The Impact of Having a Child With Special Healthcare Needs on Length of Military Service

ABSTRACT Introduction In 2010, the National Survey of Children with Special Healthcare Needs revealed that parents of children with special healthcare needs (CSHCN) report employment decisions are influenced by healthcare coverage needs. The U.S. military healthcare system arguably offers service member parents of CSHCN with the most comprehensive, inexpensive, long-term healthcare in the country—potentially increasing their incentive to remain in the military. This study explored the effect of having a CSHCN on the length of parental military service. Materials and Methods A retrospective cohort was formed using the Military Health System database from 2008 to 2018. Included children were <10 years in 2010 and received ≥1 year of military healthcare between 2008 and 2010. The Pediatric Medical Complexity Algorithm categorized children as having special healthcare needs via ICD 9/10 codes as having complex chronic (C-CD), non-complex chronic (NC-CD), or no chronic disease (CD). Families were classified by the child with the most complex healthcare need. Duration of military healthcare eligibility measured parental length of service (LOS). ANOVA and linear regression analysis compared LOS by category. Logistic regression determined odds of parental LOS lasting the full 8-year study length. Adjusted analyses controlled for child age and sex, and military parent sex, rank, and marital status. Results Over 1.45 million children in 915,584 families were categorized as per the algorithm. Of individual children included, 292,050 (20.1%) were CSHCN including those with complex chronic and non-complex chronic conditions. After grouping by family, 80,909 (8.8%) families had a child/children with C-CD (mean LOS 6.39 years), 170,787 (18.7%) families had a child/children with NC-CD (mean LOS 6.41 years), and 663,888 (72.5%) families had children with no CD (mean LOS 5.7 years). In adjusted analysis, parents of children with C-CD and NC-CD served 0.4 [0.37-0.42] and 0.33 [0.31-0.34] years longer than parents of children with no CD; odds of parents serving for the full study period were increased 33% (1.33 [1.31-1.36]) in families of children with C-CD and 27% (1.27 [1.26-1.29]) in families of children with NC-CD. Conclusions Findings indicate that military parents of CSHCN serve longer military careers than parents of children with no chronic conditions. Continued provision of free, high-quality healthcare coverage for dependent children may be important for service member retention. Retaining trained and experienced service members is key to ensuring a ready and lethal U.S. military.

Download Full-text

An Analysis of International Military Health Systems Using the Military Medical Corps Worldwide Almanac

Military Medicine ◽

10.1093/milmed/usaa376 ◽

2020 ◽

Author(s):

Ryan M Leone ◽

Zenobia Homan ◽

Antonin Lelong ◽

Lutz Bandekow ◽

Martin Bricknell

Keyword(s):

