title: Soldier Readiness Processing: Time for a New Paradigm in Managing Musculoskeletal Injuries After Deployment?
abstract: The drowning impact that musculoskeletal injuries (MSI) have on Soldier readiness, deployability, and escalating health care costs is growing. These injuries are associated with approximately 25 million lost duty days each year. The need to curb costs and improve efficacy and efficiency of health care delivery is pressing. This requires the consideration of new paradigms for clinical pathways and health care delivery processes. Soldiers returning from a deployment go through a screening process to ensure any medical, dental, and administrative issues are adequately addressed. This is a great opportunity to influence optimal musculoskeletal (MSK) care, as nonbattle MSI are the most common injury sustained during a combat deployment. These screening processes usually consist of high throughput in short periods, taxing the usual flow of care through the associated medical clinic. Because the highest percentage of medical visits are related to MSK complaints, a dedicated clinic with specialty providers seeing these patients directly may improve the quality and efficiency of care.
  
  
  
  This report provides the details related to the implementation of a MSK specialty clinic such as this at Madigan Army Medical Center, for the return of a U.S. Army Reservist Brigade Combat Team of approximately 4,000 Soldiers. It provides a framework for determining patient flow and triaging of patients to expedited appropriate care directly from the screening site. We report on the demographics and types of injuries seen after deployment, and the patient satisfaction associated with those that were seen in this specialty clinic.
  
  
  
  Comparison to usual care were outside the scope of this report, however the patient satisfaction with the process was recorded, and was very high for all 284 patients that received care through this expedited care pathway.
  
  
  
  This article provides a framework for an expedited clinical care pathway for patients returning from deployment that have MSI. It provides a platform for future feasibility testing and prospective studies related to the economic impact of this model when compared to usual care.
authors.affiliation: Center for the Intrepid, 3551 Roger Brooke Drive, Brooke Army Medical Center, JBSA Fort Sam Houston, TX, 78234.
authors.forename: Daniel I
authors.initials: DI
authors.lastname: Rhon
authors.affiliation: Office of the Assistant Secretary of Defense, Undersecretary of Defense for Personnel and Readiness, Office of the Secretary of Defense, The Pentagon, 2 North Rotary Road, Arlington, VA, 22202.
authors.forename: Kerrie J
authors.initials: KJ
authors.lastname: Golden
authors.affiliation: Olympic Sports and Spine Rehabilitation, 9514 Gravelly Lake Drive SW, Lakewood, WA, 98499.
authors.forename: Amy J
authors.initials: AJ
authors.lastname: Trevino
authors.affiliation: Madigan Army Medical Center, Building 9040, Fitzsimmons Drive, JBLM, Tacoma, WA, 98391.
authors.forename: Brian S
authors.initials: BS
authors.lastname: Hatler
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003695:Delivery of Health Care / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008889:Military Personnel / Q000706:statistics & numerical data*; D009017:Morbidity / Q000639:trends; D009140:Musculoskeletal Diseases / Q000150:complications / Q000209:etiology*; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D014481:United States; D014857:Warfare