New DoD Patient Safety Guide Draws Roadmap for Patient Activation

Posted by: Health.mil Staff

A newly released Patient Activation Reference Guide from the Department of Defense Patient Safety Program supports an agency-wide effort to foster an environment where patients are engaged participants in their health care. The guide provides a roadmap for moving patients toward full involvement and assistance of the health care team. The five module guide provides insight, background and resources that apply to all team members who care for patients and their families, including clinical and administrative staff, as well as the patient/family units themselves.

Activated patients have the information, skills and confidence to effectively make decisions about their health care. Research shows that patients who are engaged in their own care have better health outcomes, improving the quality of health care for both individuals and the entire system. Patients Safety Program leaders say that having an active patient population is critical as the Military Health System works toward high quality, cost-effective health care.

The Patient Activation Reference Guide is available on the Patient Safety Program website.

Study Takes Closer Look at Non-Combat Burn Hazards

Posted by: Health.mil Staff

In a recent study published in the Journal of the American College of Surgeons, researchers from the U.S. Army Institute of Surgical Research (USAISR) in San Antonio analyzed non-combat burn epidemiology among active duty service members deployed in Iraq and Afghanistan, using similar civilian burn data as context.

During the Vietnam War, more than half of the evacuated burn casualties were burned outside of combat-related activities. Initial reports from current conflicts in Iraq and Afghanistan have revealed that more than one-third of burn injuries are classified as non-combat.

Between March 2003 and June 2008, the study examined data from burn causalities evacuated to the USAISR, which is the sole U.S. military burn center.

The data was then used to characterize deployed military burn risks in comparison to the risks observed in the U.S. civilian population, to determine which environment was more or less dangerous for unintentional burns. Civilian burn data was extracted from the Centers for Disease Control (CDC) and statistics published by the American Burn Association.

Of 688 burn causalities admitted to the USAIR during the study, 180 of the cases were considered non-combat. Waste burning, handling ammunition, and fueling generators were some of the major causes of burning incidents for those deployed.

Researchers concluded that the prevalence of non-combat burn injuries in Operation Iraqi Freedom and Operation Enduring Freedom was about 20 patients per 100,000 per year, compared to almost seven patients per 100,000 per year for civilians. Therefore, service members are almost three times more likely to suffer unintentional burning than a similar civilian cohort. The increased risk was found to be proportionately mitigated by the specific requirements of their environment.

The most commonly burned body area for service members were the hands, totaling 67 percent of the casualties, significantly more than the civilian burn population. Wearing gloves to protect from burns to the hands and developing other fire safety procedures will potentially reduce the number of non-combat burning incidents in military operations.

Click here to access the full research study on PubMed.

Full Article Citation:

Kauvar DS, Wade CE, Baer DG. Burn hazards of the deployed environment in wartime: epidemiology of noncombat burns from ongoing United States military operations.J Am Coll Surg. 2009 Oct;209(4):453-60. Epub 2009 Aug 8. (US Army Institute of Surgical Research, Fort Sam Houston, TX)

Vision Center of Excellence, Leading 21st Century Eye Care

The Military Health System Blog
Friday, August 21, 2009 - Posted by: Guest Blogger

Today, guest blogger Col. (Dr.) Donald Gagliano, director of the DoD/VA Vision Center of Excellence, explains what the center is all about.

The Vision Center of Excellence (VCE) is a newly formed, intergovernmental effort between the Department of Defense (DoD) and the Department of Veterans Affairs (VA). The mission of the VCE is to continuously improve the health and quality of life for members of the armed forces and veterans through advocacy and leadership in the development of initiatives focused on the prevention, diagnosis, mitigation, treatment, research and rehabilitation of disorders of the visual system.

The VCE has been established as an intergovernmental program office for vision, comprised of five broad divisions: Informatics and Information Management, Clinical Care, Research and Surveillance, Rehabilitation and Restoration and Global Outreach. The center’s primary focus areas include the development of the Defense and Veterans Eye Injury Registry (DVEIR), enhancement of the electronic health record for vision, patient care support, provider education, research, and strategic outreach and these commitments have shaped its infrastructure needs and the prioritization of its recruitment efforts.

