.2010-05-16nominal benefit, but may inject ex- ante moral hazard into the equation through unhealthy lifestyles, in essence substituting healthcare for health.50.onto a tax dollar mandate, addressing the drivers of the escalating healthcare costs is important. It is an especially critical topic in light of.benefit ratio seen in the American healthcare system to be substantially higher than those studies noted. Moving Forward: Addressing Cost Drivers and.2005-12-01Business Board Utilize specially trained care managers to proactively attend to/assist high-risk population. Customize a comprehensive.ADDRESS(ES) Defense Business Board,1155 Defense Pentagon,Washington,DC, 8. PERFORMING ORGANIZATION REPORT NUMBER 9. THIS PAGE unclassified Standard Form 298 (Rev. 8-98) Prescribed by ANSI Std Z39-18 Defense Business Board HEALTHCARE FOR MILITARY RETIREES.Adesoye, Taiwo; Kimsey, Linda G; Lipsitz, Stuart R; Nguyen, Louis L; Goodney, Philip; Olaiya, Samuel; Weissman, Joel S2017-08-01To compare geographic variation in healthcare spending and utilization between the Military Health System (MHS) and Medicare across hospital referral regions (HRRs).
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Retrospective analysis. Data on age-, sex-, and race-adjusted Medicare per capita expenditure and utilization measures by HRR were obtained from the Dartmouth Atlas for 2007 to 2010. Similarly, adjusted data from 2007 and 2010 were obtained from the MHS Data Repository and patients assigned to HRRs. We compared high- and low-spending regions, and computed coefficient of variation (CoV) and correlation coefficients for healthcare spending, hospital inpatient days, hip surgery, and back surgery between MHS and Medicare patients. We found significant variation in spending and utilization across HRRs in both the MHS and Medicare. CoV for spending was higher in the MHS compared with Medicare, (0.24 vs 0.15, respectively) and CoV for inpatient days was 0.36 in the MHS versus 0.19 in Medicare. The CoV for back surgery was also greater in the MHS compared with Medicare (0.47 vs 0.29, respectively).
Per capita Medicare spending per HRR was significantly correlated to adjusted MHS spending (r = 0.3; P 1.7 million women, aged 14-40 years, who were enrolled in the US military healthcare system, TRICARE Prime, between October 2009 and September 2014. Individuals were assessed for long-acting reversible contraception initiation and continuation with the use of medical billing records. Method continuation and factors that were associated with early method discontinuation were evaluated with the Kaplan-Meier estimator and Cox proportional hazard models. During the study dates, 188,533 women initiated long-acting reversible contraception. Of these, 74.6% women selected intrauterine contraceptives. Method initiation rates remained relatively stable (41.7-50.1/1000 women/year) for intrauterine methods, although the rate for subdermal implants increased from 6.1-23.0/1000 women/year.
In analysis of women who selected intrauterine contraceptives, 61.2% continued their method at 36 months, and 48.8% continued at 60 months. Among women who selected the implant, 32.0% continued their.Mattocks, Kristin; Schwarz, Eleanor Bimla; Borrero, Sonya; Skanderson, Melissa; Zephyrin, Laurie; Brandt, Cynthia; Haskell, Sally2014-01-01Abstract Background: Women Veterans who suffered military sexual trauma (MST) may be at high risk for unintended pregnancy and benefit from contraceptive services. The objective of this study is to compare documented provision of contraceptives to women Veterans using the Department of Veterans Affairs (VA) health system who report or deny MST. Methods: This retrospective cohort study included women Veterans aged 18–45 years who served in Operation Enduring or Iraqi Freedom and had at least one visit to a VA medical center between 2002 and 2010. Data were obtained from VA administrative and clinical databases. Chi-squared tests and logistic regression were conducted to evaluate the association between MST, ascertained by routine clinical screening, and first documented receipt of hormonal or long-acting contraception. Results: Of 68,466 women Veterans, 13% reported, 59% denied and 28% had missing data for the MST screen.
Among the entire study cohort, 30% of women had documented receipt of a contraceptive method. Women reporting MST were significantly more likely than those denying MST to receive a method of contraception (adjusted odds ratio aOR 1.12, 95% confidence interval CI 1.07–1.18) including an intrauterine device (odds ratio OR 1.29, 95% CI 1.17–1.41) or contraceptive injection (OR 1.17, 95% CI 1.05–1.29). Women who were younger, unmarried, seen at a women's health clinic, or who had more than one visit were more likely to receive contraception. Conclusions: A minority of women Veterans of reproductive age receive contraceptive services from the VA.
