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

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.

scholarly journals Extending Peer Support Across the Military Health System to Decrease Clinician Burnout

2020 ◽  
Author(s):  
Erin A Keyser ◽  
Larissa F Weir ◽  
Michelle M Valdez ◽  
James K Aden ◽  
Renée I Matos
Keyword(s):  
Health System ◽  
Peer Support ◽  
Improve Patient Safety ◽  
Military Hospital ◽  
Military Health System ◽  
Patient Death ◽  
Provider Type ◽  
Military Health ◽  
High Staff Turnover ◽  
The Military

Abstract Introduction Clinician burnout is widespread throughout medicine, affecting professionalism, communication, and increases the risk of medical errors, thus impacting safe quality patient care. Previous studies have shown Peer Support Programs (PSPs) promote workforce wellness by supporting clinicians during times of heightened stress and vulnerability. Although these programs have been implemented in large institutions, they have not been used in military hospitals, which have high staff turnover and added stressors of deployments. Materials and Methods In December 2018, 50 physicians received 5 hours of PSP training at a military hospital from a nationally recognized PSP expert, following the programmatic structure described by Shapiro and Galowitz (2016). Utilization of the program was tracked from December 2018 to December 2019, recording only classification of provider type, triggering event, and provider specialty to maintain confidentiality. Qualitative comments from recipients and supporters were saved anonymously for quality improvement purposes. Results In the first year of our PSP, 254 clinicians (102 [40.2%] residents/fellows, 91 [35.8%] staff physicians, 4 [1.6%] medical students, 35 [13.8%] nurses, 22 [8.7%] allied health) received 1:1 peer support. Primary specialties utilizing peer support included 135 (52.9%) medical, 59 (23.2%) surgical, 43 (16.9%) obstetric, and 18 (7.1%) pediatric. Patient death (25%), risk management notification (22%), medical error/complication (15%), and poor patient outcome (13%) were the most common events triggering peer support. Peer support was provided at 8 locations across the continental United States with universally positive comments from recipients. Conclusions Implementation of a PSP at our institution led to rapid utilization across multiple hospitals in the military health system, a model that could easily expand to deployed settings and remote locations. Access to peer support across the military health system could both mitigate the increased risks of military clinician burnout, and improve patient safety, healthcare worker resilience, and service member readiness.

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

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.

scholarly journals 775. The Burden of Arboviral Infection in the Military Health System, 2011-2019

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S432-S432
Author(s):  
Trevor Wellington ◽  
Jamie Fraser ◽  
Patrick Hickey ◽  
David Lindholm
Keyword(s):  
Health System ◽  
Health Knowledge ◽  
Armed Forces ◽  
Direct Care ◽  
Data Repository ◽  
Military Health System ◽  
Case Definitions ◽  
Military Health ◽  
Icd Codes ◽  
The Military

Abstract Background Travel-related arboviral infections are important preventable, emerging infectious diseases, with an estimated annual global toll of US$950 million. We investigated the burden of arboviral infections in the military health system (MHS). Methods KAPOS (Deployment and Travel Health: Knowledge, Attitudes, Practices, and Outcomes Study) is a multi-cohort study evaluating the burden of travel-associated diseases in the MHS. The MHS Data Repository was searched for International Classification of Diseases (ICD)-9/10 codes for arboviral infection in military beneficiaries receiving care in military treatment facilities (direct care) or civilian centers (purchased care) for fiscal years 2011-2019. Diagnostic codes were classified as Dengue, Chikungunya, Zika, or other arboviral infection. 755 outpatient charts in the direct-care system were randomly selected for diagnostic validation using Armed Forces Health Surveillance Center case definitions, and review of travel history, medical comorbidities, and pre-travel counseling. Results 11,066 unique-patient ICD codes for arboviral infections were identified; 6356 (57.4%) were direct care; 4710 (42.6%) were purchased care; 889 (8.0%) were inpatient. Median age was 31 years; 5110 (46.2%) were active duty. The most frequent ICD codes for arboviral infection were Japanese encephalitis virus (JEV) (n=4483), dengue (DENV) (n=1786), yellow fever (YF) (n=230), Zika virus (ZIKV) (n=217), West Nile virus (WNV) (n=171), and chikungunya virus (CHIKV) (n=91). DENV codes were confirmed in 166/249 (66.7%) charts; CHIKV in 23/41 (56.1%), and ZIKV in 15/129 (11.6%). No cases of JEV were confirmed in 171 encounters; all codes referred to JEV vaccine administration. 173/204 (84.8%) of confirmed arboviral cases did not undergo pre-travel counseling. Conclusion Arboviral infections constitute a substantial burden of preventable infections within the MHS. Dengue contributed the largest burden of arboviral infection when corrected for accuracy. Coding for ZIKV and JEV likely overestimated the burden of these diseases in the MHS. Low rates of pre-travel counseling among patients with confirmed, non-endemic arboviral infections represent an opportunity for increased emphasis on travel counseling and insect-avoidance precautions. Disclosures All Authors: No reported disclosures

scholarly journals Common Symptoms of Mild Traumatic Brain Injury and Work Functioning of Active-Duty Service Members with a History of Deployment

2021 ◽  
Vol 18 (15) ◽  
pp. 8079
Author(s):  
Patrick Richard ◽  
Nilam Patel ◽  
Daniel Gedeon ◽  
Regine Hyppolite ◽  
Mustafa Younis
Keyword(s):  
Health System ◽  
Brain Injuries ◽  
Active Duty ◽  
Emergency Department Visits ◽  
Service Members ◽  
Data Repository ◽  
Work Functioning ◽  
Military Health System ◽  
Military Health ◽  
The Military

