What is ASMF? When was it formed and why?

ASMF is a publicly-supported nonprofit organization dedicated to the promotion, support and sponsorship of education and research in the field of sports medicine. AFSMER was officially formed in the spring of 1996 and received its 501(c)(3) designation as a public nonprofit corporation on October 1, 1996. It's mission is to provide sound research and education in the field of sports medicine.

Americans sustain 33 million musculo-skeletal injuries annually (1) with 20% of these injuries occurring during sports activities or on school grounds. (2) Ninety per cent of these injuries require some form of medical attention and care.(1) The cost in lost work days is more than 26 billion dollars each year. This does not begin to take into account the costs to the individual for health care, loss of function and quality of life. Research and education are necessary to prevent sports injuries and develop new ways to care for those who sustain injuries in order to improve outcomes and help people return to active lives as quickly as possible.

 

What are the goals of ASMF?

*        To function as a resource to the public, providing education and resource materials on fitness, sports training, safety and prevention of athletic injuries.

Special programs for the public are aimed at encouraging a healthy life style for active people of all ages. These programs include lectures in sports safety, rehabilitation, nutrition, and specific topics such as osteoporosis prevention, helmet use in sports, etc. The initial educational objective is to create a series of educational programs that address the cause, effect and prevention of sport-related injuries. The programs benefit community members and visitors by educating them on sports specific injuries and in the steps that can be taken toward injury prevention. The concept of the community seminar is to emphasize injury prevention by encouraging each participant to take a proactive role in one's own health and conditioning. We are developing an entire series of summer and winter sports injury courses covering skiing, snowboarding, mountain biking, running and others. Each of the presentations address various cross sections of the community including youth groups and the adolescent population, senior citizens, women, ski professionals (instructors, ski patrol), etc. When space permits, we plan to develop a resource library for the public. The library will have up-to-date information for the sports enthusiast, including books, journals and computer access to on-line information.

*        To perform scientific research to enhance effectiveness and efficiency in the delivery of health care and to develop innovative treatment techniques which speed the recovery from injuries and improve outcomes for those who sustain injuries.

The Foundation fosters the development and initiation of new ideas and approaches to sports medicine by stimulating and sponsoring appropriate clinical and laboratory research. Because of recent structural changes in the U.S. medical system, now more than ever before, physicians and hospitals must strive to identify the most effective treatment pathways and offer these treatments to their patients, rather than allow managed care to dictate the decision making process. This can be accomplished through research efforts designed to explore and enhance the quality and efficiency of the care provided and to validate the need for certain treatment pathways for special populations, such as those sustaining sports injuries. Our research is changing how orthopaedic care is delivered across the country. Examples of recent accomplishments include the following research projects:

*        The Snowboarder's Foot and Ankle. This study was completed in 1996 and was published in the March/April 1998 issue of the American Journal of Sports Medicine. This paper has been presented at meetings across the country and in Canada. The project calls attention to a specific ankle injury that is seen frequently in snowboarders - fracture of the lateral process of the talus. It is a difficult fracture to identify and, when overlooked, has the potential to cause long term problems.

*          Acute Skier's Thumb with a Proximal Phalanx Bone Anchor. This project evaluated the outcomes of a new method of treatment for a common skiing injury ñ a torn ulnar collateral ligament of the thumb. Fifty-eight patients who were treated for this injury during the 1992-1993 ski season were contacted and given a questionnaire. The results of this study showed that this new technique allows for early motion and activity as well as excellent long term outcomes. This paper has been presented at meetings across the country and in Canada. This paper was published in the September/October 1998 issue of the American Journal of Sports Medicine.

*        The Impact of Surgical Timing on Post-Operative Range of Motion and Stability Following ACL Reconstruction. This study was conducted from the fall of 1991 until spring, 1993. It demonstrated the efficacy of anterior cruciate ligament reconstruction (ACL) when performed early after injury. This disputed previous reports that early ACL reconstruction resulted in an increased incidence of knee stiffness and restricted motion post-operatively. This paper has been presented at meetings across the country. The completed manuscript was published in the journal, Arthroscopy in December 1996.

*          Primary Traumatic Anterior Shoulder Dislocation in Patients 40 Years of Age and Older.