Women Veterans who report MST, and particularly those who seek care at VA women's health clinics, are more likely to receive contraception. PMID:24787680.Luxton, David D; Thomas, Elissa K; Chipps, Joan; Relova, Rona M; Brown, Daphne; McLay, Robert; Lee, Tina T; Nakama, Helenna; Smolenski, Derek J2014-03-01Caring letters is a suicide prevention intervention that entails the sending of brief messages that espouse caring concern to patients following discharge from treatment. First tested more than four decades ago, this intervention is one of the only interventions shown in a randomized controlled trial to reduce suicide mortality rates. Due to elevated suicide risk among patients following psychiatric hospitalization and the steady increase in suicide rates among the U.S. Military personnel, it is imperative to test interventions that may help prevent suicide among high-risk military personnel and veterans. This paper describes the design, methods, study protocol, and regulatory implementation processes for a multi-site randomized controlled trial that aims to evaluate the effectiveness of a caring emails intervention for suicide prevention in the military and VA healthcare systems.
The primary outcome is suicide mortality rates to be determined 24 months post-discharge from index hospital stay. Healthcare re-utilization rates will also be evaluated and comprehensive data will be collected regarding suicide risk factors. Recommendations for navigating the military and VA research regulatory processes and implementing a multi-site clinical trial at military and VA hospitals are discussed. Published by Elsevier Inc.Jennings, B M; Loan, L A1999-11-01A study was performed to evaluate military beneficiaries' motivation for choosing to change from a civilian managed care system to the military managed care system. Concerns about healthcare cost, quality, and access underpin major reform in military healthcare. The military health system (MHS) is implementing managed care through an initiative known as TRICARE. Patient choice and satisfaction are highly relevant to all healthcare delivery systems; they are being explored aggressively in the MHS as TRICARE evolves.
This descriptive study was conducted using a telephone survey consisting of 63 items derived from four pre-existing instruments as well as five facility-specific questions and demographics. The population of interest targeted military beneficiaries on a TRICARE waiting list who, at the time of enrollment, indicated a desire to receive care at the military facility. Consumers were inclined to return to the military system because of loyalty.
Also, this study provided evidence that staff courtesy is important to those who seek healthcare. Good quality and accessibility were verified as essential elements in sustaining a consumer's positive view of and attraction to a particular healthcare system. Cost was proven to be a less substantial factor of consumer decision making. Surveys such as this give healthcare providers more information about aspects of care, such as patient loyalty and interpersonal dynamics, that attract people to their healthcare delivery systems. For healthcare systems to thrive, consumer influence and the power of patient dissatisfaction must be understood.2014-01-01Naval Health Research Center Changes in Healthcare Use Across the Transition from Civilian to Military Life Stephanie K. McWhorter.Library (wileyonlinelibrary.com) DOI: 10.1002/hpm.2176Changes in healthcare use across the transition from civilian to military life Stephanie K.entry into the Military Health System (MHS). Entrance into the MHS was marked by increased use of preventive care.
Although few systematic differences.Stephens, Elisabeth K; Nguyen, Phuong L; Radecki Breitkopf, Carmen; Jatoi, Aminah2011-12-01Few studies have focused on perceptions of healthcare among Vietnamese who came to the United States (US) as refugees. A 48-item survey that included information on demographics, health status, and satisfaction with healthcare including the Patient Satisfaction Questionnaire-18 (PSQ-18) was sent to 49 former Vietnamese military officers, who are now living in the US, based on their current geographic residence. A total of 22 of 49 delivered questionnaires were completed and returned, yielding a response rate of 45%. The survey was sent in Vietnamese and English, and all except one was completed in Vietnamese.
In response to 'Language barriers have prevented me from accessing health care when I need it,' 77% of respondents acknowledged that this was 'sometimes' the case even today. Most respondents otherwise viewed the healthcare system favorably, but cost concerns were an issue: 28% strongly agreed or agreed with the statement, 'I have to pay for more of my medical care than I can afford.' In contrast, only 9% described that they would have strongly agreed or agreed to this statement upon first arriving to the US. Write-in comments revealed themes that centered on language barriers, favorable impressions of healthcare in the US, financial concerns, and patriotism towards the US. Further study of this aging population of Vietnamese Americans might help shed light on concerns faced by other refugee populations who have arrived more recently.Dave, Ajal; Cagniart, Kendra; Holtkamp, Matthew D2018-06-07The development of primary stroke centers has improved outcomes for stroke patients.
