Classification of Participants Into Two Health Resource Utilization Groups By the Health Enrollment Assessment Review (HEAR) Survey

The study examined the ability of the Health Enrollment Assessment Review (HEAR) survey instrument to classify participants into one of two groups according to utilization of health resources anticipated in the following year. Developed by the U.S. Air Force, the HEAR survey is used worldwide by the Department of Defense for enrollees in TRICARE Prime, the military\u27s adaptation of the HMO model of managed care. Individual HEAR reports are prepared for survey participants and their primary care providers in TRICARE Prime. Although it is currently administered worldwide to a majority of the 8.4 million health care beneficiaries of the Department of Defense, the developers expected the health resource utilization (HRU) measure scored from HEAR survey data to be validated in the future when suitable criterion data became available. This study estimated the reliability and validity of the original HRU model. Further, an alternate HRU model was derived with optimal use of the data available from the HEAR survey. The original HRU model was based on the Pareto principle, which states that “in any population that contributes to a common effect, a relative few of the contributors account for the bulk of the effect” (Juran, 1992, p. 57). Alternatively, it is sometimes stated as the 80/20 rule: 20% of the contributors account for about 80% of the common effect (Caldwell, 1994). The target population for the study was adult active duty family members continuously enrolled in TRICARE Prime in the Hampton Roads metropolitan area of Southeastern Virginia in 1997. The survey was mailed to a random sample that yielded 391 usable surveys. A Pareto analysis revealed that 21.2% of participants utilized 50.4% of the primary care visits. Attempting to identify those participants, the sensitivity (true positive rate) of the original HRU model was 25.3% and the specificity (true negative rate) was 90.9%. The reliability coefficient was .619 and the validity coefficient was .200. The sensitivity of the derived HRU model was 34.9% and the specificity rate was 84.1%. It had a reliability coefficient of .816 and a validity coefficient of .195. Neither model was deemed sufficient to classify members into utilization groups

Improving the Practice Model in a Military Clinic

Military members and their families face numerous stressors due to the unique lifestyle of this career (Lester, 2011). The occupational impact on these members creates a highly stressful and physically demanding environment with low morale, chronic medical complaints, and poor mental health for these individuals. This project incorporated the current patient-centered medical home (PCMH) model and fused it with the operational medical model for all the active duty members in this unit. The combination of models allowed the provider to have a better understanding of the population’s needs. By embedding in the units, the provider developed a team approach to disease prevention, health awareness, injury reduction, and allowed for better access to care. The team and leadership worked together and determined the needs of the population and developed a plan to meet those needs

Selecting a Health Care Option for Military Beneficiaries that Minimizes Health Care Costs While Maintaining Personal Desires for Choice

Tricare, the triservice, triple-option, managed care plan for the uniformed services, incorporates a managed care support contract to complement Military Treatment Facilities. Currently being implemented throughout the CONUS, Tricare provides more equitable health care service to all military beneficiaries, improved access to care, a reduction in health care costs, and provides beneficiaries with an expanded choice of medical-care providers. This thesis examines the Tricare program and reviews relevant health care literature, both military and civilian. Using these inputs, the author presents a deterministic decision analysis model that allows a military beneficiary to select a health care option that minimizes his or her annual out-of-pocket costs while maintaining personal desires for choice among health care providers. Using several carefully selected examples that span the pool of military beneficiaries, the results of this study are presented. Every individual faced with the Tricare decision, approximately six million people, will gain insight from this thesis. While individual impact may only be on a scale of thousands of dollars, the impact for the entire pool of beneficiaries ranges well into the millions

A Study of the Factors That Impact Female Military Beneficiaries Obtaining Preventive Health Services