This study used data from the Military Health System Data Repository to examine the association between mild traumatic brain injuries (mTBI) and work functioning such as work duty limitations, hospital emergency room visits and inpatient admissions for active-duty service members (ADSMs). Further, this study assessed the role that common symptoms of mTBI play in work functioning. Multivariate results showed that having a mTBI diagnosis is not a major factor that results in being “released with work duty limitations”. However, findings from these regression models also showed that the interaction of mTBI with cognitive and linguistic symptoms resulted in odds of 3.63 (CI: 1.40–9.36, p < 0.01) for being “released with work duty limitations” and odds of 4.98 (CI: 1.16–21.39, p < 0.05) for having any emergency department visits compared to those with no diagnosis of mTBI and none of these symptoms. Additionally, the interaction of mTBI with sleep disturbance and chronic pain showed odds of 2.72 (CI: 1.31–5.65, p < 0.01) and odds of 11.56 (CI: 2.65–50.44, p < 0.01) for being “released with work duty limitations” compared to those with no diagnosis of TBI and none of these symptoms, respectively. Further research is needed to investigate the association between mTBI and duration of time off work to provide a comprehensive understanding of the effect of mTBI on work functioning in the Military Health System.

scholarly journals Variation in Bariatric Surgery Costs and Complication Rates in the Military Health System

2019 ◽  
Vol 185 (7-8) ◽  
pp. e1057-e1064
Author(s):  
William Patrick Luan ◽  
Todd C Leroux ◽  
Cara Olsen ◽  
Douglas Robb ◽  
Jonathan S Skinner ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Quality Improvement ◽  
Health System ◽  
Logistic Models ◽  
Data Repository ◽  
Complication Rates ◽  
Military Health System ◽  
Surgical Quality ◽  
Military Health ◽  
The Military

Abstract Introduction: Within the Military Health System (MHS), facilities have struggled to meet minimum recommended volume thresholds for certain procedures. Understanding variations in complication rates and cost can help policymakers tailor policy to target improvement. Our objective was to quantify the variation in bariatric surgery complication rates and costs across a sample of military hospitals. Materials and Methods: We study a retrospective cohort of 38 military surgeons practicing in 21 military treatment facilities from 2007 to 2014 who performed 1,277 bariatric surgeries. Data from the Centralized Credentials and Quality Assurance System, which provides education and training characteristics of physicians, were linked to patient encounter data from the MHS Data Repository. Physicians were included if they performed at least five bariatric surgeries over the study period. Patients were included if they had a diagnosis of obesity (body mass index &gt; 30) and underwent a bariatric weight loss surgery. We calculated and summarized inpatient costs and complication rates across both surgeons and facilities using multivariable mixed-effects linear or logistic models. We used these models to calculate adjusted complication rates and average costs across both providers and hospitals to characterize variation in bariatric outcomes within the MHS. This study was considered exempt by the Uniformed Services University Institutional Review Board. Results: We find evidence of large variations in both complication rates and costs per admission. Overall, we found a 15.5% complication rate across the sample. When comparing averages across facilities, we find large variation in complications (49.4% coefficient of variation [CV]) and procedure costs (25.9% CV). Controlling for patient comorbidities, BMI, and year attenuates much of the variation (12.6% CV complications, 4.4% CV cost), but cannot completely explain differences across facilities. Our model suggests that complications cost 32% more than complication-free surgeries on average suggesting that quality improvement efforts could potentially yield large savings. Conclusions: We find large variations in complication rates even after controlling for patient health. Furthermore, surgical complications are a significant determinant of cost. Policymakers should target efforts to improve surgical quality across facilities and physicians. Surgical quality improvement initiatives could produce savings to the MHS through reduced complications and improved surgical readiness.

scholarly journals Early Childhood Outcomes Among Infants Born by Vaginal Birth After Cesarean and Repeat Cesarean Delivery in the Military Health System

2020 ◽  
Author(s):  
Jacqueline Kikuchi ◽  
Anju Ranjit ◽  
Wei Jiang ◽  
Catherine Witkop ◽  
Lynette Hamlin ◽  
...  
Keyword(s):  
Early Childhood ◽  
Cesarean Section ◽  
Health System ◽  
Otitis Media ◽  
Vaginal Birth ◽  
Military Health System ◽  
Vaginal Birth After Cesarean ◽  
Military Health ◽  
Repeat Cesarean Section ◽  
The Military

ABSTRACT Objective This study examines whether children delivered by repeat cesarean section experience higher incidences of otitis media, respiratory infections, and allergic diseases than children delivered by vaginal birth after cesarean section (VBAC) in the Military Health System. Study Design This is a retrospective cohort study from the Military Health System Data Repository of women who underwent repeat cesarean section or VBAC between 2006 and 2012 and their offspring through 2014. Results About 11,659 infants with 2 years of follow-up were identified. Infants delivered by VBAC had lower odds of developing respiratory illness (P &lt; .000), otitis media (P &lt; .001), and allergies (P = .022) compared with infants born by repeat cesarean section. There were no differences in the development of food allergies. Conclusion Emerging data regarding early childhood health are additional factors that can influence the mother’s decision on mode of birth after a primary cesarean section.

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

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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