Health Systems ◽

Organizational Structures ◽

Healthcare Systems ◽

Medical Community ◽

Medical Services ◽

Medical Systems ◽

Military Health ◽

Military Healthcare ◽

The Military

Abstract Introduction A number of organizations publish comparisons of civilian health systems between countries. However, the authors were unable to find a global, systematic, and contemporary analysis of military healthcare systems. Although many databases exist for comparing national healthcare systems, the only such compilation of information for military medical systems is the Military Medical Almanac. A thorough review of the Almanac was conducted to understand the quality of information provided in each country’s profile and to develop a framework for comparing between countries. This information is valuable because it can facilitate collaboration and lesson sharing between nations while providing a structured source of information about a nation’s military medical capabilities for internal use. Materials and Methods Each of the 142 profiles (submitted by 132 countries) published in the Almanac were reviewed. The information provided was extracted and aggregated into a spreadsheet that covered the broader categories of country background, force demographics, beneficiary populations, administration and oversight, physical structures and capabilities, research capabilities, and culture and artifacts. An initial sample of 20 countries was evaluated to test these categories and their subsections before the rest of the submissions were reviewed. Clear definitions were revised and established for each of the 69 subcategories. Qualitative and quantitative data were compiled in the spreadsheet to enable comparisons between entries. Results Significant variation was found in how information was presented in country profiles and to what extent this was comparable between submissions. The most consistently provided information was in the country background, where the categories ranged from 90.15% to 100% completion across submissions. There was inconsistency in reporting of the numbers and types of healthcare workers employed within military medical services. Nearly 25% of nations reported providing medical care to family members of service members, but retirees, veterans, reservists, and law enforcement personnel were also mentioned. Some countries described organizational structures, military medical education institutions, and humanitarian operations. A few reported military medical research capabilities, though each research domain was present in 25% or less of all submissions. Interestingly, cultural identities such as emblems were present in nearly 90% of profiles, with many countries also having badges, symbols, and mottos. Conclusions The Military Medical Almanac is potentially a highly valuable collection of publicly available baseline information on military medical services across the world. However, the quality of this collection is highly dependent on the submission provided by each country. It is recommended that the template for collecting information on each health system be refined, alongside an effort to increase awareness of the value of the Almanac as an opportunity to raise the international profile of each country’s military medical system. This will ensure that the Almanac can better serve the international military medical community.

Download Full-text

Optimizing the Impact of Pragmatic Clinical Trials for Veteran and Military Populations: Lessons From the Pain Management Collaboratory

Military Medicine ◽

10.1093/milmed/usab458 ◽

2021 ◽

Author(s):

Joseph Ali ◽

Margaret Antonelli ◽

Lori Bastian ◽

William Becker ◽

Cynthia A Brandt ◽

...

Keyword(s):

Clinical Trials ◽

Pain Management ◽

Pragmatic Trial ◽

Dissemination And Implementation ◽

Large Network ◽

Military Health ◽

Healthcare Needs ◽

Unmet Healthcare Needs ◽

Pragmatic Clinical Trials ◽

The Impact

ABSTRACT Pragmatic clinical trials (PCTs) are well-suited to address unmet healthcare needs, such as those arising from the dual public health crises of chronic pain and opioid misuse, recently exacerbated by the COVID-19 pandemic. These overlapping epidemics have complex, multifactorial etiologies, and PCTs can be used to investigate the effectiveness of integrated therapies that are currently available but underused. Yet individual pragmatic studies can be limited in their reach because of existing structural and cultural barriers to dissemination and implementation. The National Institutes of Health, Department of Defense, and Department of Veterans Affairs formed an interagency research partnership, the Pain Management Collaboratory. The partnership combines pragmatic trial design with collaborative tools and relationship building within a large network to advance the science and impact of nonpharmacological approaches and integrated models of care for the management of pain and common co-occurring conditions. The Pain Management Collaboratory team supports 11 large-scale, multisite PCTs in veteran and military health systems with a focus on team science with the shared aim that the “whole is greater than the sum of the parts.” Herein, we describe this integrated approach and lessons learned, including incentivizing all parties; proactively offering frequent opportunities for problem-solving; engaging stakeholders during all stages of research; and navigating competing research priorities. We also articulate several specific strategies and their practical implications for advancing pain management in active clinical, “real-world,” settings.

Download Full-text

Diagnostic Evaluation of Hypoglycemia Due To an Insulinoma in a Deployed Infantryman: Significance of Neuroglycopenia and the Role of the Military Health System

Military Medicine ◽

10.1093/milmed/usab261 ◽

2021 ◽

Author(s):

Samuel T Olatunbosun ◽

Ayodeji F Alaketu ◽

Joseph H McDermott ◽

Al M Elsayed von Bayreuth

Keyword(s):

