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  • 1
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    Online Resource
    The collaborative research and service delivery partnership between the United States healthcare system and the U.S. Military Health System during the COVID-19 pandemic
    Springer Science and Business Media LLC ; 2022
    In:  Health Research Policy and Systems Vol. 20, No. 1 ( 2022-12)
    Details
    In: Health Research Policy and Systems, Springer Science and Business Media LLC, Vol. 20, No. 1 ( 2022-12)
    Abstract: To examine the military-civilian collaborative efforts which addressed the unprecedented challenges of the COVID-19 pandemic, particularly in areas including provision of supplies, patient and provider support, and development and dissemination of new vaccine and drug candidates. Methods We examined peer reviewed and grey literature from September 2020 to June 2021 to describe the relationship between the U.S. healthcare system and Military Health System (MHS). For analysis, we applied the World Health Organization framework for health systems, which consists of six building blocks. Results The strongest collaborative efforts occurred in areas of medicine and technology, human resources, and healthcare delivery, most notably in the MHS supplying providers, setting up treatment venues, and participating in development of vaccines and therapeutics. Highlighting that the MHS, with its centralized structure and ability to deploy assets rapidly, is an important contributor to the nation’s ability to provide a coordinated, large-scale response to health emergencies. Conclusions Continuing the relationship between the two health systems is vital to maintaining the nation’s capability to meet future health challenges.
    Type of Medium: Online Resource
    ISSN: 1478-4505
    URL: Article
    DOI: 10.1186/s12961-022-00885-4
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
    detail.hit.zdb_id: 2101196-5
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  • 2
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    Designing a knowledge translation tool for women’s health research in the U.S. Military Health System
    Springer Science and Business Media LLC ; 2023
    In:  Health Research Policy and Systems Vol. 21, No. 1 ( 2023-06-08)
    Details
    In: Health Research Policy and Systems, Springer Science and Business Media LLC, Vol. 21, No. 1 ( 2023-06-08)
    Abstract: Current United States Department of Defense (DoD) estimates indicate that women comprise 17% of the total active duty component. Despite this, the specific health needs of service women have often been neglected. The Center for Health Services Research (CHSR) at the Uniformed Services University (USU) has been working to create a portfolio of rapid research synthesis briefs on topics including, but not limited to reproductive health, infertility, pregnancy loss, and contraceptive use among active duty service women. The goal of these briefs is to condense and translate the existing research literature for a non-academic audience. The aim of this study is to evaluate the utility of the research briefs to inform decision making around service women’s health issues and impart an overall understanding of the current literature surrounding these topics to a non-academic audience. Methods Adopting a previously tested knowledge translation evaluation tool, we conducted a series of key informant interviews in July–August 2022 with decision makers in the Military Health System and the US DoD to elicit feedback regarding the overall utility of the research brief, as well as its ability to meet standards of usefulness, usability, desirability, credibility, and value. Results We interviewed a total of 17 participants of a diverse range of healthcare occupations and educational backgrounds, but all currently were working within the Department of Defense in support of the Military Health System. User feedback on the research brief was thematically evaluated based on the predetermined themes of usefulness, desirability, credibility, value, and two emergent themes—findability and language. Conclusions This study allowed us to gather key insights from decision makers to better tailor future iterations of our research brief toward rapidly disseminating information for improving the healthcare and policy of active duty service women. The key themes ascertained from this study may help others when adapting their own knowledge translation tools.