The DVEIR will track the occurrence, treatment and outcomes of all eye injuries or visual dysfunction experienced by service members who have served on active duty since September 11, 2001. The DVEIR will be the first major registry linking the DoD's health information system, AHLTA, with the VA's health information system, VISTA, the Veterans Health Information System and Technology Architecture. Data collected in the DVEIR will allow the VCE to develop initiatives to focus research more effectively, evaluate DoD/VA health care processes, and establish guidelines for care, among other improvements. A recent collaboration, led by the VCE resulted in the development of vision research priorities for the Congressionally Directed Medical Research Program.

As the VCE evolves, the DVEIR and other initiatives will increase awareness of eye injuries and visual dysfunction throughout the services and veterans' organizations, foster promising research and provide a more seamless transition of care within and between DoD and VA.

August is Eye Health Month, and we’ve set up a page full of healthy tips and resources to help you see things a little clearer. Check it out at www.health.mil/eyehealth.

Posted at 2009-08-21 08:53:28 in Monthly Themes| Permalink

Special Pay for Health Professions Officers

The Military Health System Blog
Tuesday, August 18, 2009 - Posted by: Health.mil Staff

On July 23, 2009, the Directive-Type Memorandum (DTM) 09-009, “Implementation of Special Pay for Health Professions Officers (HPOs)”, was signed by Ms. Gail H. McGinn, Performing the Duties of the Under Secretary of Defense, Personnel and Readiness.

This DTM establishes Department of Defense (DoD) policy, assigns responsibilities, and implements special pay for licensed clinical psychologists, licensed clinical social workers, physician assistants, licensed veterinary officers, and public health officers (Air Force only). The DTM 09-009 is effective immediately and will be incorporated into the DoD Instruction 6000.13 within 180 days.

This is the first action taken to implement the Consolidation of Special Pay (CSP) under Section 335 of Title 37.

Posted at 2009-08-18 14:42:23 in Policies and Guidelines| Permalink

It's Wise to Immunize

Tue, 04 Aug 2009 19:00:00 -0500

Learn the benefits of keeping your immunization record up-to-date from Lt. Col. Patrick Garman, deputy director of the Military Vaccine Agency.

Protection and Education Have Reduced Eye Injuries in the Military

The Military Health System Blog

Tuesday, July 21, 2009 - Posted by: Health.mil Staff

Many eye injuries have occurred among service members in Operations Iraqi Freedom (OIF) and Enduring Freedom (OEF), and some have led to blindness. A recent article in The Journal of Trauma examines the effectiveness of military eye protection to reduce the rate of eye injuries in service members deployed to Iraq (OIF) and Afghanistan (OEF).

The article was published by Brooke Army Medical Center (BAMC) at Fort Sam Houston, Texas. It’s based on research conducted by article first author Roger Thomas, M.D., and others who evaluated the rate of eye injuries in OIF and OEF and sought to determine if education on the use of eye protection was related to a decrease in the rate of eye injuries. This study was based on data in the Joint Theater Trauma Registry (JTTR), which was established for the explicit purpose of collecting medical data on injuries in OIF and OEF. (Read more about the JTTR)

3,276 service members were included in the study, who were injured during March 2003 to September 2006. 605 service members reported that they had not been wearing eye protection; and 26% of them sustained an eye injury. 2,671 service members reported that they had been wearing eye protection; and 17% of them sustained an eye injury.

After an intense education program on eye protection, the rate and severity of eye injuries decreased in service members who were wearing eye protection. This study demonstrated that the military eye protection currently being used in OIF and OEF resulted in significantly fewer injuries and less severe injuries. In addition, it appeared that educational programs were successful in increasing compliance with eye protection.

Click here to access the research study at PubMed

Full article citation:

Thomas R, McManus JG, Johnson A, Mayer P, Wade C, Holcomb JB. Ocular injury reduction from ocular protection use in current combat operations. J Trauma. 2009 Apr;66(4 Suppl):S99-103. (Brooke Army Medical Center, Fort Sam Houston, TX)

Posted at 2009-07-21 08:58:48 in Research| Permalink

Tips For Improving Fitness - The Military Health System Blog

Posted by: Health.mil Staff

For Men's Health Month, Mike Caviston, director of fitness at the Naval Special Warfare Center, submitted the following piece on becoming and remaining physically fit. (Caviston was also the guest on a recent episode of our podcast, Dot Mil Docs. Click here to listen!)

