Impact of Civilian Patient Care on Major Amputation Case Volume in the Military Health System

ABSTRACT Background Sustaining critical wartime skills (CWS) during interwar periods is a recurrent and ongoing challenge for military surgeons. Amputation surgery for major extremity trauma is exceptionally common in wartime, so maintenance of surgical skills is necessary. This study was designed to examine the volume and distribution of amputation surgery performed in the military health system (MHS). Study Design All major amputations performed in military treatment facilities (MTF) for calendar years 2017–2019 were identified by current procedural terminology (CPT) codes. The date of surgery, operating surgeon National Provider Identifier, CPT code(s), amputation etiology (traumatic versus nontraumatic), and beneficiary status (military or civilian) were recorded for each surgical case. Results One thousand one hundred and eighty-four major amputations at 16 of the 49 military’s inpatient facilities were identified, with two MTFs accounting for 46% (548/1,184) of the total. Six MTFs performed 120 major amputations for the treatment of acute traumatic injuries. Seventy-three percent (87/120) of traumatic amputations were performed at MTF1, with the majority of patients (86%; 75/87) being civilians emergently transported there after injury. Orthopedic and vascular surgeons performed 78% of major amputations, but only 9.7% (152/1,570) of all military surgeons performed any major amputation, with only 3% (52) involved in amputations for trauma. Nearly all (87%; 26/30) of the orthopedic surgeons at MTF1 performed major amputations, including those for trauma. Conclusion This study highlights the importance of civilian patient care to increase major amputation surgical case volume and complexity to sustain critical wartime skills. The preservation and strategic expansion of effective military–civilian partnerships is essential for sustaining the knowledge and skills for optimal combat casualty care.

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Volume as an Indicator for Outcomes for Severe Maternal Morbidity in the Military Health System

Military Medicine ◽

10.1093/milmed/usab442 ◽

2021 ◽

Author(s):

Aimee Hunter ◽

Amanda Banaag ◽

Monica A Lutgendorf ◽

Col Barton Staat ◽

Tracey P Koehlmoos

Keyword(s):

Health System ◽

Maternal Morbidity ◽

Healthcare Systems ◽

Severe Maternal Morbidity ◽

Military Health System ◽

Case Volume ◽

Military Health ◽

Treatment Facilities ◽

The Military ◽

Military Treatment Facilities

ABSTRACT Background Maternal obstetric morbidity is a growing concern in the USA, where rates of maternal morbidity exceed Europe and most developed countries. Prior studies have found that obstetric case volume affects maternal morbidity, with low-volume facilities having higher rates of morbidity. However, these studies were done in civilian healthcare systems that are different from the Military Health System (MHS). This study evaluates whether obstetric case volume impacts severe maternal morbidity (SMM) in military hospitals located in the continental United States. Methods This cross-sectional study included all military treatment facilities (MTFs) (n = 35) that performed obstetric deliveries (n = 102,959) from October 2015 to September 2018. Data were collected from the MHS Data Repository and identified all deliveries for the study time period. Severe maternal morbidity was defined by the Centers for Disease Control. The 30-day readmission rates were also included in analysis. Military treatment facilities were separated into volume quartiles for analysis. Univariate logistic regressions were performed to determine the impact of MTF delivery volume on the probability of SMM and 30-day maternal readmissions. Results The results for all regression models indicate that the MTF delivery volume had no significant impact on the probability of SMM. With regard to 30-day maternal readmissions, using the upper middle quartile as the comparison group due to the largest number of deliveries, MTFs in the lower middle quartile and in the highest quartile had a statistically significant higher likelihood of 30-day maternal readmissions. Conclusion This study shows no difference in SMM rates in the MHS based on obstetric case volume. This is consistent with previous studies showing differences in MHS patient outcomes compared to civilian healthcare systems. The MHS is unique in that it provides families with universal healthcare coverage and access and provides care for approximately 40,000 deliveries annually. There may be unique lessons on volume and outcomes in the MHS that can be shared with healthcare planners and decision makers to improve care in the civilian setting.