Telestroke networks have expanded the reach of stroke experts to underserved, geographically remote areas. This study illustrates the outcome and cost differences between neurology and primary care ischemic stroke admissions to demonstrate a need for telestroke networks within the Military Health System (MHS). All adult admissions with a primary diagnosis of ischemic stroke in the MHS Military Mart database from calendar years 2010 to 2015 were reviewed. Neurology, primary care, and intensive care unit (ICU) admissions were compared across primary outcomes of (1) disposition status and (2) intravenous tissue plasminogen activator administration and for secondary outcomes of (1) total cost of hospitalization and (2) length of stay (LOS). A total of 3623 admissions met the study's parameters. The composition was neurology 462 (12.8%), primary care 2324 (64.1%), ICU 677 (18.7%), and other/unknown 160 (4.4%). Almost all neurology admissions (97%) were at the 3 neurology training programs, whereas a strong majority of primary care admissions (80%) were at hospitals without a neurology admitting service.
Hospitals without a neurology admitting service had more discharges to rehabilitation facilities and higher rates of in-hospital mortality. LOS was also longer in primary care admissions. Ischemic stroke admissions to neurology had better outcomes and decreased LOS when compared to primary care within the MHS. This demonstrates a possible gap in care. Implementation of a hub and spoke telestroke model is a potential solution.
Published by Elsevier Inc.Klein, David A.; Adelman, William P.; Thompson, Amy M.; Shoemaker, Richard G.; Shen-Gunther, Jane2015-01-01Data examining sexuality and substance use among active duty and military-dependent youth is limited; however, these psychosocial factors have military implications. Adolescents and young adults aged 12–23 were recruited from an active-duty trainee clinic (n = 225) and a military pediatric clinic (n = 223). Active duty participants were more likely to be older, male, White, previous tobacco users, and report a history of sexual activity and less contraception use at their most recent intercourse, compared to the dependent group.
Over 10% of all participants indicated attraction to members of the same gender or both genders. In logistic regression analysis, non-White participants were less likely to use contraception compared to White participants. Adolescents and young adults seen in military clinics frequently engage in high-risk behavior. Clinicians who care for military youth should assess their patient’s psychosocial history. Further study of this population is warranted to identify factors that may influence risk and resilience.
PMID:26512892.Grady, Brian J2002-01-01The National Naval Medical Center, Bethesda, Maryland, integrated telemental health care into its primary behavioral health-care outreach service in 1998. To date, there have been over 1,800 telemental health visits, and the service encounters approximately 100 visits per month at this time. The objective of this study was to compare and contrast the costs to the beneficiary, the medical system, and the military organization as a whole via one of the four methods currently employed to access mental health care from remotely located military medical clinics. The four methods include local access via the military's civilian health maintenance organization (HMO) network, patient travel to the military treatment facility, military mental health specialists' travel to the remote clinic (circuit riding) and TeleMental Healthcare (TMH). Interactive video conferencing, phone, electronic mail, and facsimile were used to provide telemental health care from a military treatment facility to a remote military medical clinic. The costs of health-care services, equipment, patient travel, lost work time, and communications were tabulated and evaluated.
While the purpose of providing telemental healthcare services was to improve access to mental health care for our beneficiaries at remote military medical clinics, it became apparent that this could be done at comparable or reduced costs.Clarke, Steve2017-04-01An analogy is sometimes drawn between the proper treatment of conscientious objectors in healthcare and in military contexts. In this paper, I consider an aspect of this analogy that has not, to my knowledge, been considered in debates about conscientious objection in healthcare. In the USA and elsewhere, tribunals have been tasked with the responsibility of recommending particular forms of alternative service for conscientious objectors. Military conscripts who have a conscientious objection to active military service, and whose objections are deemed acceptable, are required either to serve the military in a non-combat role, or assigned some form of community service that does not contribute to the effectiveness of the military. I argue that consideration of the role that military tribunals have played in determining the appropriate form of alternative service for conscripts who are conscientious objectors can help us to understand how conscientious objectors in healthcare ought to be treated. Additionally, I show that it helps us to address the vexed issue of whether or not conscientious objectors who refuse to provide a service requested by a patient should be required to refer that patient to another healthcare professional. Published by the BMJ Publishing Group Limited.