The first thing to do is define the term fitness. We want to improve it, but what exactly is it? Essentially, it means being physically prepared for a specific job or activity. You might be a cross country runner, you might be a ditch digger, you might be a Navy SEAL—each of those jobs requires a certain level and type of fitness that is different from the others. Improving your fitness involves “training,” which is a lot like “exercise,” but more focused on improving your ability to perform a specific task rather than improving your general health (though good training will also lead to good health!)

Exercise scientists recognize some general principles and variables related to fitness and training. First, the Overload Principle tells us we need to work hard enough to challenge the body to adapt and improve. So we have to run a little further or lift a little more weight than we are comfortable with, or our hearts and muscles won’t have any reason to alter the status quo. At the same time, we don’t want to do too much or go too hard too often, which leads to burnout and injury. The Specificity Principle tells us we need to focus explicitly on the things we want to improve. Do we want endurance or strength? Do we want endurance for running or swimming? Do we want strength in the arms or legs? Or all of these combined? The adaptations we see are specific to the training we do. According to the Reversibility Principle, the gains we make aren’t permanent, and we have to keep using it or we’re going to lose it (we can maintain fitness with less training than it takes to acquire fitness, but if we stop training altogether we regress towards our starting point). The Individual Differences Principle reminds us that we’re all unique, both genetically and with reference to the amount of fitness we start with, so results we see from a particular training program will vary from person to person.

The variables we need to manipulate while training can be remembered by the acronym F.I.T.T., which stands for Frequency, Intensity, Time, and Type. Frequency refers to the number of training sessions per week; 3-4 times per week is recommended at a minimum, and up to 2 times a day for the serious, committed, experienced athlete. Intensity is all about how hard you work, and is directly related to the Overload Principle. Again, we need to work hard enough to stimulate gains but not so hard that we become injured or are unable to recover before the next session.

Different methods have been developed to measure intensity that include monitoring heart rate, breathing, or blood chemistry. A simple but quite accurate way to judge intensity is to make sure the effort feels “somewhat hard” (not “easy” or “excruciating”). The time spent training during a single session will vary depending on your goals and abilities, but somewhere between twenty minutes and an hour is a pretty good range in most cases. The type, or mode, of exercise you do needs to reflect the job or event you are preparing for (remember the Specificity Principle). For example, a swimmer might supplement training with a few land-based activities, but needs to spend a significant amount of time in the water.

Designing a training program doesn’t have to be especially complicated, but you should put a little thought into it, and bear in mind the principles and variables described above. You should make a training plan to accomplish your specific goals, taking into account your particular strengths and weaknesses, rather than stringing together a random collection of exercises with arbitrary targets. I recommend five simple steps to take before outlining a program:

1. Decide what you are training for (example: a military Physical Fitness Test that involves push-ups, pull-ups, and running).
2. Decide how good you want/need to be (will you be satisfied with achieving the minimal standards, or do you really want to blow it out of the water?)
3. Determine your current fitness level (are you completely sedentary or are you already in decent shape?)
4. Determine how much time you will be able to devote to training (the number of weeks until you will be tested, as well the number of hours per day/week you will realistically spend training).
5. Take stock of the resources you have to train with (do you have a gym and a running track at your disposal, or will you be exercising in your garage and running through your neighborhood?)

A plan’s effectiveness should be measured based on how well it accomplishes your fitness goals and improves your ability to perform, not on how sore it makes you or whether it causes you to throw up. Of course we’d like to avoid injuries caused by training, but remember that training doesn’t come without risks. The only way to avoid training injuries is to avoid training – hardly an acceptable solution, especially for people for whom fitness may potentially affect survival, such as our warriors, police officers, and firefighters. But it is not appropriate for a warrior’s effectiveness or readiness to be compromised by an avoidable training injury, and the risks of training should always be outweighed by the benefits.

Aggressive training should always be moderated with intelligent programming. Probably the most common mistake made while training is simply attempting to do too much too soon (running too many miles, lifting too much weight, doing too many reps). A general rule of thumb is to increase your workload by no more than 5-10 percent per week. Slow, steady, continual progress is preferable to the one step forward, one step back scenario that results from re-aggravating the same injuries over and over without modifying the program. Learn proper technique, follow instructions, and don’t let ego get in the way by focusing on comparison with others rather than your own needs and abilities.

