USU Study Finds Nurse Practitioners and Physician Assistants Provide Cost-Effective Care for Military Traumatic Brain Injury Patients
Analysis of a decade of Military Health System data reveals major cost savings from nurse practitioners and physician assistants treating mild TBI.
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Traumatic brain injury is considered a signature injury of recent conflicts and a top health concern within the Department of War. The recent USU analysis suggests that advanced practice providers offer a viable, cost-effective solution for treating these common conditions within the Military Health System. (Photo credit: Capt. Connie Braybrook, USU) |
December 9, 2025 by Sharon Holland
A recent study led by researchers at the Uniformed Services University of the Health Sciences (USU) has found that nurse practitioners (NPs) and physician assistants (PAs) deliver care for mild traumatic brain injury (mTBI) in the Military Health System (MHS) at significantly lower costs than primary care physicians (PCPs), with no clear compromise in quality.
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Dr. Patrick Richard of USU’s SOM is the lead author of the study highlighting the cost-effectiveness of nurse practitioners and physician assistants in treating mild traumatic brain injury. (Photo credit: Tom Balfour, USU) |
According to the findings, both PAs and NPs provided care at per-patient cost savings ranging from $53 to over $275 when compared to PCPs, depending on the patient’s risk category and whether they were new or existing patients. Among dependent populations, PAs and NPs were also associated with significant savings.
“Our research highlights the important and growing role that nurse practitioners and physician assistants play in military medicine,” said lead author Dr. Patrick Richard of USU’s F. Edward Hébert School of Medicine. “In a healthcare environment facing ongoing shortages of primary care physicians, these results suggest that advanced practice providers are a cost-effective and viable solution—particularly for treating common conditions like mild traumatic brain injury.”
While the cost advantages were clear, the study revealed mixed outcomes when it came to quality. For example, PAs were found to order fewer brain and spine imaging scans—an evidence-based practice—when treating high-risk new patients, but also conducted fewer depression assessments in the same group. NPs, on the other hand, performed more neuropsychological testing for high-risk existing patients and were associated with fewer hospital readmissions among low-risk new patients in the dependent population.
The study was supported by the Congressionally Directed Medical Research Program and the USU Center for Health Services Research. It leveraged the unique structure of the MHS, where NPs and PAs often provide care independently, allowing for a natural comparison of provider types without the confounding influence of patient self-selection.
In addition to Dr. Richard, co-authors of the study include researchers from USU’s Graduate School of Nursing, the National Intrepid Center of Excellence, Henry M. Jackson Foundation for the Advancement of Military Medicine, and Brown University.
As the signature injury of recent military conflicts, traumatic brain injury—particularly mild forms—remains a top health concern within the Department of War. The results of this study could inform staffing models, training priorities, and policy decisions aimed at maximizing readiness while controlling healthcare costs.
“These findings not only reinforce the value of non-physician providers in delivering efficient care,” said Dr. Richard, “but also identify specific areas where clinical practice guidelines and provider education can help optimize outcomes."
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