For permission to use (where not already granted under a licence) please go to Lara; Bader, Karlen S; Meyer, Holly S; Durning, Steven J; Artino, Anthony R; Hamwey, Meghan K2018-05-08Research into healthcare delivered via interprofessional healthcare teams (IHTs) has uncovered that IHT can improve patient satisfaction, enhance collaborative behaviors, reduce clinical error rates, and streamline management of care delivery. Importantly, these achievements are attained by IHTs that have been trained via interprofessional education (IPE). Research indicates that interprofessional healthcare team training must be contextualized to suit the demands of each care context. However, research into the unique demands required of military IHTs has yet to be explored. For any form of IPE to be successfully implemented in the military, we need a clear understanding of how interprofessional healthcare team competencies must be tailored to suit military care contexts. Specifically, we must know: (1) What evidence is currently available regarding IHTs in the military?; and (2) What gaps in the evidence need to be addressed for IPE to be customized to meet the needs of military healthcare delivery? We conducted a scoping review of the literature was conducted to identify the breadth of knowledge currently available regarding MIHTs.
A search of PubMed, EMBASE, PsycInfo, ERIC, DTIC.mil, and NYAM Gray Literature databases was conducted without date restrictions. The search terms were: (interprofessional. OR interprofessional.) AND ( military OR Army OR Navy OR Navy OR Marines OR 'Air Force' OR 'Public Health Service') AND (health OR medicine).
Of the 675 articles identified via the initial search, only 21 articles met inclusion criteria (i.e., involved military personnel, teams were medically focused, comprised at least two professional disciplines, and at least two people). The manuscripts included: seven original research studies, six commentaries, five reviews, one letter, one annual report, and one innovation report. Analyses identified three themes (i.e., effective communication, supportive team environments, members) related to successful MIHT collaborations.1998-07-01Intermediate Care Facility ICN Internal Control Number ICU Intensive Care Unit Desk Reference 59 ID Identification IDC Independent Duty Corpsman IDFN. Intermediate Care Facility - A less expensive healthcare setting for patients who are not in need of acute or skilled nursing care but yet need more care.Kimsey, Linda; Olaiya, Samuel; Smith, Chad; Hoburg, Andrew; Lipsitz, Stuart R; Koehlmoos, Tracey; Nguyen, Louis L; Weissman, Joel S2017-04-13This study seeks to quantify variation in healthcare utilization and per capita costs using system-defined geographic regions based on enrollee residence within the Military Health System (MHS). Data for fiscal years 2007 - 2010 were obtained from the Military Health System under a data sharing agreement with the Defense Health Agency (DHA). DHA manages all aspects of the Department of Defense Military Health System, including TRICARE.
Adjusted rates were calculated for per capita costs and for two procedures with high interest to the MHS- back surgery and Cesarean sections for TRICARE Prime and Plus enrollees. Coefficients of variation (CoV) and interquartile ranges (IQR) were calculated and analyzed using residence catchment area as the geographic unit. Catchment areas anchored by a Military Treatment Facility (MTF) were compared to catchment areas not anchored by a MTF.
Variation, as measured by CoV, was 0.37 for back surgery and 0.13 for C-sections in FY 2010- comparable to rates documented in other healthcare systems. The 2010 CoV (and average cost) for per capita costs was 0.26 ($3,479.51). Procedure rates were generally lower and CoVs higher in regions anchored by a MTF compared with regions not anchored by a MTF, based on both system-wide comparisons and comparisons of neighboring areas. In spite of its centrally managed system and relatively healthy beneficiaries with very robust health benefits, the MHS is not immune to unexplained variation in utilization and cost of healthcare.Loewy, Erich H.2007-01-01Despite the fact that most American physicians, at least until around the 1970s, stood in the way of developing a universal healthcare system, most are generally not happy with the current state of healthcare – or its lack thereof – today. The primary reasons for this general unhappiness are that insurance companies and managed care have successfully conspired to remove much of the physician's autonomy (via imposed time constraints, burdensome paperwork, the time-consuming chore of having to defend going against stringent treatment algorithms that are often inappropriate for some patients) and the satisfaction of knowing their patients. Few physicians in managed care organizations (MCOs) are able to practice without constant and blindly algorithmic interference concerning the diagnostic tests and therapeutic interventions they order. As copayments have increased, they often find that patients, even though “covered,” cannot afford the therapy they deem necessary.
While physicians expect to earn sufficient to pay back their not insignificant educational debts, provide their children with help through college, and assure retirements sufficient for themselves and their spouses, these should not be considered unreasonable expectations. Most physicians today do favor universal healthcare – to the point of having included such language in their various professional codes of ethics (which, perversely enough, bioethicists as a group have failed to do). Contrary to the claims of our colleagues, Altom and Churchill, physicians seem to be genuinely frustrated as to what else they can do to change the current inequitable system. PMID:174-01-01Soldiers, and 915 Army Civilians (Sheftick & Holzer, 2007).