Posted at 2009-06-25 15:48:09 in Monthly Themes| Permalink

Your Care in MiCare

Wednesday, June 24, 2009
Posted by: Health.mil Staff

Today, Col. Keith L. Salzman, M.D., M.P.H., gives an update on the personal health record pilot program going on at Madigan Army Medical Center at Ft. Lewis, Wash. Salzman is Chief, Western Regional Medical Command/ Madigan Army Medical Center Informatics.

It’s been almost 12 months since Madigan Army Medical Center started MiCare to bring the concept of a personal health record (PHR) to military beneficiaries.

Through demonstration projects with industry leaders Microsoft HealthVault and Google Health, we have been able to take personal medical information from the MHS electronic medical record, AHLTA, and put the information in our patients’ hands. Into their own personal health record—the patient owns a copy and controls it. Over 400 patients at Madigan have participated in the MiCare, and they like what they see.

It’s been an important year—and it’s paving the way for DoD to be able to share medical information with our patients in an even more comprehensive way. Here are just a few of the early benefits we are seeing from this demonstration project:

• Patients become partners in their care. Our patients are viewing their lab test results, medication profiles, medical histories and are enabled to be more active participants in managing their medical issues. (The traffic on open accounts is about 10 percent a day).

• PHRs improve the quality of the information in AHLTA. By sharing medical information with our patients, we are also improving our own systems and we’re better prepared for a patient visit. Medication profiles and medical histories can be outdated—when we share our information from the patient, we introduce another quality control check that ensures the information we look at in AHLTA is more current and relevant.

• PHRs improve the provider-patient interaction and compliance. We’re in the early stages of this project, but we are also seeing that patients who use a PHR are asking more questions and becoming more engaged in following their treatment plans.

This is an early report from the field. We have much more to do—more capabilities to add, more technical issues to resolve, and expansion to a larger group of users. But in Year One, we are dealing with the big issues—and focused on the end results: improving the quality of every visit, improving the quality of care, and increasing patient participation in their care.

Greater transparency and sharing between AHLTA and the MiCare PHR has great benefits for our patients and our system. As the country engages in an active debate about the future of our health system, the Military Health System is poised to be a leader in this area.

Our team at Madigan is excited to share the results of this pilot program with others in this system. We don’t have all the answers and don’t even know all the questions. I would like to hear from any of you in the MHS. Where do you think the PHR is directed? What are the most valuable uses of a PHR—for patients and for providers? What bridges should be built between our EHR and a PHR? Please share your thoughts and I will continue to provide MiCare updates over the coming months.

Posted at 2009-06-24 12:59:34 in Technology| Permalink

House Reviews MHS Budget with ASD

Monday, June 01, 2009
Posted by: Health.mil Staff

On May 21, Ellen P. Embrey, performing the duties of assistant secretary of defense for health affairs, testified before the House Appropriations Committee’s Subcommittee on Defense on the Military Health System budget for fiscal year 2010.

Embrey outlined the priorities of the $47.4 billion request, stating that, apart from defending the nation, the Department of Defense has “no higher priority that to provide the highest quality care and support” to America’s armed forces and their families.

Among those priorities, Embrey said, is superior follow-on care, particularly for service members with psychological health needs or traumatic brain injury.

“When young Americans step forward of their own free will to serve,” Embrey said, quoting Secretary of Defense Robert Gates, “they do so with the expectation that they, and their families, will be properly taken care of—we agree.”

Other areas of emphasis include achieving the lowest possible rate of death, injury and disease during deployments; building healthy and resilient individuals, families and communities, and providing the highest quality care at the most efficient cost to the taxpayer.

The Military Health System also provides humanitarian assistance at home and around the world, and supports world-class medical education, training, and research.

