Identifying Best Practices in Pharmacy Experience: An Analysis of Military Treatment Facilities With the Highest Pharmacy Patient Experience Scores

ABSTRACT Introduction Pharmacy patient experience within military treatment facilities (MTFs) is a significant indicator of healthcare quality, as hospital admissions correlate with medication use (Budnitz et al., 2006) and pharmacists have a unique opportunity to influence patients’ health (Dalton & Byrne, 2017). To improve patient care across the military health system (MHS), we investigated best practices within MTF pharmacies with the highest patient experience scores. Materials and Methods Researchers performed semi-structured telephone interviews with pharmacists, pharmacy technicians, and patient experience officers from three of the highest ranked MTF pharmacies according to outpatient satisfaction survey results to glean “best practice” approaches to patient care. Researchers utilized the Gioia approach as a guiding theory for qualitative analysis of the interview data, and the study was excluded from a requirement to obtain institutional review board approval due to the number of respondents in accordance with the Paperwork Reduction Act of 1980 guidelines. Results Interview participants from highly rated pharmacies emphasized the importance of communication among and between staff and patients, staff engagement and morale, and supportive leadership at their facilities for creating a positive patient experience and clinical environment. Conclusion These findings provide valuable insights to improve public health in military-connected populations through improved patient care practices in pharmacies across the MHS. Initiatives aimed at improving health care for pharmacy patients should prioritize improved communication and structural support for team members to create patient-friendly environments, which enables pharmacists and technicians to connect with patients and positively impact health outcomes. Limitations include lack of comparison data for lower performing pharmacies; future research will explore practices at lower ranking pharmacies to provide insights into communication practices, environments, and staff relationships impacting patient experience scores as well as the role patient demographics (e.g., retirees vs. active duty) and characteristics including facility size play in potential improvements.

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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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How Industry Alignment and Best Practices Can Improve Patient Care

Cardiovascular Digital Health Journal ◽

10.1016/j.cvdhj.2021.05.002 ◽

2021 ◽

Author(s):

Gary J. Shapiro

Keyword(s):

Best Practices ◽

Patient Care ◽

Improve Patient Care ◽

Improve Patient

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Procedural Volume Within Military Treatment Facilities—Implications for a Ready Medical Force

Military Medicine ◽

10.1093/milmed/usaa001 ◽

2020 ◽

Vol 185 (7-8) ◽

pp. e977-e981

Author(s):

Brandon M Carius ◽

Michael D April ◽

Steve G Schauer

Keyword(s):

Retrospective Analysis ◽

Central Venous Access ◽

Military Force ◽

Central Venous ◽

Data Set ◽

Military Health ◽

Procedural Volume ◽

Treatment Facilities ◽

The Military ◽

Military Treatment Facilities

Abstract Introduction Consistent procedural volume is important for emergency physicians (EPs) to maintain opportunities for critical lifesaving skills. While non-EP literature demonstrates improved patient outcomes with higher volumes, few studies examine the optimal number of repetitions needed to maintain procedural competency in EP populations. The largely young, healthy active duty population that constitutes the majority of patients in military treatment facilities (MTFs) decreases the likelihood to utilize emergent procedures. Despite this likelihood, EPs are expected to maintain proficiency and readiness to perform critical procedures in deployed settings. Materials and Methods A retrospective analysis of de-identified data obtained through the Military Health System Mart was performed for procedural codes involving surgical airway, central venous access, and intubation. Data were sought for 2014–2016 calendar years from seven Army hospitals under the Southwest Region Medical Command. Procedural numbers were obtained for both overall volume and those performed per 1,000 encounters. Additionally, we analyzed for volume differences with the highest volume MTF (Brooke Army Medical Center [BAMC]) removed from the data set. Results A total of 1,450 procedures were performed among the MTFs analyzed, including 973 intubations, 473 central venous catheter placements, and 4 surgical airways. MTFs averaged 69.5 intubations and 38.8 venous catheters placed each year, but decreased to 28.1 intubations and 13.0 venous catheters placed annually when BAMC was removed from the data set (a 59.6 and 61.6% decrease, respectively). Monthly averages of 40.5 intubations and 19.7 central venous catheterizations per month among all included MTFs decreased to 14.0 and 6.5 when BAMC was removed. All surgical airways were performed at BAMC. Procedural frequency per 1,000 encounters was highest at BAMC, although ordinal differences were noted in the remaining six MTFs compared with overall procedural volumes. Conclusions This retrospective analysis demonstrates a significant variation in procedural volumes across MTFs, illustrating disproportionate opportunities for procedural skill maintenance among Army EPs. Low procedural volume threatens the maintenance of critical EP skills. These numbers could also suggest low skills for other providers (such as physician assistants), further illustrating decreased skill readiness throughout the force. Further research is needed to examine procedural volumes per individual EP, as well as those performed by other providers to evaluate for overall procedural readiness across the military force.

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Patient Experience and Hospital Environment Measures at Military Treatment Facilities

Journal of Healthcare Management ◽

10.1097/jhm-d-20-00316 ◽

2022 ◽

Vol 67 (1) ◽

pp. 38-53

Author(s):

Amanda Grifka ◽

Joseph Dorris ◽

Kimberley Marshall-Aiyelawo ◽

Melissa Gliner ◽

Chantell Frazier

Keyword(s):

Patient Experience ◽

Hospital Environment ◽

Treatment Facilities ◽

Military Treatment Facilities

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Knowledge Translation in Nursing Through Decision Support at the Point of Care

Human, Social, and Organizational Aspects of Health Information Systems ◽

10.4018/978-1-59904-792-8.ch019 ◽

2010 ◽

pp. 314-330

Author(s):

Diane Doran ◽

Tammie Di Pietro

Keyword(s):

Decision Support ◽

Knowledge Translation ◽

Patient Care ◽

Real Time ◽

Patient Outcomes ◽

Health Professionals ◽

Clinical Decision Making ◽

Improve Patient Care ◽

Future Research ◽

Seeking Behavior

With advances in electronic health record systems and mobile computing technologies it is possible to re-conceptualize how health professionals access information and design appropriate decision-support systems to support quality patient care. This chapter uses the context of nursing-sensitive patient outcomes data collection to explore how technology can be used to increase nurses’ and other health professionals’ access to patient outcomes information in real time to continually improve patient care. The chapter draws upon literature related to: (1) case-based reasoning, (2) feedback, (3) and evidence-based nursing practice to provide the theoretical foundation for an electronic knowledge translation intervention that was developed and tested for usability. Directions for future research include the need to understand how nurses experience uncertainty in their practice, how this influences information seeking behavior, and how information resources can be designed to support real-time clinical decision making.

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