Self - Esteem Rosenberg (1965) provided a broad and frequently cited description of self.Teaching Mental Skills for Self - Esteem Enhancement in a Military Healthcare Setting Jon Hammermeister, Michael A. Pickering and LTC Carl J. Ohlson.The need exists for educational methods which can positively influence self - esteem, especially in demanding military healthcare settings.Enzenaue, Robert W2007-01-01Trite sayings from Chinese military classics often find their way into after-dinner fortune cookies in many Chinese restaurants in America. However, no one should underestimate the lessons from those Chinese military classics, and they certainly should never be trivialized. Leaders at all levels of healthcare management can learn timeless lessons spanning three millennia from the wisdom of ancient Chinese military writings.Hunter, Edna J., Ed.Recently, the military system has begun to feel the impact of the military family.
Whenever sudden dramatic changes or transitions occur, crises may result either for the individual or for the institution. At present both the military system and the military family are in a period of rapid transition. Perhaps one of the most important changes that.Bain, C.
N.1978-01-01The military implications of the reference satellite power system (SPS) were examined is well as important military related study tasks. Primary areas of investigation were the potential of the SPS as a weapon, for supporting U.S. Military preparedness, and for affecting international relations. In addition, the SPS's relative vulnerability to overt military action, terrorist attacks, and sabotage was considered.Lester, Paul B; Taylor, Lauren C; Hawkins, Stacy Ann; Landry, Lisa2015-02-01After more than a decade of war, the US military continues to place significant emphasis on psychological health and resilience.
While research and programs that focus on the broader military community's resilience continue to emerge, less is known about and until recently little focus has been placed on military medical provider resilience. In this article, we review the literature on military medical provider resilience, provide an overview of the programmatic and technological advances designed to sustain and develop military medical provider resilience, and finally offer recommendations for future research.Smith, Katherine; Firth, Kimberly; Smeeding, Sandra; Wolever, Ruth; Kaufman, Joanna; Delgado, Roxana; Bellanti, Dawn; Xenakis, Lea2016-01-01Research suggests that the development of mind-body skills can improve individual and family resilience, particularly related to the stresses of illness, trauma, and caregiving. To operationalize the research evidence that mind-body skills help with health and recovery, Samueli Institute, in partnership with experts in mind-body programming, created a set of guidelines for developing and evaluating mind-body programs for service members, veterans, and their families. The Guidelines for Creating, Implementing, and Evaluating Mind-Body Programs in a Military Healthcare Setting outline key strategies and issues to consider when developing, implementing, and evaluating a mind-body focused family empowerment approach in a military healthcare setting.
Although these guidelines were developed specifically for a military setting, most of the same principles can be applied to the development of programs in the civilian setting as well. The guidelines particularly address issues unique to mind-body programs, such as choosing evidence-based modalities, licensure and credentialing, safety and contraindications, and choosing evaluation measures that capture the holistic nature of these types of programs. The guidelines are practical, practice-based guidelines, developed by experts in the fields of program development and evaluation, mind-body therapies, patient- and family-centered care, as well as, experts in military and veteran's health systems. They provide a flexible framework to create mind-body family empowerment programs and describe important issues that program developers and evaluators are encouraged to address to ensure the development of the most impactful, successful, evidence-supported programs possible.
Copyright © 2016 Elsevier Inc. All rights reserved.Gibbons, Susanne W; Hickling, Edward J; Watts, Dorraine D2012-01-01While there has been a growing body of literature on the impact of combat stressors and post-traumatic stress on military service members involved in current conflicts, there has been little available information that directly examines the impact of these on healthcare providers.
Aims for this integrative review included: (1) identifying exposures, experiences and other factors influencing stress responses in military healthcare providers previously engaged in a war effort and (2) describing the incidence of post-traumatic stress and related mental health problems in this population. Using Cooper's integrative review method, relevant documents were collected and analysed using content categories and a coding scheme to assist with identifying and recording data for units of analysis. Literature searches (including all years to present) were conducted using keywords for stress reaction, for healthcare provider and for military war effort involvement. Literature was obtained using the Cumulative Index to Nursing and Allied Health Literature, the National Library of Medicine and the American Psychological Association databases.
Evidence suggests that similar to military combatants, military healthcare provider exposure to life-threatening situations will increase the probability of adverse psychological disorders following these traumatic experiences. The presence of a strong sense of meaning and purpose, within a supportive environment appear to help mediate the impact of these dangerous and stressful events. Results of this review and other supporting literature indicate the need for a systematic approach to studying combat stress and post-traumatic stress in deployed healthcare providers.