Health System ◽

Rare Condition ◽

Service Member ◽

Hyperinsulinemic Hypoglycemia ◽

Suspected Case ◽

Military Health System ◽

Military Population ◽

Military Health ◽

The Military

ABSTRACT Insulinoma, the prototype of endogenous hyperinsulinemic hypoglycemia, is a very rare condition, with an incidence of four cases per million person-years. Its rate of occurrence in the U.S. military population is unknown. Two cases of insulinomas involving active duty service members have been published. However, there has been no reported case of an insulinoma in a deployed service member. We report the case of a 21-year-old infantryman with clinical hypoglycemia of insidious onset, manifesting with overt neuroglycopenic symptoms during his deployment as a combatant soldier, and the ultimate diagnosis of an insulinoma as the underlying cause. The series of multiple clinical evaluations and the unique circumstances leading to the formal evaluation of the patient’s hypoglycemia and treatment are chronicled. The significance of neuroglycopenia and the diagnostic approach to any suspected case of hypoglycemia, the potential challenges and opportunities, and educational aspects of evaluation and management of the insulinoma are elaborated. The potential role of the Military Health System in facilitating the detection and treatment of this rare condition in the service member is discussed as well.

Download Full-text

Military Pain Medicine: Sustaining the Fighting Force

Military Medicine ◽

10.1093/milmed/usab419 ◽

2021 ◽

Author(s):

Scott Hughey ◽

Christopher Spevak ◽

Eric Stedje-Larsen

Keyword(s):

Military Service ◽

Force Structure ◽

Healthcare Workforce ◽

Structure Changes ◽

Military Service Members ◽

Military Healthcare ◽

The Usa ◽

The Military ◽

Pain Care ◽

Opioid Policy

ABSTRACT Active duty military service members (ADSMs) suffer disproportionately from chronic pain. In the USA, military pain physicians serve an important role in the treatment of pain conditions in addition to the maintenance of the fighting force. Expanding roles for pain physicians, including novel therapies, consulting roles for opioid policy, and usefulness in a deployed setting create enormous value for military pain physicians. Ongoing force structure changes, including proposed reduction in the U.S. Military’s healthcare workforce may significantly impact pain care and the health of the fighting forces. Military pain physicians support a variety of different roles in the military healthcare system. Ultimately, maintaining a robust faculty of pain physicians allows for both preservation of the fighting forces and a ready medical force.

Download Full-text

Mild Traumatic Brain Injury and Postconcussive Symptom Endorsement: A Parallel Comparison Between Two Nonclinical Cohorts

Military Medicine ◽

10.1093/milmed/usaa504 ◽

2020 ◽

Author(s):

R Elisabeth Cornwell ◽

Jorge I Arango ◽

C B Eagye ◽

Candace Hill-Pearson ◽

Karen Schwab ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Mild Traumatic Brain Injury ◽

Epidemiological Studies ◽

Emergency Department Visits ◽

Survey Study ◽

Military Health ◽

History Of ◽

The Military ◽

The Impact

ABSTRACT Introduction The prevalence of mild traumatic brain injury (mTBI) is commonly estimated based on indirect metrics such as emergency department visits and self-reporting tools. The study of postconcussive symptoms faces similar challenges because of their unspecific character and indistinct causality. In this article, we compare two nonclinical, epidemiological studies that addressed these two elements and were performed within a relatively narrow period in the state of Colorado. Materials and Methods De-identified datasets were obtained from a random digit-dialed survey study conducted by the Craig Hospital and a study surveying soldiers returning from deployment by Defense and Veteran Traumatic Brain Injury Center. Information pertinent to participants’ demographics, a history of mTBI, and symptom endorsement was extracted and homogenized in order to establish a parallel comparison between the populations of the two studies. Results From the 1,558 (Warrior Strong, 679; Craig Hospital, 879) records selected for analysis, 43% reported a history of at least one mTBI. The prevalence was significantly higher among individuals from the Defense and Veteran Traumatic Brain Injury Center study independent of gender or race. Repetitive injuries were reported by 15% of the total combined cohort and were more prevalent among males. Symptom endorsement was significantly higher in individuals with a positive history of mTBI, but over 80% of those with a negative history of mTBI endorsed at least one of the symptoms interrogated. Significant differences were observed between the military and the civilian populations in terms of the types and frequencies of the symptoms endorsed. Conclusions The prevalence of mTBI and associated symptoms identified in the two study populations is higher than that of previously reported. This suggests that not all individuals sustaining concussion seek medical care and highlights the limitations of using clinical reports to assess such estimates. The lack of appropriate mechanisms to determine symptom presence and causality remains a challenge. However, the differences observed in symptom reporting between cohorts raise questions about the nature of the symptoms, the impact on the quality of life for different individuals, and the effects on military health and force readiness.