This study, conducted in 1995-1996, found that older patients who sustained a first time anterior shoulder dislocation had an increased risk of associated pathology. Early identification and treatment of these problems is necessary in order to assure successful outcomes from these injuries. This paper has been presented at several national meetings and the manuscript was published in the April 1998 issue of the journal, Arthroscopy

*          Outcome Study of Nonoperative Management Versus Operative Reconstruction of Anterior Cruciate Ligament Rupture in Patients 50 Years of Age and Older. This study was conducted from the fall of 1993 until spring, 1994. It confirmed the need for ACL reconstruction in an active population of people over the age of fifty. This group of patients traditionally receives more conservative (non-surgical) treatment of their ACL tears. This paper was presented at the 11th International Congress on Ski Trauma and Skiing Safety in Voss, Norway and the manuscript is being prepared for publication.

*        To provide education to health care professionals, including physicians, physical therapists, nurses and other health care professionals.

The Foundation's goal is to advance scholarship in the recognition, treatment, rehabilitation and prevention of sports injuries. Sports medicine as a specialty area of practice is no longer restricted to the treatment of athletic injuries. It also includes work in conditioning, training, injury prevention, rehabilitation, use and abuse of drugs, sports psychology and nutrition. Professionals in the field must have the opportunity to continually update their skills and knowledge in this ever-changing discipline. Our goal is to provide a comprehensive educational program with stimulating topics that cover the basics of sports medicine and what is new and innovative in the field. The work of the Foundation provides opportunities for professional advancement for sports physicians, physical therapists, registered nurses, trainers, emergency room staff along with family practitioners, radiologists, and other health care professionals.

The Foundation's sponsorship and governance of the Aspen Sports Medicine Foundation Fellowship is part of the educational program. The Fellowship provides an opportunity for orthopaedic surgeons who have completed their orthopaedic surgery training to acquire added clinical competence as a specialist in the field of orthopaedic sports medicine. Through the program, two orthopaedic surgeons are selected annually to work with the Aspen faculty for a year of subspecialty training in sports medicine and sports trauma. The fellowship began in the early 1970's under the direction of Robert R. Oden, MD. Aspen offers an exciting and challenging experience for these physicians with our large skiing population, high school varsity athletics, a very active local populace and established referral practices. The fellowship meets the stringent criteria for accreditation by the Accreditation Council for Graduate Medical Education (ACGME), the federal council which reviews all fellowships in medicine and surgery. A comprehensive teaching curriculum for sports medicine and sports trauma has been developed consisting of didactic lectures, weekly x-ray conference, journal club, audio-visual training tapes, hands-on cadaver dissections, as well as an extensive experiential clinical experience. The fellowship attracts top level candidates from the most prestigious orthopaedic residency programs in the country. Former fellows rate the program highly and have gone on to successful careers in orthopaedic sports medicine practices.

Who benefits from this organization?

*        The public -- through access to resources necessary to maintain a healthy, active lifestyle.

The Foundation's goal is to become the main informational and educational resource on sports medicine for the active citizens and visitors of our valley.

*        The patients -- who receive state-of-the-art health care in a rural setting.

The Foundation research efforts support patient advocacy - the most important service that research activities can provide to consumers. Comparing patient outcomes and satisfaction with existing standards and with outcomes from centers throughout the United States and the world helps to promote improvement in recognition and care of sports injuries. Research can evaluate and validate patient care decisions regarding treatment techniques employed (conservative versus surgical management) and technology utilized (e.g. magnetic resonance imaging) to resolve pathologic processes.

*          Aspen and the Roaring Fork Valley -- known for excellence in sports medicine care.

The high volume of orthopaedic procedures performed here attests to the claim that Aspen and the Roaring Fork Valley offers state-of-the-art sports medicine care. Through the Foundation's publications and presentations, Aspen will continue as the treatment location of choice on the basis of proven quality of service and cost-effectiveness - bringing more visitors into the area. Also, the Foundation extends itself to the community through presentations at the schools, at the hospital and by volunteering at community sports events, like the World Cup, the 24 Hours of Aspen, etc. In addition, the sports medicine fellows staff indigent care clinics, perform pre-employment screening exams and participate in Aspen Valley Hospital's annual health fair.

*          Aspen Valley Hospital -- distinction as a center of excellence and partner in the training of professionals in sports medicine.

The hospitals that will survive the current reorganization of the health care delivery system are those that provide the most efficient and effective care and are recognized among their peers as centers of excellence. Aspen Valley Hospital is unique in its ability to provide high-quality specialized care in the area of orthopaedics in a rural setting. It's distinction as an academic institution enhances the hospital's potential to be the first referral choice for patients in this community and the western slope. Aspen Valley Hospital can truly represent itself as a "center of excellence" in the orthopaedic sports medicine field. This makes it possible for the hospital to attract and retain specialists who are recognized as leaders in the orthopaedic field.

