeletal Conditions. J Athl Train 2021; 55:768-779. [PMID: 32693404 DOI: 10.4085/1062-6050-388-19] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Telemedicine is the delivery of medical care from a distance using technology. The integration of telemedicine as a supplement to musculoskeletal-based patient encounters may be feasible in sports medicine. OBJECTIVE To investigate health care professionals' perceptions of and experiences with telemedicine. DESIGN Cross-sectional explanatory sequential mixed-methods study. PATIENTS OR OTHER PARTICIPANTS A purposeful sample of 17 athletic trainers from a National Collegiate Athletic Association Division I institution and 5 orthopaedic physicians from a sports medicine clinic located 92 miles from the campus. INTERVENTION(S) Participants were trained on the telemedicine platform and used it over 5 months for initial, follow-up, and discharge patient encounters. MAIN OUTCOME MEASURE(S) Participants completed a preintervention survey containing the Theory of Planned Behavior and Technology Acceptance Model tool. Responses were analyzed using descriptive statistics and an independent-samples t test. After the intervention period, participants completed individual semistructured interviews that we coded using the consensual qualitative research tradition. RESULTS From the interviews, the clinicians were characterized as telemedicine adopters (n = 14) or nonadopters (n = 8). The adopters reported higher levels of agreement on the Theory of Planned Behavior and Technology Acceptance Model tool as compared with nonadopters for all constructs. When comparing adoption status, we identified a difference (P < .01), with nonadopters reporting a low level of agreement for the subjective norm construct. The interviews revealed 5 domains: integration challenges, integration opportunities, collaborative practice, anticipatory socialization to future use, and benefits of integration. The participants indicated that integration challenges centered on "buy in," whereas opportunities aligned with the patient's condition and technology ease of use. They reflected that the telemedicine encounters required more preparation and yet allowed for cooperative behaviors between clinicians. The benefits of telemedicine included convenience and scheduling preferences that encouraged future use. CONCLUSIONS The integration of telemedicine in sports medicine brought about both challenges and opportunities for collaboration among athletic trainers and physicians that were heavily predetermined by the social pressures of colleagues.
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Affiliation(s)
| | - Lindsey E Eberman
- Department of Applied Medicine and Rehabilitation, Indiana State University, Terre Haute
| | - Kenneth E Games
- Department of Applied Medicine and Rehabilitation, Indiana State University, Terre Haute
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Marshall AN, Lam KC. Research at the Point of Care: Using Electronic Medical Record Systems to Generate Clinically Meaningful Evidence. J Athl Train 2020; 55:205-212. [PMID: 31935140 DOI: 10.4085/1062-6050-113-19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
CONTEXT Health care leaders have recommended the use of health information technology to improve the quality of patient care. In athletic training, using informatics, such as electronic medical records (EMRs), would support practice-based decisions about patient care. However, athletic trainers (ATs) may lack the knowledge to effectively participate in point-of-care clinical research using EMRs. OBJECTIVES To discuss the role of EMRs in athletic training and identify methodologic approaches to conducting clinical research at the point of care. DESCRIPTION The 2020 Commission on Accreditation of Athletic Training Education curricular content standards included the use of an electronic patient record to document care, mitigate error, and support decision making through the collection and use of patient data (Standard 64). Patient data are collected by ATs at the point of care via routine documentation, and these data can be used to answer clinical questions about their practice. Observational or descriptive study designs are ideal for this type of data. Observational research (ie, case-control, cross-sectional, cohort studies) evaluates factors that influence patients' lives in the "real world," whereas descriptive research (ie, case study or series, descriptive epidemiology studies) identifies characteristics of individuals and groups. If ATs are comprehensively documenting patient care using an EMR, they have the means to participate in observational and descriptive research. CLINICAL AND RESEARCH ADVANTAGES Using an EMR to its full capacity allows ATs to collect meaningful data at the point of care, conduct practice-based research, and improve health care for the patient and clinician. However, to ensure data quality, these approaches must include routine and comprehensive documentation habits.
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Affiliation(s)
- Ashley N Marshall
- Department of Health and Exercise Science, Appalachian State University, Boone, NC
| | - Kenneth C Lam
- Department of Interdisciplinary Health Sciences, A.T. Still University, Mesa, AZ
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13
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Post EG, Roos KG, Rivas S, Kasamatsu TM, Bennett J. Access to Athletic Trainer Services in California Secondary Schools. J Athl Train 2019; 54:1229-1236. [PMID: 31714144 DOI: 10.4085/1062-6050-268-19] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT California is currently the only state that does not regulate who can and cannot call themselves athletic trainers (ATs). Therefore, previous national or state-specific investigations may not have provided an accurate representation of AT availability at the secondary school level in California. Similarly, it is unknown whether the factors that influence AT availability in California, such as socioeconomic status, are similar to or different from those identified in previous studies. OBJECTIVE To describe the availability of ATs certified by the Board of Certification in California secondary schools and to examine potential factors influencing access to AT services in California secondary schools. DESIGN Cross-sectional study. SETTING Online survey. PATIENTS OR OTHER PARTICIPANTS Representatives of 1270 California high schools. MAIN OUTCOME MEASURE(S) Officials from member schools completed the 2017-2018 California Interscholastic Federation Participation Census. Respondents provided information regarding school type, student and student-athlete enrollment, whether the school had ATs on staff, and whether the ATs were certified by the Board of Certification. The socioeconomic status of public and charter schools was determined using the percentage of students eligible for free or reduced-price lunch. RESULTS More than half (54.6%) of schools reported that they either did not employ ATs (47.6%) or employed unqualified health personnel (UHP) in the role of AT (7.0%). Nearly 30% of student-athletes in California participated in athletics at a school that did not employ ATs (n = 191 626, 28.9%) and 8% of student-athletes participated at a school that employed UHP in the role of AT (n = 54 361, 8.2%). Schools that reported employing ATs had a lower proportion of students eligible for free or reduced-price lunch than schools that did not employ ATs and schools that employed UHP (both P values < .001). CONCLUSIONS With ongoing legislative efforts to obtain regulation of ATs in California, secondary school administrators are encouraged to hire ATs with the proper certification to enhance the patient care provided to student-athletes and improve health outcomes.
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Affiliation(s)
- Eric G Post
- School of Exercise and Nutritional Sciences, San Diego State University, CA
| | - Karen G Roos
- Department of Kinesiology, California State University, Long Beach
| | | | | | - Jason Bennett
- Department of Kinesiology, California State University, Fullerton
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