Download Full-text

Military Service and Lifetime Arrests: Examining the Effects of the Total Military Experience on Arrests in a Sample of Prison Inmates

Criminal Justice Policy Review ◽

10.1177/0887403415619007 ◽

2015 ◽

Vol 29 (1) ◽

pp. 24-44 ◽

Cited By ~ 9

Author(s):

Erika J. Brooke ◽

Jacinta M. Gau

Keyword(s):

Criminal Justice ◽

Military Service ◽

Prison Inmates ◽

Civilian Life ◽

Military Experience ◽

Entry Length ◽

Life Trajectories ◽

Increased Risk ◽

The Military ◽

The Impact

Service in the military is an important event that may shape veterans’ life trajectories. Research has shown that military service is associated with increased risk of alcohol and substance abuse, mental illness, and antisocial behaviors, yet it remains unclear whether service places veterans at elevated risk of criminal justice involvement. In addition, most prior research treats military service as a dichotomous variable and does not consider the specific components of the military experience that might affect the impact that service has upon veterans. In the present study, a large sample of state prison inmates is utilized to test for the potential impact of military service, by itself, as well as age of entry, length of service, combat exposure, discharge type, and branch status on lifetime arrests. Results have implications for both military and criminal justice policies in ensuring that veterans have the assistance they need as they re-enter civilian life.

Download Full-text

Evaluating the Impact of Hospital Efficiency on Wellness in the Military Health System

Military Medicine ◽

10.7205/milmed-d-15-00309 ◽

2016 ◽

Vol 181 (8) ◽

pp. 827-834 ◽

Cited By ~ 5

Author(s):

Nathaniel D. Bastian ◽

Hyojung Kang ◽

Eric R. Swenson ◽

Lawrence V. Fulton ◽

Paul M. Griffin

Keyword(s):

Health System ◽

Hospital Efficiency ◽

Military Health System ◽

Military Health ◽

The Military ◽

The Impact

Download Full-text

A nature-based health intervention at a military healthcare center: a randomized, controlled, cross-over study

PeerJ ◽

10.7717/peerj.10519 ◽

2021 ◽

Vol 9 ◽

pp. e10519

Author(s):

Rezvan Ameli ◽

Perry Skeath ◽

Preetha A. Abraham ◽

Samin Panahi ◽

Josh B. Kazman ◽

...

Keyword(s):

Quantitative Research ◽

Well Being ◽

Present Moment ◽

Military Health ◽

Urban Road ◽

Medical Treatment Facility ◽

Military Healthcare ◽

Health Promoting ◽

Study Intervention ◽

The Impact

We describe a mixed qualitative and quantitative research study in a military facility regarding the role of nature in well-being. Study intervention included two 20-minute walks. One walk was in an intentionally designed woodland environment (Green Road) and the other was on a busy campus road in a medical treatment facility (Urban Road). Twelve volunteers from a military facility participated in both walks in a cross-over experimental design. The two walking sessions were randomly ordered and preceded by pre-walk instructions appropriate to each road’s characteristics and incorporated focused attention and present moment orientation. A semi-structured post-walk interview, the primary outcome, was conducted after the conclusion of each walk. Qualitative data analyses consisted of sentiments and themes by using NVivo 12 software. The Green Road was unanimously rated as positive (100%). Responses to Urban Road were evenly distributed among positive (33.3%), negative (33.3%), and neutral/mixed (33.3%) sentiments. The Green Road yielded predominantly positive themes such as enjoyment of nature, relaxation, and feelings of privacy and safety. Urban Road produced significantly more negative themes such as concerns for safety, dislike of noise and other noxious experiences. Quantitative assessment of distress and mindfulness with Distress Thermometer (DT) and Mindful Attention Awareness Scale-state version (MAAS) demonstrated that a walk on the Green Road significantly decreased distress and increased mindfulness compared to a walk on the Urban Road. We also observed that pre-walk instructions could direct attention to both obvious and subtle elements of experience and enhance awareness. Results support the notion that an intentional nature-based environment may produce significantly more positive experiences and result in health-promoting benefits in a military health-care setting compared to an urban environment. Future studies with clinical populations could advance our understanding of the healing value of nature-based interventions. The impact of intentional green environments may be enhanced by well-designed instructions for both recreational and therapeutic use.