Because of the academic strength and advanced skills of its medical professionals, the hospital is able to provide a comprehensive, state-of-the-art program with a broad scope of services: reconstructive surgery, sports medicine, arthroscopy, foot and ankle care, hand surgery and trauma care. The sports medicine fellows have a significant impact on quality of patient care; patients have the benefit of the shared expertise and knowledge of both the attending orthopaedist and the fellows. This creates a stimulating environment that promotes an ongoing exchange of scientific and clinical information between the patient and the physicians. The presence of fellows working alongside the staff orthopaedic surgeons expedites handling of the large number of patients who come to the emergency room each day during the ski season and the active summer season, and assures that each patient receives a thorough assessment of his/her needs. The fellowship provides a cost-effective way to maximize both the quality and quantity of care. This is especially important at a time when insurance companies are demanding quality services for less reimbursement.

*        The medical community -- physicians, physical therapists, nurses, trainers and other health care professionals who receive high quality education and training.

The Foundation serves a broad range of health care professionals through its research and educational programs and the ASMF Fellowship program. These programs have created an academic setting that encourages the professional growth of health care professionals from the Roaring Fork Valley and beyond.

What are some of the programs and services that ASMF offers?

The Foundation's research goals are to conduct, report and publish scientifically sound clinical, epidemiological and basic science research. The research is designed to improve the understanding, treatment and prevention of sports injuries. Its educational goals are to advance the knowledge and skills of all medical practitioners in the field of sports medicine and to disseminate the results of that research to the medical and lay communities for the betterment of the community at large. Specific services include provision of trained, experienced staff who can facilitate research project completion from concept through submission of completed manuscripts for publication, including the following:

*          Development of collection tools and analytic techniques for measuring the effectiveness of health care interventions that improve the quality of health care provided to patients.

*          Collection, analysis, interpretation and reporting of data.

*          Assistance in the design, implementation and integration of patient-centered outcomes studies to improve quality of patient care.

*          Dissemination of research findings through presentations at local, regional and national programs.

*          Publication of findings in professional journals.

 
The Foundation's staff creates a climate of learning by developing and implementing a plan of organized presentations for health care professionals as well as the general public in the prevention and care of sports medicine injuries. The staff coordinates and advertises these presentations, and assures preparation of necessary materials including slide development, audio-visual equipment support, room reservation and set-up, preparation of outlines, objectives, handouts and evaluation forms.

Other services available include on-line searches of the medical literature and conference planning.

What does ASMF hope to achieve over the next several years?

ASMF plans to promote and encourage communication among health care professionals and the general public about the need for research and education in the area of sports medicine. We want to facilitate programs which will help people make better life style decisions when engaging in sports and recreational activities.

How have these programs been funded in the past?

Since its inception, the majority of the costs of the research and education program has been underwritten by Orthopaedic Associates of Aspen & Glenwood. However, recent changes in health care make it impossible for the Foundation to depend on private funds much longer. These changes are as follow:

1. Teaching programs across the country accredited by the ACGME are facing the loss of the traditional ways of funding their programs. These accredited medical training programs have relied on insurance reimbursements by way of surgical assistant fees as a source of funding to recover some of the costs of training MDs. New policy has been proposed at the federal level that will remove the ability of medical training programs to bill for these procedures. The government's reasoning is that this experience is educational and therefore should not be paid for. Programs who have worked hard to attain accreditation, such as the Aspen Sports Medicine Fellowship, face being penalized for this designation.

2. Along these same lines, there has been a gradual erosion of reimbursements for surgical assistant fees from private insurers. Insurance companies are reducing the amount they will pay or denying payment altogether for surgical assistant fees for medical practices across the country. These fees were a critical source of funding for research and educational activities.

3. Reimbursements for orthopaedic care have dropped approximately 30-35% over the past five years due to managed care contracts and pricing changes in the medical insurance industry. These reductions, although potentially beneficial to consumers, make private funding of teaching programs substantially more difficult.

What are the goals of the Foundation's fund drive?

The Foundation hopes to raise $2.5 million dollars that will be set aside as an endowment to support the costs of the Foundation. These costs for 2001 are expected to reach $200,000. The endowment, along with continued fund-raising efforts, will support the existing programs and allow for growth of the organization.

References:

1. Praemer A, Furner S, Rice D: Musculoskeletal conditions in the United States. p.105. American Academy of Orthopaedic Surgeons, 1992.

 2. Praemer A, Furner S, Rice D: Musculoskeletal conditions in the United States. p.92. American Academy of Orthopaedic Surgeons, 1992.