    Type of Medium: Online Resource
    ISSN: 1478-4505
    URL: Article
    DOI: 10.1186/s12961-023-01002-9
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2023
    detail.hit.zdb_id: 2101196-5
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  • 3
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    Abstract P197: Heart Failure In A Universally Insured Working Age Population: The Military Community Experience
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Circulation Vol. 145, No. Suppl_1 ( 2022-03)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 145, No. Suppl_1 ( 2022-03)
    Abstract: Background: Heart disease is the leading cause of death in the United States (US) and deaths due to heart failure (HF) are increasing, while disparities are widening. The military community is pertinent to the study of the epidemiology of HF for several reasons: the 9.6 million individuals receiving care through the Military Health System (MHS) are representative of the working age US population and the MHS is the closest model to universal healthcare in the US. Hence, this environment is conducive to evaluate health disparities as access to care is uncoupled from race, sex, and ethnicity. Further, persons who serve have numerous risk factors (hypertension, smoking, PTSD, anxiety), HF is a leading cause of death among veterans and for those on active duty presents challenges to military readiness. Methods: We conducted a cross-sectional study of MHS beneficiaries aged 18 to 64 years to measure the prevalence of HF in 2018-19 overall and by sex, race, and other sociodemographic characteristics. HF was defined by International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes. Results: Among 6,375,086 MHS beneficiaries aged 18 to 64 years, 142,201 (2.23%) were diagnosed with HF. Beneficiaries with HF were mainly men (60%), age 50 to 59 (41%), retired from military service (52%), with a Senior Enlisted rank (proxy for lower socio-economic status based on salary) (79%) and serving in the US Army (39%). In logistic regression, male sex, older age, Black race, and lower rank were associated with higher relative odds of HF. After multivariable adjustment, Black race and lower rank were independently associated with large increases in prevalent HF (Table). Conclusion: Among MHS beneficiaries of working age, the prevalence of HF is high and substantial disparities exist. The large excess odds of HF among Black beneficiaries and among lower rank individuals underscores the urgent need to understand and address the determinants of these disparities.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.145.suppl_1.P197
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
    detail.hit.zdb_id: 1466401-X
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  • 4
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    Utilization and prescription patterns of phosphidiesterase-5 inhibitor medications in the United States military health system
    Springer Science and Business Media LLC ; 2018
    In:  International Journal of Impotence Research Vol. 30, No. 6 ( 2018-11), p. 300-305
    Details
    In: International Journal of Impotence Research, Springer Science and Business Media LLC, Vol. 30, No. 6 ( 2018-11), p. 300-305
    Type of Medium: Online Resource
    ISSN: 0955-9930 , 1476-5489
    URL: Article
    DOI: 10.1038/s41443-018-0037-3
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2018
    detail.hit.zdb_id: 1495676-7
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  • 5
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    Child immunization coverage in rural hard-to-reach areas of Bangladesh
    Elsevier BV ; 2010
    In:  Vaccine Vol. 28, No. 5 ( 2010-2), p. 1221-1225
    Details
    In: Vaccine, Elsevier BV, Vol. 28, No. 5 ( 2010-2), p. 1221-1225
    Type of Medium: Online Resource
    ISSN: 0264-410X
    URL: Article
    DOI: 10.1016/j.vaccine.2009.11.028
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2010
    detail.hit.zdb_id: 1468474-3
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  • 6
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    Implementation research evidence uptake and use for policy-making
    Springer Science and Business Media LLC ; 2012
    In:  Health Research Policy and Systems Vol. 10, No. 1 ( 2012-12)
    Details
    In: Health Research Policy and Systems, Springer Science and Business Media LLC, Vol. 10, No. 1 ( 2012-12)
    Abstract: A major obstacle to the progress of the Millennium Development Goals has been the inability of health systems in many low- and middle-income countries to effectively implement evidence-informed interventions. This article discusses the relationships between implementation research and knowledge translation and identifies the role of implementation research in the design and execution of evidence-informed policy. After a discussion of the benefits and synergies needed to translate implementation research into action, the article discusses how implementation research can be used along the entire continuum of the use of evidence to inform policy. It provides specific examples of the use of implementation research in national level programmes by looking at the scale up of zinc for the treatment of childhood diarrhoea in Bangladesh and the scaling up of malaria treatment in Burkina Faso. A number of tested strategies to support the transfer of implementation research results into policy-making are provided to help meet the standards that are increasingly expected from evidence-informed policy-making practices.