FY 2010 budget:

• $27.9 billion to fund the Defense Health Program, which includes operations and maintenance (day-to-day operational costs), procurement, and research, development, test and evaluation
• $10.8 for the Medicare-Eligible Retiree Health Care Fund
• $7.7 billion to support more than 84,000 military health care service providers
• $3.3 billion to provide world-class health and rehabilitative care for wounded, ill and injured service members
• $1 billion for military construction including 23 medical construction projects in 16 locations

Regarding psychological health and traumatic brain injury (TBI), Embrey said significant progress was made throughout 2008 to comprehensively transform the system of care for service members with those conditions including:

• The establishment of the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE)
• Early mental health identification and intervention programs
• The development of clinical standards and guidelines in partnership with the Department of Veterans Affairs (VA)
• The new Military Acute Concussion Evaluation tool to assess the likelihood o mild TBI
• Increased funds for research development, testing and evaluation.

Going forward, Embrey said the Defense Department will continue to work to ensure the quality and consistency of care; meet the needs of Reserve forces, especially those in underserved areas; improve efforts to recruit and retain high-quality mental health providers; reduce the rate of suicide, improve our ability to share and exchange data with the VA; and continually seek new ways to expand our knowledge and improve our ability to care for service members, veterans and families.

Embrey also discussed many of the specific ways that the MHS keeps its service members fit to fight, including:

• Comprehensive health assessments program before, during and after deployments
• Vaccination programs with an unparalleled record of safety that is setting the standard for the private sector
• Global disease surveillance, education and rapid eradication
• Environmental force health protection that routinely monitors air, water and soil to detect and prevent hazardous exposure before it occurs
• State-of-the-art treatment and equipment that reaches the wounded within the first hour of injury, and transports personnel from the battlefield to the U.S. in less than 48 hours

Embrey noted that, as a result of these and other measures, the disease, non-battle injury rates for Operation Enduring Freedom and Operation Iraqi Freedom are the lowest in history, 5 percent and 4 percent respectively, and the battlefield survival rate now stands at 97 percent.

“The Military Health System,” Embrey said, “is about doing the very best we can
for the men and women who give everything they have for each one of us.

“We can never fully repay them for the sacrifices they make on our behalf,” she said. “But we can and will continue to do everything we can to heal their wounds and honor their courage and commitment to our nation.”

Preparing Mentally for Deployments

Tuesday, May 26, 2009 - The Military Health System Blog

Posted by: Guest Blogger

Today we hear from USPHS Cmdr. Guy Mahoney.

One of the hardest things about deployment is being separated from your family and friends. During deployment, we often think about our loved ones and their welfare, and, when problems arise at home, it can become especially distressful for us. At times we feel powerless because we are not physically there to help.

As a clinician, I know these home-front difficulties often negatively impact mission performance and our own health. So what can we do to head off these problems? Put simply, I’ve learned that the more we prepare for difficulties before deployment, the better we cope once we’re apart. I recommend taking these few steps before you deploy.

1. Have your contact information and your family’s contact information updated regularly.

Maintaining contact is essential when you are apart. Keep a running list of things you want to discuss, remembering to share the good things, too. Additional opportunities for communicating might crop up unexpectedly. This way you’ll be prepared.

2. Accomplish as much as you can together before the deployment.

Taking care of standing issues or setting plans in motion that will resolve such issues well before your deployment will ease everyone’s mind and allow you to maintain some control. For example, use the pre-deployment period to have family discussions about legal concerns or medical issues; create budget and financial plans; and think realistically about housing, utilities, transportation, school, and childcare needs.

3. Create a list of local community and base resources.

Especially for those situations you can not anticipate, it is vital that your family can quickly and easily find assistance in their local communities and through support organizations. Good planning and networking here will lessen the edge on home problems when they arise (and they will!).

4. Actively prepare for your family’s and your own deployment stress

You and your family should resolve to stay positive and flexible before, during, and after deployment. Communication by phone or by text should be regular. Keep connected within your social circles, and identify “personal sanctuaries” where you and your family can refresh yourselves physically, mentally, and spiritually. Make sure everyone is balancing sleep, rest, play, diet and exercise. Encourage seeking assistance when it is needed.

5. Have a trusted family member or friend who’ll check in with your family from time to time.

One of the most important things you can do is to identify a resourceful family member or trusted friend (or a few of them) who will check in with your family from time to time.

These are some easy and practical steps to take to help you with deployment. Preparation and planning together with your loved ones will go a long way in lessening the impact of any issues should they arise.