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Psychotropic Medications and Opioids Prescribed to Cancer Patients in the Military Health System

PsycEXTRA Dataset ◽

10.1037/e512512018-001 ◽

2018 ◽

Author(s):

Diana D. Jeffery ◽

Laura Hopkins ◽

Harry B. Burke

Keyword(s):

Health System ◽

Cancer Patients ◽

Psychotropic Medications ◽

Military Health System ◽

Military Health ◽

The Military

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Assuring Force Readiness and Beneficiary Health Through Health Promotion and Preventive Medicine in the Military Health System

10.21236/ada346982 ◽

1998 ◽

Author(s):

Robin J. Tefft

Keyword(s):

Health Promotion ◽

Health System ◽

Preventive Medicine ◽

Military Health System ◽

Military Health ◽

The Military

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Curricular Change and Resiliency in the Era of Coronavirus (COVID-19): The Uniformed Services University of the Health Sciences (USU) Experience

Military Medicine ◽

10.1093/milmed/usaa491 ◽

2020 ◽

Author(s):

Arnyce R Pock ◽

Pamela M Williams ◽

Ashley M Maranich ◽

Ryan R Landoll ◽

Catherine T Witkop ◽

...

Keyword(s):

Health System ◽

Health Sciences ◽

Lessons Learned ◽

Organizational Response ◽

Educational Goals ◽

Military Health System ◽

Military Health ◽

Health Crisis ◽

Core Curricula ◽

The Military

ABSTRACT Introduction The Coronavirus (COVID-19) pandemic has presented a myriad of organizational and institutional challenges. The Uniformed Services University of the Health Sciences, like many other front line hospitals and clinics, encountered a myriad of challenges in fostering and sustaining the education of students enrolled at the nation’s only military medical school. Critical to the function of any academic medical institution, but particularly one devoted to the training of future physicians for the Military Health System, was the ability to rapidly adapt, modify, and create new means of keeping medical students engaged in their core curricula and progressing toward full and timely attainment of established educational goals and objectives. Methods This article highlights some of the particular challenges faced by faculty and students during the first 6 months of the COVID-19 pandemic and describes how they were managed and/or mitigated. Results Six key “lessons learned” were identified and summarized in this manuscript. These lessons may be applicable to other academic institutions both within and outside of the Military Health System. Conclusions Recognizing and embracing these key tenets of academic change management can accelerate the generation of a cohesive, organizational response to the next pandemic or public health crisis.

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Comparison of Nurse-Midwife and Physician Birth Outcomes in the Military Health System

Policy Politics & Nursing Practice ◽

10.1177/1527154421994071 ◽

2021 ◽

pp. 152715442199407

Author(s):

Lynette Hamlin ◽

Lindsay Grunwald ◽

Rodney X. Sturdivant ◽

Tracey P. Koehlmoos

Keyword(s):

Health System ◽

Birth Outcomes ◽

Health Care Systems ◽

Vaginal Birth ◽

Data Repository ◽

Military Health System ◽

Provider Type ◽

Pregnancy Risk ◽

Military Health ◽

The Military

The purpose of this study is to identify the socioeconomic and demographic characteristics of women cared for by Certified Nurse-Midwives (CNMs) versus physicians in the Military Health System (MHS) and compare birth outcomes between provider types. The MHS is one of America’s largest and most complex health care systems. Using the Military Health System Data Repository, this retrospective study examined TRICARE beneficiaries who gave birth during 2012–2014. Analysis included frequency of patients by perinatal services, descriptive statistics, and logistic regression analysis by provider type. To account for differences in patient and pregnancy risk, odds ratios were calculated for both high-risk and general risk population. There were 136,848 births from 2012 to 2014, and 30.8% were delivered by CNMs. Low-risk women whose births were attended by CNMs had lower odds of a cesarean birth, induction/augmentation of labor, complications of birth, postpartum hemorrhage, endometritis, and preterm birth and higher odds of a vaginal birth, vaginal birth after cesarean, and breastfeeding than women whose births were attended by physicians. These results have implications for the composition of the women’s health workforce. In the MHS, where CNMs work to the fullest scope of their authority, CNMs attended almost 4 times more births than our national average. An example to other U.S. systems and high-income countries, this study adds to the growing body of evidence demonstrating that when CNMs practice to the fullest extent of their education, they provide quality health outcomes to more women.

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