title: An Orthopedic Performance Improvement Initiative at a Small Military Treatment Facility.
abstract: 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.
  
  
  
  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.
  
  
  
  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%).
  
  
  
  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.
authors.affiliation: Department of Biology, U.S. Air Force Academy, 2355 Faculty Drive, Suite 2P389, USAF Academy, CO 80840.
authors.forename: John Christopher
authors.initials: JC
authors.lastname: McGee
authors.affiliation: Department of Physical Therapy, University of Pittsburgh, 100 Technology Drive, Suite 210, Pittsburgh, PA 15219-3130.
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Bise
authors.affiliation: Department of Physical Therapy, University of Pittsburgh, 100 Technology Drive, Suite 210, Pittsburgh, PA 15219-3130.
authors.forename: Joel M
authors.initials: JM
authors.lastname: Stevens
mesh_terms: D003362:Cost-Benefit Analysis / Q000379:methods*; D005845:Georgia; D006772:Hospitals, Military / Q000592:standards / Q000639:trends*; D006801:Humans; D008889:Military Personnel / Q000706:statistics & numerical data; D009985:Orthopedics / Q000379:methods* / Q000592:standards*; D026741:Physical Therapy Modalities / Q000706:statistics & numerical data; D015397:Program Evaluation / Q000379:methods; D058996:Quality Improvement