    Type of Medium: Online Resource
    ISSN: 1478-4505
    URL: Article
    DOI: 10.1186/1478-4505-10-20
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2012
    detail.hit.zdb_id: 2101196-5
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  • 7
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    In defense of Direct Care: Limiting access to military hospitals could worsen quality and safety
    Wiley ; 2022
    In:  Health Services Research Vol. 57, No. 4 ( 2022-08), p. 723-733
    Details
    In: Health Services Research, Wiley, Vol. 57, No. 4 ( 2022-08), p. 723-733
    Abstract: Ongoing health care reforms within the US Military Health System (MHS) are expected to shift 〉 1.9 million MHS beneficiaries from military treatment facilities (MTFs) into local civilian hospitals over the next 1–2 years. The objective of this study was to examine how such health care reforms are likely to affect the quality of MHS care. Data sources Adult MHS beneficiaries, aged 18–64 years, treated in MTFs (under a program known as Direct Care) were compared against (1) MHS beneficiaries treated in locally available civilian hospitals (under a program known as Purchased Care) and (2) similarly‐aged adult civilian patients across the United States. MHS beneficiaries in Direct and Purchased Care were identified from fiscal‐year 2016–2018 MHS inpatient claims. National inpatients were identified in the 2017 Nationwide Readmissions Database. Study design Retrospective cohort. Data collection Differences in quality were compared using two sets of quality metrics endorsed by the US Agency for Healthcare Research and Quality (AHRQ): Inpatient Quality Indicators, 19 quality metrics that look at differences in in‐hospital mortality, and Patient Safety Indicators, 18 quality metrics that look at differences in in‐hospital morbidity and adverse events. Among MHS beneficiaries (Direct and Purchased Care), we further simulated what changes in quality indicators might look like under various proposed scenarios of reduced access to Direct Care. Principal findings A total of 502,252 MHS admissions from 37 MTFs and surrounding civilian hospitals were included (326,076 Direct Care, 179,176 Purchased Care). Nationwide, 9.34 million adult admissions from 2453 hospitals were included. On average, MHS beneficiaries treated in MTFs experienced better inpatient quality and improved patient safety compared with MHS beneficiaries treated in locally available civilian hospitals (e.g., summary observed‐to‐expected ratio for medical mortality: 0.98 vs. 1.03, p   〈  0.001) and adult patients across the United States (0.98 vs. 1.02, p   〈  0.001). Simulations of proposed changes resulted in consistently worse outcomes for MHS patients, whether reducing MTF access by 10%, 20%, or 50% nationwide; limiting MTF access to active‐duty beneficiaries; or closing MTFs with the worst performance on patient safety ( p   〈  0.001 for overall quality indicators for each). Conclusions Reducing access to MTFs could result in significant harm to MHS patients. The results underscore the importance of health‐policy planning based on evidence‐based evaluation and the need to consider the consequential downstream effects caused by changes in access to care.
    Type of Medium: Online Resource
    ISSN: 0017-9124 , 1475-6773
    URL: Issue
    URL: Article
    DOI: 10.1111/hesr.v57.4
    DOI: 10.1111/1475-6773.13885
    Language: English
    Publisher: Wiley
    Publication Date: 2022
    detail.hit.zdb_id: 2078493-4
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  • 8
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    Changes in body mass index and behavioral health among adolescents in military families during the COVID-19 pandemic: a retrospective cohort study
    Springer Science and Business Media LLC ; 2023
    In:  BMC Public Health Vol. 23, No. 1 ( 2023-08-24)
    Details
    In: BMC Public Health, Springer Science and Business Media LLC, Vol. 23, No. 1 ( 2023-08-24)
    Abstract: Widely published findings from the COVID-19 pandemic show adverse effects on body mass index (BMI) and behavioral health in both adults and children, due to factors such as illness, job loss, and limited opportunity for physical and social activity. This study investigated whether these adverse effects were mitigated in adolescents from military families, who are universally insured with consistent access to healthcare, and who generally have at least one parent who must adhere to physical and mental fitness as a condition of employment. Methods We conducted a cohort study using two groups of adolescents receiving care in the U.S. Military Health System during the COVID-19 pandemic; one for changes in Body Mass Index (BMI) and the second for changes in behavioral health diagnoses, using TRICARE claims data. Beneficiaries (160,037) ages 13 to 15 years in fiscal years 2017–2018, were followed up during October 2020 to June 2021. Results Among the BMI cohort, 44.32% of underweight adolescents moved to healthy weight, 28.48% from overweight to obese, and 3.7% from healthy weight to underweight. Prevalence of behavioral disorders showed an overall 29.01% percent increase during the study period, which included in mood (86.75%) and anxiety (86.49%) disorders, suicide ideation (42.69%), and suicide attempts (77.23%). Decreases in percent change were observed in conduct disorders (-15.93%) and ADD/ADHD (-8.61%). Conclusions Adolescents in military families experienced adverse health outcomes during the pandemic at approximately the same rates as those in non-military families, suggesting that universal insurance and military culture were not significantly mitigating factors. Obesity and underweight present significant opportunities to intervene in areas such as exercise and food access. Decreased conduct disorders and ADD/ADHD may reflect lower prevalence due to favorable home environment, or lower rates of diagnosis and referral; however, increased rates of anxiety, mood disorders, suicide ideation and attempt are especially concerning. Care should be taken to ensure that adolescents receive consistent opportunity for physical activity and social interaction, and those at risk for suicide should receive active monitoring and appropriate referral to behavioral healthcare providers.