The purpose of this study was to determine what factors predict whether female military retirees or the female beneficiary of a military retiree, ages 40 to 64, will obtain preventive health services, specifically, Pap smears, mammograms, and clinical breast examinations. Based on the findings of the study, it is suggested that it may be important for the Department of Defense to broaden their scope of interest to include those areas that are most prominent in affecting female military retirees or the female beneficiary of a military retiree, particularly those 40 to 64, in obtaining preventive health services. The study comprised of 8252 female, military health system beneficiaries who were retired or the female beneficiary of a retiree, 40 to 64 years of age. The 1998 Health Care Survey of Department of Defense Beneficiaries was the instrument used for this study. The theoretical framework was an adaptation of Aday and Andersen\u27s (1975), Aday, Fleming and Andersen\u27s (1984) and Aday et al\u27s (1998) models known as the framework for the study of access to medical care and the framework for classifying topics and issues in health services research. Multiple regression analyses were conducted on twenty-seven hypotheses. The results from the analyses of the individual components of the model proved that women who have less difficulty getting necessary care and less difficulty caused by delays in health care while waiting for approval will obtain the three preventive health services. Further, being enrolled in TRICARE significantly impacted the women\u27s ability to obtain a Pap smear and a mammogram. Age, race, and the retiree\u27s rank are additional contributors to a woman obtaining a Pap smear and a clinical breast examination. In analysis of enabling factors, level of education, income, having supplemental insurance, utilizing TRICARE Prime or other civilian insurance/HMO, and never traveling more than 30 minutes to the primary care manager\u27s facility were found to be significant to a women obtaining the three preventive health services. Factors such as feeling downhearted and blue, having a lot of energy and a general perception of overall health were significant to the women obtaining the preventive health services. Waiting longer for an appointment with a civilian provider, in addition to satisfaction with the military health care system and overall satisfaction were significant to a woman obtaining all three preventive health services. Lastly, women who smoke were found to be less likely to obtain the three preventive health services. Multiple regression analyses were performed to determine whether the full model predicts the subjects\u27 ability to obtain the preventive health services. In two of the cases, Pap smear (F (41, 194) = 1.71, p \u3c .05) and mammogram (F (41, 194) = 1.68, p \u3c .05), the overall regression was statistically significant beyond the .05 level. Therefore, the assumption that the model of access to preventive health services will predict the likelihood of female military retirees or the female beneficiary of a military retiree to obtain preventive services is only partially supported

Manager Onboarding to Improve Knowledge and Confidence to Lead

Background: Primary care (PC) is increasingly the setting for affordable, coordinated, end-to-end patient care, with PC managers in charge of organizational performance. While PC managers are central to high-functioning teams, they often receive inadequate onboarding. Local Problem: Primary care onboarding competes with other operational priorities and faces time constraints, lack of mentorship, and cost. Context: At an integrated healthcare system, a need was identified to develop structured, role-specific onboarding for newly hired PC managers to improve knowledge and confidence to lead. Interventions: Bauer’s Four Cs framework for onboarding guided the development of a manager onboarding program for 12 new PC managers. Content drew on best practices from the literature and was informed by the knowledge gap discovered through a needs assessment. Outcome Measures: Knowledge, confidence to lead, and intent to stay were chosen to assess the impact of onboarding on the competencies of new PC managers to be successful in their roles. The metrics were percent change from pre- to post-implementation. Data to evaluate outcomes were obtained from the pre- and post-intervention surveys. Results: Confidence to lead increased 13% (t(21) = 2.33, p = .03); knowledge increased 29% ((t(21) = 2.94, p = .01). Intent to stay in the role did not show a significant increase. Conclusions: Evidence from the literature and the project results suggest strong connections between structured onboarding practices for new managers and preparedness to lead high-functioning teams. Empirical research is needed to examine the implications of onboarding relative to hire date on intent to stay in the role

An Intervention Program to Reduce Medication-Related Problems Among Polymedicated Home-Dwelling Older Adults (OptiMed): Protocol for a Pre-Post, Multisite, Pilot, and Feasibility Study.

