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Navigating the Leadership Tightrope: A Case Study in the Art of Following and Supporting. 在领导力的钢丝绳上航行:追随与支持的艺术案例研究》。
IF 1.2 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-26 DOI: 10.1093/milmed/usae538
Matthew C Pflipsen

Military physicians serve as staff officers where both leading and following are important competencies. Navigating between the two roles is a necessary skill to avoid undermining one's boss and to support the mission. This case describes a deployed junior officer reconciling his role as the lead medical expert while supporting a Commander's decision, highlighting the challenges of followership in situations of disagreement.

军医作为参谋,领导和服从都是重要的能力。在这两种角色之间游刃有余是一项必要的技能,既能避免削弱上司的威信,又能为任务提供支持。本案例描述了一名已部署的下级军官在支持指挥官决策的同时,如何协调自己作为首席医学专家的角色,凸显了在意见分歧的情况下服从领导所面临的挑战。
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引用次数: 0
Dosimetry as a Lagging Indicator of Occupational Exposure to Nitrous Oxide in Pediatric Sedation: A Collaborative Process Improvement Project With Industrial Hygiene. 剂量测定作为儿科镇静中一氧化二氮职业暴露的滞后指标:与工业卫生部门合作的流程改进项目。
IF 1.2 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-26 DOI: 10.1093/milmed/usae523
Jennifer S Kicker, Cynthia Y Timbie, Susan L Kline

Introduction: Nitrous oxide (N2O) is commonly used in pediatric procedural sedation. It is an attractive option to facilitate intravenous line placement, as it does not extend sedation recovery from subsequently administered agents. Although debate exists regarding health consequences of occupational exposure now that scavenging of exhaled gases is common, cooperation of pediatric patients to maximize engineering controls is not guaranteed and can contribute to repeated exposure over the course of a clinician's career. There is no global consensus on personal exposure limits, but the National Institute for Occupational Safety and Health published U.S. guidelines. A dosimetry survey of our sedation team during a short N2O procedure for intravenous line placement exceeded the National Institute for Occupational Safety and Health Recommended Exposure Limit (REL) of 25 parts per million. We designed a process improvement initiative to reduce occupational exposure below the Recommended Exposure Limit on serial surveys.

Materials and methods: A continuous flow, titratable, full-face mask N2O delivery system with scavenging by a central vacuum connection was used. A retrospective chart review of N2O procedures performed before the initial dosimetry survey revealed practice trends in provider behavior during N2O administration. Initiation of N2O gas flow and maintenance of face mask seal on an uncooperative patient were identified as two sources of variability. Two-handed face-masking technique, initiation of N2O gas flow only after masking, and continued masking for 2 min of exhaled scavenging were standardized and socialized as best practices. Subsequent dosimetry surveys of the sedation team were coordinated by Industrial Hygiene.

Results: Pre- and post-intervention phases were 17 months each and included 92 and 201 N2O patients, respectively. Six dosimetry surveys occurred in the post phase. Intravenous line placement was the typical procedure surveyed. Dosimetry results for all team members during surveys 1-4 were below the REL, with 14 of 16 samples falling below the level of quantitation. Elevated dosimetry results in survey 5 prompted reevaluation of work practices and equipment. A loose component on the delivery system was discovered, corrected, and incorporated as a pre-procedure check. With no further changes to work practices, dosimetry results were below the REL for survey 6.

Conclusion: We layered work practice changes atop engineering controls to reduce occupational exposure levels for medical team members. We utilized dosimetry as a lagging indicator, prompting frequent reassessments of our equipment and processes that we might not otherwise have performed. Pediatric sedation programs are encouraged to consider whether Industrial Hygiene resources might provide synergy to process improvement efforts with inhalational sedation agents.

