Mind the Gap Integrating Public Health and Health Care in a Military Population. Theresa Casey, DVM, MPH, ACVPM Brigadier General (ret), USAF
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1 Mind the Gap Integrating Public Health and Health Care in a Military Population Theresa Casey, DVM, MPH, ACVPM Brigadier General (ret), USAF 1
2 Overview Military necessity Organization supports integration Integration in clinical care Successes/consequences Integration in All Hazards incidents 2
3 Military Necessity Tactical/strategic impact of infectious disease Camp/personal sanitation Chronic disease Enlistment standards Mental health If you are careful of your men, and camp on hard ground, the army will be free from disease of every kind and this will spell victory. Infectious Chronic Behavioral
4 Military Public Health Integration critical to recruiting and maintaining a fit force WWII experience demonstrated clinical and preventive medicine must work in close coordination in establishing standards
5 Spanish-American War Dodge Commission Report, 1899 Civilian physicians unprepared to oversee camp sanitation Training/discipline essential in preserving health in garrison/field Military medicine/hygiene training is essential Preparation key, "In time of peace prepare for war Army medicine reorganized to improve medical care/preventive medicine
6 Organization/Governance Organization includes prevention/wellness Dedicated staffing assigned Vision, values, mission statement Governance and accountability 6
7 Organization Commander/CEO Quality/Credentials Patient Safety Chief Operations Officer Chief, Medical Staff Chief Nurse Executive Chief, Aerospace Medicine Medical Operations Dental Operations Aerospace Medicine Medical Support Operations Primary care Specialty care Behavioral health Family advocacy Substance abuse pv Primary care Specialty care Community health Individual wellness Occupational health Disease pv/control
8 Public Health Officers Bioenvironmental Engineers Medical Entomologists Social Workers Clinical Psychologists Dieticians Public Health Staffing
9 Integration from the Top
10
11 Stakeholders Report
12 Operation Re-Deployment Accession Deployment Prevention for Force Protection Duty Human Weapon System Life Cycle Vision Post-Deployment Operational Health & Surveillance Pre-Deployment Training Mental Health Family Support Health Education Retirement/ Separation & Beyond Career Health & Surveillance Health & Wellness Prevention for Force Enhancement & Peacetime Benefit Pilot Preventive Medicine Direct Care TRICARE
13 Integrated Prevention
14 Primary Prevention Community Food safety, vulnerability Environmental, workplace, community surveillance Vector surveillance/control No-smoking installations 14
15 Primary Prevention Individual Consequence-based fitness testing Health and Wellness Centers Family Advocacy parenting instruction/consultation 15
16 Integrated Prevention
17 Primary Immunizations Smoking cessation Secondary Pre-deployment assessments Occupational exams Disease screening Clinical practice guidelines Behavioral Health Optimization Tertiary Clinical practice guidelines Specialty care Clinical Prevention 17
18 VA/DoD CPGs Asthma Chronic Heart Failure Chronic Kidney Disease COPD Diabetes Mellitus Dyslipidemia Hypertension Ischemic Heart Disease Obesity and Overweight Tobacco Use Concussion-mTBI Lower Limb Amputation Stroke Rehabilitation Lower Back Pain Post-Operative Pain Bipolar Disorder in Adults Major Depressive Disorder Post Traumatic Stress Disorder Substance Use Disorder Suicide Risk Assessment/Mgt Opioid Therapy for Chronic Pain Lower Back Pain Post-Operative Pain Foster integration of evidence-based practice into VA/DoD initiatives related to health promotion, disease prevention and wellness initiatives
19 AF Medical Home AIR FORCE MEDICAL HOME Health Plan Mgmt (TOPA) Process Practice Variation (GPM) Decision Support & Knowledge Mgmt (IM/IT) Balance RSV Training (Readiness) Virtual Care QUALITY MEASURES PHYSICIAN led TEAM PATIENT Social Media PATIENT EXPERIENCE PATIENT EXPERIENE INFORMATION MANAGEMENT & TECHNOLOGY Our Foundation is the PCMH Healthcare Team Shift from Healthcare to Health in the AF Medical Home
20 Patient Activation What is Patient Activation? Broadly refers to an individual s ability to manage his or her health or healthcare Level 4 Level 3 Level 2 Level 1 Maintaining Behaviors Taking Action Building Knowledge & Confidence Starting To Take A Role Increasing Activation Patient Activation Measure (PAM) Developed by Dr. Judy Hibbard and colleagues 13 questions categorized under the four domains Sources: Building RAPPORT Through Teamwork And Patient Activation
21 Sure, but can you make him drink? Patient Activation
22 22 HEDIS Metrics
23 Successes Smoking among recruits Seat belt use is high Childhood immunizations high Responsible alcohol use but abuse persists HIV prevention and control
24 Unintended Consequences Submaximal cycle ergometry fitness testing Fitness testing abdominal circumference/taping 1½ mile run fitness criteria Occupational injury reporting incentives Influenza immunization rate incentives
25 e-health Transformation TIMELINE (FY) ACTIVITIES Tri-Service Workflow Feb 12: Training of LBP CPG in MTF's Apr 12; Deploy Metabolic Syndrome CPG Fall 12: Deploy Behavioral Health Workflow CarePoint and HSDW Jun: Launch CarePoint into Production Sep: Publish Hospital Dashboards Oct: AFRESS Available Future: Incorporate Other Apps Virtual Medical Center (VMC) Dec 11: Prioritized List of Future Virtual Clinics April 12: Ortho & Cardio Validation SGROC Dec 12: DVC; Full Op Capability (FOC) Mar 13: Ortho & Cardio FOC Secure Messaging/PHR Nov 11; Wave Deployment Began Jun 12: 26 MTFs Complete Apr 13: Deployment Complete iehr iehr Rolled Out in Capability Sets Phase 1 Phase 2 Capability Set 1 Set 2 Set 3 Set 4 Set
26 Social Networking Creates the Buzz to Make Messages Stick AF Medical Service Exploiting New Avenues of Communication 26
27
28 All Hazards Public Health Deploying member Pre-deployment screening Camp sanitation Immunizations/prophylaxis Mission requirements War versus humanitarian Tailor to event/population
29 Summary Military necessity Organization supports integration Integration in clinical care Successes/consequences Integration in All Hazards incidents
30 Questions
31 Genomics in Individual Health Family history current surrogate for genetic testing Improves prediction of disease Targets screening and prevention Genetic testing supplements, not supplants family history Improved disease management Rare diseases Cancer Point-of-care testing emerging Diagnostics Pharmacogenomics
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