BACKGROUND Effective medication management is one of the essential preconditions for enabling polymedicated home-dwelling older adults with multiple chronic conditions to remain at home and preserve their quality of life and autonomy. Lack of effective medication management predisposes older adults to medication-related problems (MRPs) and adverse health outcomes, which can lead to the degradation of a patient's acute clinical condition, physical and cognitive decline, exacerbation of chronic medical conditions, and avoidable health care costs. Nonetheless, it has been shown that MRPs can be prevented or reduced by using well-coordinated, patient-centered, interprofessional primary care interventions. OBJECTIVE This study aimed to explore the feasibility and acceptability of an evidence-based, multicomponent, interprofessional intervention program supported by informal caregivers to decrease MRPs among polymedicated home-dwelling older adults with multiple chronic conditions. METHODS This quasi-experimental, pre-post, multisite pilot, and feasibility study will use an open-label design, with participants knowing the study's objectives and relevant information, and it will take place in primary health care settings in Portugal and Switzerland. The research population will comprise 30 polymedicated, home-dwelling adults, aged ≥65 years at risk of MRPs and receiving community-based health care, along with their informal caregivers and health care professionals. RESULTS Before a projected full-scale study, this pilot and feasibility study will focus on recruiting and ensuring the active collaboration of its participants and on the feasibility of expanding this evidence-based, multicomponent, interprofessional intervention program throughout both study regions. This study will also be essential to projected follow-up research programs on informal caregivers' multiple roles, enhancing their coordination tasks and their own needs. Results are expected at the end of 2024. CONCLUSIONS Designing, establishing, and exploring the feasibility and acceptability of an intervention program to reduce the risks of MRPs among home-dwelling older adults is an underinvestigated issue. Doing so in collaboration with all the different actors involved in that population's medication management and recording the first effects of the intervention will make this pilot and feasibility study's findings very valuable as home care becomes an ever more common solution. TRIAL REGISTRATION Swiss National Clinical Trials Portal 000004654; https://tinyurl.com/mr3yz8t4

Going Beyond Promoting: Preparing Students to Creatively Solve Future Problems

While we cannot know what problems the future will bring, we can be almost certain that solving them will require creativity. In this article we describe how our course, a first-year undergraduate mathematics course, supports creative problem solving. Creative problem solving cannot be learned through a single experience, so we provide our students with a blend of experiences. We discuss how the course structure enables creative problem solving through class instruction, during class activities, during out of class assessments, and during in class assessments. We believe this course structure increases student comfort with solving open-ended and ill-defined problems similar to what they will encounter in the real world

Enhancing Collaboration Between Primary and Subspeciality Care Providers for Children and Youth with Special Health Care Needs

Summary: The goals of this guide are to discuss the complementary roles of generalist and subspecialist physicians in providing coordinated and effective care for children and youth with special health care needs. We will emphasize the centrality of family-professional partnerships. We also will describe various models for collaboration among generalist and subspecialist physicians and families. Ultimately, the value of this guide will be to serve as a framework for discussion about how primary and subspecialty care physicians can work collaboratively to enhance the quality of care that children and youth with special health care needs and their families receive

Caring for High-Need, High-Cost Patients: What Makes for a Successful Care Management Program?

Provider groups taking on risk for the overall costs of care in accountable care organizations are developing care management programs to improve care and thereby control costs. Many such programs target "high-need, high-cost" patients: those with multiple or complex conditions, often combined with behavioral health problems or socioeconomic challenges. In this study we compared the operational approaches of 18 successful complex care management programs in order to offer guidance to providers, payers, and policymakers on best practices for complex care management. We found that effective programs customize their approach to their local contexts and caseloads; use a combination of qualitative and quantitative methods to identify patients; consider care coordination one of their key roles; focus on building trusting relationships with patients as well as their primary care providers; match team composition and interventions to patient needs; offer specialized training for team members; and use technology to bolster their efforts