    Type of Medium: Online Resource
    ISSN: 1471-2458
    URL: Article
    DOI: 10.1186/s12889-023-16548-0
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2023
    detail.hit.zdb_id: 2041338-5
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  • 9
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    Distribution of chronic disease mortality and deterioration in household socioeconomic status in rural Bangladesh: an analysis over a 24-year period
    Oxford University Press (OUP) ; 2015
    In:  International Journal of Epidemiology Vol. 44, No. 6 ( 2015-12), p. 1917-1926
    Details
    In: International Journal of Epidemiology, Oxford University Press (OUP), Vol. 44, No. 6 ( 2015-12), p. 1917-1926
    Type of Medium: Online Resource
    ISSN: 0300-5771 , 1464-3685
    URL: Article
    DOI: 10.1093/ije/dyv197
    RVK:
    XF 4100
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2015
    detail.hit.zdb_id: 1494592-7
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  • 10
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    Intrepid Spirit Centers: Considerations for Active Duty, National Guard, Reserves, and Retirees
    Oxford University Press (OUP) ; 2023
    In:  Military Medicine Vol. 188, No. 7-8 ( 2023-07-22), p. e1534-e1539
    Details
    In: Military Medicine, Oxford University Press (OUP), Vol. 188, No. 7-8 ( 2023-07-22), p. e1534-e1539
    Abstract: Traumatic brain injury (TBI) is a significant concern to the military health system (MHS) and a signature wound of America’s current conflict. To address the influx of patients with military-related TBI, the Department of Defense has partnered with the Fisher Foundation and the Intrepid Fallen Heroes Fund to establish the National Intrepid Center of Excellence and satellite network of Intrepid Spirit Centers. The purpose of this study is to review the prevalence of disease and geographic density of TBI among active duty, National Guard, reservist, and retired military populations in order to inform decision-making around the development of additional Intrepid Spirit Centers. Methods We used the MHS Data Repository to perform a cross-sectional examination to assess the prevalence of TBI among active duty, National Guard, reservist, and retired military personnel from fiscal years (FY) 2016 to 2019. Statistical analyses included descriptive statistics on patient demographics and the prevalence of TBI. Results We identified a total of 3,221,682 active duty, National Guard, reservists, and retired military personnel in the U.S. Army, Air Force, Navy, and Marine Corps during FY 2016 to 2019; 59.5% were active duty personnel, 23.1% were Retirees, and 17.4% were National Guard and reservists. A total of 72,002 were found to have a TBI-related diagnosis. Texas, North Carolina, and California had the highest case counts for TBI. High prevalence of TBI was found in Bexar County, TX, Muscogee County, GA, Okaloosa County, FL, San Diego County, CA, and Virginia Beach City, VA. Conclusions Additional Intrepid Spirit Centers are warranted to better meet the needs of active duty, active and inactive National Guard and reservists, and retired military personnel in locations including San Antonio, TX, and Columbus, GA. These locations currently have the medical infrastructure necessary to facilitate the care of wounded warriors and return to duty ensuring the health of the Nation’s fighting force and veterans.
    Type of Medium: Online Resource
    ISSN: 0026-4075 , 1930-613X
    URL: Article
    DOI: 10.1093/milmed/usac051
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2023
    detail.hit.zdb_id: 2130577-8
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