简介:一氧化二氮(N2O)常用于儿科手术镇静。一氧化二氮不会延长后续用药的镇静恢复时间,因此在促进静脉置管方面是一种很有吸引力的选择。虽然现在对呼出气体的清除已很普遍,但关于职业暴露对健康的影响仍存在争议,儿科患者对最大化工程控制的配合并不能得到保证,这可能会导致临床医生在职业生涯中反复暴露于这种气体。目前全球尚未就个人暴露限值达成共识,但美国国家职业安全与健康研究所公布了美国的指导方针。我们的镇静团队在一次短暂的静脉置管 N2O 过程中进行了剂量测定调查,结果超过了美国国家职业安全与健康研究所建议的暴露限值 (REL),即百万分之 25。我们设计了一项流程改进措施,以在连续调查中将职业接触降至建议接触限值以下:我们使用了一种可滴定的连续流全脸面罩 N2O 输送系统,该系统通过中央真空连接进行清除。对首次剂量测定调查前进行的一氧化二氮程序进行的回顾性病历审查显示了提供者在施用一氧化二氮过程中的行为趋势。对不合作的患者启动一氧化二氮气流和保持面罩密封被认为是两个变量来源。双手面罩技术、面罩密封后才开始 N2O 气体流动以及持续面罩 2 分钟的呼气清除被标准化和社会化,成为最佳实践。随后由工业卫生部协调对镇静小组进行剂量测定调查:干预前和干预后阶段各为 17 个月,分别包括 92 名和 201 名一氧化二氮患者。后阶段进行了六次剂量测定调查。调查的典型程序是静脉置管。在第 1-4 次调查中,所有小组成员的剂量测定结果均低于 REL 值,16 个样本中有 14 个低于定量水平。第 5 次调查的剂量测定结果升高,促使对工作方法和设备进行重新评估。发现并纠正了输送系统上的一个松动部件,并将其作为程序前检查的一部分。在没有进一步改变工作方法的情况下,剂量测定结果低于第 6 次调查的 REL 值:我们在工程控制的基础上改变了工作方法,以降低医疗小组成员的职业暴露水平。我们利用剂量测定作为滞后指标,促使我们经常重新评估设备和流程,否则我们可能不会这样做。我们鼓励儿科镇静项目考虑工业卫生资源是否可以为吸入性镇静剂的流程改进工作提供协同作用。
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引用次数: 0
Utilization of Prognosis Assignment: A Cross-Sectional Survey of Military Periodontists. 预后分配的使用:军事牙周病学家的横断面调查。
IF 1.2 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-22 DOI: 10.1093/milmed/usae496
Richard E Sawaya, Noel E Dickens, Keith R Merchant, John H Wilson, Caitlin D Darcey

Introduction: Prognosis is a forecast of the likely course of a disease and its future implications on treatment outcomes. The significance of periodontal prognosis in clinical practice is evident by its influence on treatment planning, communication, and in the retrospective evaluation of treatment results. While there are multiple well-known prognosis systems reported in the periodontal dental literature, there is an absence of data on the actual use of prognosis assignment among practicing clinicians. The purpose of this study was to survey military periodontists regarding their utilization of periodontal prognosis and associated systems and to evaluate prognosis' influence on treatment planning as well as its implications on operational dental readiness.

Methods: A 19-question internet survey was disseminated to military periodontists in the U.S. Air Force, Army, and Navy via their respective Periodontal Consultants to the Surgeon Generals. The survey inquired on provider-specific demographic information, the provider's favored periodontal prognosis system, when and how prognosis is applied, and on the relationship between prognosis and operational dental readiness.

Results: Fifty-five percent (n = 65 out of 120) of eligible survey participants completed the survey. Army (94.4%, n = 17) and Air Force (72.2%, n = 13) respondents preferred utilizing the Kwok and Caton periodontal prognosis system compared to 37.9% (n = 11) of Navy periodontists. Most respondents assigned prognosis at multiple time points in a patient's overall course of treatment (68%, n = 44), identified the severity of the periodontal presentation and the predictability of treatment outcomes as the most important factors involved in assigning a prognosis (82%, n = 55), and indicated that periodontal prognosis did not influence their dental readiness classification and vice versa.

Conclusions: Kwok and Caton and McGuire periodontal prognosis systems were utilized by the majority of respondents but differed in utilization by military service branch. Respondents considered periodontal presentation severity and treatment outcome predictability the most important factors when assigning a prognosis. There was minimal influence between operational dental readiness and periodontal prognosis. Future research will evaluate prognosis system utilization in a broader population and will assess the impact of system standardization in education and clinical practice.

