Contracting out military health care

The military health care system is currently facing a critical provider supply versus patient demand imbalance. Contracting out health care through the Civilian Health and Medical Program of the Uniformed Services and the Primary Medical Care for the Uniformed Services programs is one approach that Army Medical Department leaders have taken to correct the problem. This article critically analyzes the success of this approach using data from an Army hospital in the eastern United States. The article concludes with three suggestions aimed at improving the current situation.     

Soldiers' experiences with military health care

Patient satisfaction can be enhanced by narrowing gaps between what health care consumers experience and what they expect. A study was therefore conducted to better understand health care experiences and expectations among Army beneficiaries. Data collected using focus groups were analyzed by using qualitative research methods. A concept was identified and labeled "Soldier Care." It involves first-line care delivered at the unit level as well as the interface between first-line care and military treatment facilities. There are four features of Soldier Care, i.e., provider competence, the sick call cycle, getting appointments, and unit leadership. Together, these features affect soldiers' time from injury to recovery. Insights about Soldier Care can provide decision-makers with direction for initiating changes that may contribute to improved soldier satisfaction with health care.     

Self-rated health and health care utilization after military deployments

Self-rated general health is one element of the standard health assessment required of U.S. military service members upon completion of major deployments. A cohort study of 22,229 male U.S. Army and Air Force personnel returning from Europe or Southwest Asia in 2000 used survival analysis methods and Cox proportional hazard models to examine postdeployment self-rated health (SRH) status and subsequent hospitalization, separation, and ambulatory care visits. Self-rated health was fair/poor for 1.5% and good for 20.4%; 11% documented at least one health concern. During 30,433 person-years of follow-up (median, 1.5 person-years), there were 22.8 hospitalizations per 1,000 person-years and 4.0 ambulatory care visits per person-years. After adjustment, deployers with fair/poor SRH had an increased risk for hospitalization (hazard ratio [HRI, 1.6; 95% confidence interval [CI], 1.0,2.7); the risk was lower for those with good SRH (HR, 1.3; 95% CI,1.1,1.5). Deployers with fair/poor SRH health had an increased risk for illness-related ambulatory care visits (HR, 1.8, 95%; CI, 1.6,2.1) and administrative visits (HR, 1.4; 95% CI, 1.1,1.7), but not injury-related visits (HR, 1.2; 95% CI, 0.8,1.7). Self-reported low health status and other health concerns identify military members with higher levels of health care needs following return from major deployments.     

Strategic planning for military occupational health care

OBJECTIVE: This article describes a framework and system for planning appropriate occupational health contributions to military manpower availability and operational capability, and auditing the complete and effectiveness of implementation. METHODS: Prepared through author-led consensus-seeking serial deliberations with occupational health experts over initial and consequential drafts of, latterly, a populated strategic planning framework based on key stages in a military career. Illustrative examples are provided from the author's experience and, along with referenced sources of further information, the scientific literature. RESULTS: The resulting framework facilitates timely management of occupational health risks to recruiting, retention, operational availability and capability, and the general well-being of military personnel. Monitoring and audit are integral to the activity to provide an evidence-based spiral of refinement of the plan and improvement of outcomes. CONCLUSIONS: Key stages of the military career may provide manageable challenge bites for planning with executive and health care colleagues to forecast and control occupational health risks to operational capability and thus contribute to achieving military objectives.     

Multiple-role dilemmas for military mental health care providers

Military psychologists and psychiatrists frequently face ethical quandaries involving boundary crossings, or extratherapy contact, and multiple relationships. A multiple relationship is defined as necessarily engaging psychotherapy patients in nonclinical roles, such as coworker, superior officer, neighbor, or friend. In contrast to their civilian counterparts, military mental health professionals must often engage patients in many different contexts and roles. In this article, we consider the distinctive features of mental health practice in the military and offer military providers several practice guidelines for avoiding harm to patients in military settings. This article is also designed to enhance sensitivity to multiple-role risks among nonpsychiatric providers.     

Physical activity and child health

Clinicians should direct greater attention to positive health, with particular reference to the role of physical activity, in optimising the well-being of a child. Vigorous physical activity slows maturation, particularly if there is associated energy imbalance or emotional stress, but it does not greatly affect body size. Well-designed exercise programmes enhance the immediate physical, psychomotor and intellectual attainments of a child. Long term health benefits depend on a continuation of the physical activity. Internal motivation and the creation of positive attitudes are thus important. Acute illness is not prevented by vigorous exercise, but it has a favourable effect on the course of many chronic diseases. There are certain risks, including physical injury, psychological stress, and (occasionally) cardiac deaths, but in general, an exercise regimen enhances well-being, favouring the balanced development of a child.     

An evaluation of prenatal care utilization in a military health care setting

An assessment of prenatal care and birth outcomes was performed for a sample of 7,599 births at a military hospital between 1982 and 1985. Prenatal care patterns were similar to a civilian Health Maintenance Organization study's. Less adequate levels of prenatal care were significantly associated with higher risks of neonatal mortality and low birth weight. Five independent risk factors for receiving less adequate care were identified by multivariate analysis: 1) young maternal age (less than age 20), 2) black race, 3) residence off post, 4) high risk combinations of age and parity, and 5) residence in low-income census tracts.     

我部干部保健改革探讨

2010年4月,我部干部保健体系改革,以持续提高保健工作质量为牵引,以“保健康就是保战斗力”为宗旨,建立“医院、保健办、保健科室”三级保健管理体系,搭建“一院三点,兼顾两所”保健架构,改组干部保健科,精选政治素质强、业务能力出色的业务骨干充实专职干部保健队伍,实施常态化轮岗、进修深造等培训手段,优化规范落实各项医疗保健制度,完善精细化动态管理手段,利用数据平台及移动医疗等技术手段,提高医疗保健服务信息化水平,搭建权威保健会诊网络平台,与各领域知名专家“无缝对接”,加强保健对象慢性病综合管理能力,对各种异常指标动态跟踪干预,提高恶性肿瘤早防、早治水平。创新发展改革举措效果明显,受到各级保健对象肯定。     

Quality assessment of primary health care in a military setting

PURPOSE: The aim of this study was to analyze the quality of primary care in Israeli Defense Forces primary care clinics and physicians (PCPs) and to test the hypotheses that: (1) the quality of primary care provided in battalions is higher than that provided by other primary care providers and (2) the evaluation of a specific PCP within the framework of the quality assessment program results in an improved score during a second evaluation. METHODS: Teams of two physicians carried out the control process. Each primary care clinic is evaluated in a standardized manner by filling a prospectively established form. Five parameters are examined: (1) direct inspection of the PCP, (2) medical record audit, (3) high-risk patients' management evaluation, (4) evaluation of secondary health care characteristics, and (5) medical staff guidance evaluation. The various clinics and physicians evaluated were classified as: battalion clinics, division and brigade clinics, training center clinics, and home-front clinics. RESULTS: Between the years 1999 and 2001, 149 primary care clinics and 250 PCPs were evaluated. Seventy-four PCPs (29.6%) were evaluated twice. Battalion clinics scored higher than the other clinics. PCPs evaluated twice had significantly better quality assessment results at the second encounter. CONCLUSIONS: Quality of primary health care is the highest in battalion troops clinics. We interpret the increase in quality assessment scores from one examination to the other as an index of improvement resulting from the feedback given to the providers.