Download Full-text

Relationship Between Body Mass Index and Diagnosis of Obesity in the Military Health System Active Duty Population

Military Medicine ◽

10.1093/milmed/usab292 ◽

2021 ◽

Author(s):

Daren Yang ◽

Alexis Beauvais ◽

Whitney L Forbes ◽

Darrick Beckman ◽

Jason Estes ◽

...

Keyword(s):

Body Mass Index ◽

Health System ◽

Body Mass ◽

Military Service ◽

Active Duty ◽

Service Members ◽

Data Repository ◽

Military Health System ◽

Military Health ◽

The Military

ABSTRACT Objective The overall rate of obesity is rising in the USA; this is also reflected in the military population. It is important that providers appropriately diagnose obesity and discuss treatment options with their patients. The purpose of this study was to investigate diagnosis of obesity compared to documented body mass index (BMI) in the military health system. Methods Institutional review board approval was obtained by the 59th Medical Wing (Lackland Air Force Base, Texas) as an exempt study. This study included active duty military service members aged 18-65 years who sought outpatient care at a military treatment facility from September 2013 to August 2018 with a weight within the range of 31.8-226.8 kg and height between 121.9 and 215.9 cm. Data were collected from the Clinical Data Repository vitals and M2 encounter data to determine the percentage of each sub-population with a diagnosis of obesity according to BMI (≥30 kg/m2) and International Classification of Diseases diagnosis codes. Results Using BMI, 19.2% of female and 26.8% of male service members can be diagnosed with obesity; however, only 42.2% and 35.1%, respectively, with a BMI ≥30 was diagnosed as such. This discrepancy was consistent among all service branches and BMI ranges. Conclusion This study demonstrates that obesity is underdiagnosed compared to BMI. This may result in insufficient resources being provided to patients to reduce weight. Further investigation is warranted to identify causes of underdiagnosis and potential barriers to diagnosis.

Download Full-text

The Relation of Surgical Volume to Competence: When Is Enough, Enough?

Military Medicine ◽

10.1093/milmed/usab356 ◽

2021 ◽

Author(s):

Mary Carnduff ◽

Ronald Place

Keyword(s):

Health Care ◽

Military Service ◽

Clinical Skill ◽

Military Medicine ◽

Surgical Care ◽

American Health Care System ◽

Military Health ◽

Process Improvements ◽

American Health Care ◽

The Military

ABSTRACT Given the inherent risk in surgical intervention and the need for the optimal utilization of health care resources, achieving high-quality surgical care is a priority for the American health care system, and competent surgeons are critical to reaching this goal. Despite the multifactorial nature of patient safety and satisfaction, surgeon competence is often oversimplified to an assessment of volume because of the ease of collection and comparison. In any practice model, the analysis of competence is complex, but the components of clinical skill for military surgeons further include multiple areas of expertise, which, although superficially unrelated to surgical currency, augment the overall care delivered by these clinicians. Thus, volume as a solitary indicator of skill excludes the unique circumstances encompassed in military service. In this paper, the factors comprising volume and competence are explained, as well as the additional factors unique to military medicine. Furthermore, process improvements are proposed for assessing and optimizing surgical competence in the Military Health System.

Download Full-text