Costs and Benefits of Physical Therapy Program Implementation for Air Force Fighter Pilots
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Air Force Institute of Technology AFIT Scholar Theses and Dissertations Student Graduate Works 3-2021 Costs and Benefits of Physical Therapy Program Implementation for Air Force Fighter Pilots Christian G. Erneston Follow this and additional works at: https://scholar.afit.edu/etd Part of the Physical Therapy Commons Recommended Citation Erneston, Christian G., "Costs and Benefits of Physical Therapy Program Implementation for Air Force Fighter Pilots" (2021). Theses and Dissertations. 4944. https://scholar.afit.edu/etd/4944 This Thesis is brought to you for free and open access by the Student Graduate Works at AFIT Scholar. It has been accepted for inclusion in Theses and Dissertations by an authorized administrator of AFIT Scholar. For more information, please contact [email protected]. COSTS AND BENEFITS OF PHYSICAL THERAPY PROGRAM IMPLEMENTATION FOR AIR FORCE FIGHTER PILOTS THESIS Christian G. Erneston, Captain, USAF AFIT-ENV-MS-21-M-222 DEPARTMENT OF THE AIR FORCE AIR UNIVERSITY AIR FORCE INSTITUTE OF TECHNOLOGY Wright-Patterson Air Force Base, Ohio DISTRIBUTION STATEMENT A. APPROVED FOR PUBLIC RELEASE; DISTRIBUTION UNLIMITED. The views expressed in this thesis are those of the author and do not reflect the official policy or position of the United States Air Force, Department of Defense, or the United States Government. This material is declared a work of the U.S. Government and is not subject to copyright protection in the United States. AFIT-ENV-MS-21-M-222 COSTS AND BENEFITS OF PHYSICAL THERAPY PROGRAM IMPLEMENTATION FOR AIR FORCE FIGHTER PILOTS THESIS Presented to the Faculty Department of Systems Engineering and Management Graduate School of Engineering and Management Air Force Institute of Technology Air University Air Education and Training Command In Partial Fulfillment of the Requirements for the Degree of Master of Science in Cost Analysis Christian G. Erneston, MBA Captain, USAF March 2021 DISTRIBUTION STATEMENT A. APPROVED FOR PUBLIC RELEASE; DISTRIBUTION UNLIMITED. AFIT-ENV-MS-21-M-222 COSTS AND BENEFITS OF PHYSICAL THERAPY PROGRAM IMPLEMENTATION FOR AIR FORCE FIGHTER PILOTS Christian G. Erneston, MBA Captain, USAF Committee Membership: Dr. R. David Fass Chair Dr. Jonathan D. Ritschel Member Lt Col Amy M. Cox, PhD Member AFIT-ENV-MS-21-M-222 Abstract Air Force fighter pilots face risks associated with neck and spine injuries sustained while operating fighter aircraft. Studies from the flying and medical communities indicate that muscle-strengthening prehabilitative care may decrease the risk of flying related injuries in high performance aircraft pilots. For this reason, the U.S. Air Force provided $24.9M to implement the Optimizing the Human Weapon System (OHWS) program. The program provides physical therapy and strength training to fighter pilots in participating units at twenty-one Air Force bases with the intent of reducing injury rates and time out of the cockpit. From a healthcare perspective there is interest in the effectiveness of the program in injury reduction. From a funding perspective there is interest in the potential for a positive net present value (NPV) of the OHWS investment. This research utilizes injury data obtained from the Force Risk Reduction (FR2) tool to analyze injury rates, injury types, physiological injury locations, as well as medical and non-medical injury costs to form an NPV estimate for the OHWS program. The research finds that the OHWS program provides a NPV of $12.5M assuming the potential effects on injury reduction and fighter pilot separations from active duty service that the program provides. iv Acknowledgments I would like to thank my family and friends for supporting me throughout the process of completing my research. I could not have accomplished this goal alone, and their support did not go unnoticed nor unappreciated. I would also like to thank the AFIT faculty members who guided me through the thesis writing process. Christian G. Erneston v Table of Contents Page Abstract .............................................................................................................................. iv Acknowledgments............................................................................................................... v Table of Contents ............................................................................................................... vi List of Figures .................................................................................................................. viii List of Tables ..................................................................................................................... ix I. Introduction ..................................................................................................................... 1 Research Objectives/Questions/Hypotheses ....................................................................... 4 II. Literature Review ........................................................................................................... 6 Review of Spinal Cord Injury and Treatments ................................................................... 6 Sources of Neck and Spinal Injuries in Fighter Pilots ........................................................ 6 Prehabilitative Care in Sports ............................................................................................. 7 U.S. Army Medical Cost Avoidance Model (MCAM) ....................................................... 9 Optimizing the Human Weapon System (OHWS) Program ............................................ 11 III. Methodology ............................................................................................................... 15 Data Source Overview ...................................................................................................... 15 Data Extraction ................................................................................................................. 15 FR2 Medical Data and Costs ............................................................................................ 19 Non-Medical Costs ........................................................................................................... 23 OHWS Contract Considerations ....................................................................................... 25 Inflation Considerations .................................................................................................... 25 IV. Analysis and Results ................................................................................................... 28 Costs Associated with Fighter Pilot Neck Injuries ........................................................... 28 vi Net Present Value (NPV) Analysis ................................................................................... 31 Additional OHWS Benefits .............................................................................................. 34 V. Research Questions Answered, Conclusions, Policy Recommendations, and Future Research ............................................................................................................................ 38 Research Questions Answered .......................................................................................... 38 Net Present Value (NPV) Final Thoughts ........................................................................ 39 Recommendations for Future Research ............................................................................ 42 Works Cited ...................................................................................................................... 43 vii List of Figures Page Figure 1. Neck Pain Related to Forward Helmet Center of Gravity .................................. 3 Figure 2. Cervical Spine Flexor Muscle Contraction ......................................................... 9 Figure 3. Rate of Neck Injury Among U.S. Air Force Fighter and Bomber Pilots (2006- 2014) .......................................................................................................................... 12 Figure 4. Rate of Neck Injury Among U.S. Air Force Fighter and Bomber Pilots (2006- 2014) - Truncated Query ............................................................................................ 13 Figure 5. Organizational Map of Units Participating in the OHWS Program ................. 17 Figure 6. Neck Injury Case Counts by Base ..................................................................... 29 Figure 7. FR2 Injury Data by Case Count ........................................................................ 30 viii List of Tables Page Table 1. The MCAM Medical Cost Components, Definitions, and Descriptions ............. 10 Table 2. Bases, Units, and Commands Participating in OHWS Program ....................... 18 Table 3. Primary Injury Diagnoses - FR2 Data ............................................................... 20 Table 4. Clinical Costs for Outpatient Medical Services by Base - FR2 Data ................. 22 Table 5 . Centers for Disease Control and Prevention (CDC) Injury Costs .................... 24 Table 6. OHWS Contract Annual Costs ............................................................................ 25 Table 7. Neck-Specific Injury Costs - OHWS Participating Bases ................................... 28 Table 8. Total Injury Costs - OHWS Participating Bases ................................................ 31 Table 9. NPV Analysis of OHWS Contract - Five-Year Period of Performance .............