介绍:预后是对疾病的可能发展过程及其对治疗结果的未来影响的预测。牙周预后在临床实践中的重要性体现在它对治疗计划、沟通和治疗结果回顾评估的影响上。虽然牙周病学文献中报道了多种众所周知的预后系统,但缺乏临床医生实际使用预后分配的数据。本研究的目的是调查军事牙周病学家对牙周预后和相关系统的使用情况,评估预后对治疗计划的影响及其对牙科战备的影响:方法: 通过外科医生牙周顾问向美国空军、陆军和海军的军队牙周病医生分发了一份包含 19 个问题的网络调查。调查询问了提供者的特定人口信息、提供者偏爱的牙周预后系统、何时及如何应用预后以及预后与牙科战备之间的关系:符合条件的调查参与者中有 55%(120 人中有 65 人)完成了调查。陆军(94.4%,n = 17)和空军(72.2%,n = 13)的受访者更倾向于使用 Kwok 和 Caton 牙周预后系统,而海军牙周病医生的这一比例为 37.9%(n = 11)。大多数受访者在患者整个治疗过程中的多个时间点指定预后(68%,n = 44),认为牙周表现的严重程度和治疗结果的可预测性是指定预后的最重要因素(82%,n = 55),并表示牙周预后不会影响他们的牙科准备分类,反之亦然:结论:大多数受访者都使用了 Kwok 和 Caton 以及 McGuire 牙周预后系统,但各军种的使用情况有所不同。受访者认为牙周表现的严重程度和治疗结果的可预测性是判断预后的最重要因素。牙科战备状态与牙周预后之间的影响微乎其微。未来的研究将评估预后系统在更广泛人群中的使用情况,并评估系统标准化对教育和临床实践的影响。
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引用次数: 0
Capturing and Categorizing the Burden of Musculoskeletal Injuries in U.S. Active Duty Service Members: A Comprehensive Methodology. 美国现役军人肌肉骨骼损伤负担的捕捉和分类:综合方法。
IF 1.2 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-21 DOI: 10.1093/milmed/usae245
Veronika Pav, Xiaoning Yuan, Brad Isaacson, Wendy Funk, Ben Hando

Background: Musculoskeletal injuries (MSKIs) represent the most common, costly, and impactful medical conditions affecting active duty service members (ADSMs) of the United States Armed Forces. Inconsistent, variable MSKI surveillance methods and often incompletely described criteria for cohort selection, injuries, incidence, and prevalence have limited efforts to observe longitudinal trends, identify gaps in care, or highlight specific military branches or sites that could benefit from enhanced MSKI intervention protocols. The purpose of this manuscript is to present a comprehensive, well-documented, and reproducible framework for capturing and categorizing MSKI burden, healthcare utilization, and private sector costs for ADSMs across a 12-year period spanning the International Classification of Diseases, 10th Revision, Clinical Modification transition.

Methods: This was a retrospective, longitudinal population study, including ADSMs from the Air Force, Army, Marine Corps, and Navy. Prevalence and incidence rates for Upper Extremity, Lower Extremity, Spine, and Head/Neck MSKIs, associated health care utilization, and private sector costs were obtained by querying electronic health records from military treatment facilities, private sector care (PC) claims, and theater medical data from October 1, 2010 to September 30, 2021 (Fiscal Years 10-21), using the Military Health System Data Repository. Utilization associated with MSKIs per body region in the direct care and PC settings was classified into mutually exclusive outpatient encounter categories and acute inpatient stays. PC MSKI-associated costs were captured per year and categorized by service, body region, and setting.

Conclusions: MSKI surveillance research in ADSMs has been impacted by variable, often incompletely described methods. While our approach is not without limitations, our aim was to present a well-documented, reproducible methodology for MSKI investigation in military personnel. By presenting a comprehensive blueprint for capturing and categorizing MSKI care in U.S. service members, our goal is for this methodology to enhance the efforts of researchers, public health officials, and Military Health System leaders to combat MSKIs, the primary medical threat to military readiness.

