Newswise — DALLAS, TX – After a school district partnered with a local health system to implement a new systematic and continuous health care model, injury rates for student athletes decreased by 22% and insurance premiums by more than 50%, according to a recent study published by the National Athletic Trainers’ Association (NATA) Journal of Athletic Training.

The research was initiated when sharp increases in secondary insurance premiums occurred in the Greenville County school district in South Carolina. After a Quality Improvement (QI) process focused on preventing, treating and carefully managing sport-related injuries, was implemented, insurance premiums for Greenville County Schools declined yearly from the 2011–12 academic year, for which the total premium was nearly $500,000, to a low in 2016–17, when the total premium was reduced by approximately 50%. Yearly sports participation was relatively stable over this time while the percentage of premiums, claims and losses decreased.

The QI process established a framework to (1) identify and manage the most important and common injuries districtwide; (2) establish the athletic trainer as the primary health care professional for all student athlete’s sport-related illnesses and injuries; (3) aggregate student athlete injury data to inform decisions and program development; (4) use the data to reduce the incidence and effects of sport-related injuries within the district; and (5) provide sustainable health care services to student athletes. 

Over 7 million students (50% of the high school population) participate in athletics each year and an estimated 2 million sports-related injuries occur that result in more than 500,000 physician visits and 30,000 hospitalizations. Because of the number of people and injuries involved, the study found that sports medicine professionals, such as athletic trainers, are uniquely positioned to not only prevent, diagnose, treat and rehabilitate injuries, but also to serve in a lead role to manage the health of student athletes. This centralized role is most effective when backed by a process that includes districtwide data, communication and collaboration across school programs and medical teams. 

The initial step in research evaluated the district’s use of health resources, which was characterized by school, sport and injury type. The goal was to examine patterns of injuries, treatments and services for trends and outliers of need, timing and access to care. The findings of these initial efforts formed the basis for developing a QI process designed to improve the quality and efficiency of the health services delivered within high school sports medicine programs, which consisted of an interdisciplinary team of health care professionals including primary care sports medicine physicians, orthopedic surgeons and other specialized care professionals in addition to the primary athletic trainer charged with providing health care as needed. The data examined the injury patterns from several sources, including athletic training, physical therapy and hospital electronic medical records and insurance claims collected over nine years for more than 67,000 athletes.

The QI process was tested through several projects, including an athletic trainer supervised prevention program for upper extremity (shoulders, arms) in high school pitchers. The program resulted in a six-fold decrease in pitchers’ injury risk, especially if they had suffered from an upper extremity injury previously.

“While we recognize that school districts are unique, this study provides a process to reduce student athlete injuries and school insurance premiums that all districts should assess,” said Tory Lindley, MA, ATC, President of the National Athletic Trainers’ Association.

There are four key lessons from the research that can be applied to any school district.

  1. Form an interdisciplinary team of health care professionals. This includes primary care sports medicine physicians, orthopedic surgeons and other specialized care professionals in addition to the primary athletic trainer charged with providing health care as needed. 
  1. Commit to collecting data, such as health history, injury and treatment, to establish best athletic and medical practices. It will also aid in the allocation of resources as well as refine practice management, competition scheduling and preventative care for all athletes. 
  1. Develop a Quality Improvement (QI) process based on data, such as injury rates and patterns. In this study, researchers evaluated injury rates and patterns of two sports and used the data to develop prevention programs to reduce the risk of injury going forward. It also provided student athletes access to ongoing care, which reduced injury and overall health care cost to the district. 
  1. Establish a culture of effective communication between athletes, athletic trainers, coaches, athletic directors and their peers to foster team collaboration in caring for their athletes. Athletic trainers are key to providing cost-effective care for high school athletes because they can help prevent, assess and treat injuries as well as refer – if necessary – to the appropriate medical provider in a timely manner.

“With school budgets being cut across the country, this research suggests that the positive impact athletic trainers can have on a school’s insurance premiums alone justifies the need for a full-time athletic trainer on staff,” said Ellen Shanley, PhD, PT, OCS. “High quality care at the school level by sports medicine professionals not only impacts the individual athlete, but their school districts, local doctors’ offices, hospitals and beyond.”

Ultimately, the research shows that pooling resources, data and experience has improved the efficiency of the development and implementation of prevention, treatment and academic and athletic reintegration programs to the benefit of the entire student athlete population involved in the study.

About NATA: National Athletic Trainers’ Association (NATA) – Health Care for Life & Sport

Athletic trainers are health care professionals who specialize in the prevention, diagnosis, treatment and rehabilitation of injuries and sport-related illnesses. They prevent and treat chronic musculoskeletal injuries from sports, physical and occupational activity, and provide immediate care for acute injuries. Athletic trainers offer a continuum of care that is unparalleled in health care. The National Athletic Trainers' Association represents and supports 45,000 members of the athletic training profession. For more information, visit

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