背景:肌肉骨骼损伤(MSKIs)是影响美国武装部队现役军人(ADSMs)最常见、最昂贵、影响最大的医疗状况。由于 MSKI 监测方法不一致、多变,而且对队列选择、损伤、发病率和流行率的标准描述往往不完整,因此限制了观察纵向趋势、确定护理差距或强调可从加强 MSKI 干预方案中受益的特定军种或地点的工作。本手稿旨在提供一个全面、记录详实且可重复的框架,用于捕捉和分类ADSM在12年期间的MSKI负担、医疗保健利用率和私营部门成本,时间跨度为《国际疾病分类》第10版临床修订过渡时期:这是一项回顾性纵向人群研究,包括来自空军、陆军、海军陆战队和海军的 ADSMs。通过查询军队治疗机构的电子健康记录、私营部门的护理(PC)索赔以及战区医疗数据(2010 年 10 月 1 日至 2021 年 9 月 30 日(第 10-21 财年)),并使用军事健康系统数据存储库,获得了上肢、下肢、脊柱和头颈部 MSKI 的流行率和发病率、相关的医疗保健使用情况以及私营部门的成本。在直接医疗和私人医疗机构中,与每个身体区域的 MSKI 相关的使用情况被划分为相互排斥的门诊就诊类别和急性住院治疗类别。与 PC MSKI 相关的费用按年统计,并按服务、身体部位和环境进行分类:ADSM中的MSKI监测研究受到了各种方法的影响,这些方法往往描述不全。虽然我们的方法并非没有局限性,但我们的目标是为军事人员的 MSKI 调查提供一种有据可查、可重复的方法。通过提出一个全面的蓝图来捕捉和分类美国现役军人的 MSKI 护理,我们的目标是让这一方法加强研究人员、公共卫生官员和军事卫生系统领导者的努力,以对抗 MSKI 这一军事战备的主要医疗威胁。
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引用次数: 0
Musculoskeletal Head and Neck Injuries in U.S. Active Duty Service Members: Prevalence/Incidence, Health Care Utilization, and Cost Analysis Spanning Fiscal Years 2016-2021. 美国现役军人的头颈部肌肉骨骼损伤:2016-2021财年的流行率/发病率、医疗保健使用率和成本分析》(Prevalence/Incidence, Health Care Utilization, and Cost Analysis spanning Fiscal Years 2016-2021)。
IF 1.2 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-21 DOI: 10.1093/milmed/usae045
Xiaoning Yuan, Emma Stewart, Courtney Colahan, Paul Pasquina, Brad Isaacson, Veronika Pav, Ben Hando

Background: Active duty service members (ADSMs) of the U.S. Armed Forces are uniquely at risk for musculoskeletal injuries (MSKIs) of the Head/Neck region, including the eye and face, from training with head gear, donning Kevlar, operating aircraft, and maintaining sitting or standing postures for prolonged durations. The purposes of this descriptive study were to report the prevalence/incidence, health care utilization, and health care costs attributable to Head/Neck MSKIs across the Services from fiscal years (FYs) 2016 to 2021.

Methods: This was a retrospective, longitudinal population study, including ADSMs from the Air Force, Army, Marine Corps, and Navy. Prevalence and incidence rates for Head/Neck MSKIs, associated health care utilization, and private sector costs were obtained by querying electronic health records from military treatment facilities, private sector care (PC) claims, and theater medical data from October 1, 2015 to September 30, 2021 (FYs 16-21), using the Military Health System Data Repository. Utilization associated with Head/Neck MSKIs in both the direct care and PC settings was classified into mutually exclusive outpatient encounter categories and acute inpatient stays. PC costs related to Head/Neck MSKIs were captured for each year.

Results: In FY21, 109,683 ADSMs sought care for Head/Neck MSKIs, representing 7.3% of the U.S. Armed Forces. The prevalence of Head/Neck MSKIs ranged from 6.9 to 7.8% during FY16-21, with the highest annual prevalence among the Air Force (8.0-9.4%) and Army (7.9-8.8%). Within direct care across the services, Soldiers presented for the highest proportion (45.9-47.9%) of outpatient encounters for Head/Neck MSKI annually. The Air Force relied most heavily on PC for outpatient Head/Neck MSKI care, which accounted for $9,134,741 in PC costs and comprised 37.2% of all PC encounters in FY21.

Conclusions: This retrospective, descriptive study established prevalence/incidence, health care utilization, and PC costs for Head/Neck MSKIs across the services from FY16-21, emphasizing the burden of Head/Neck MSKIs among the U.S. Armed Forces, with PC costs amounting to $42,912,940 in FY21 alone.

背景:美国武装部队的现役军人(ADSMs)在头颈部(包括眼部和面部)的肌肉骨骼损伤(MSKIs)方面具有独特的风险,这些损伤来自于佩戴头盔、穿戴凯夫拉防护服、操作飞机以及长时间保持坐姿或站姿的训练。这项描述性研究旨在报告 2016 至 2021 财政年度(FYs)各军种头颈部 MSKI 的流行率/发病率、医疗保健利用率和医疗保健成本:这是一项回顾性纵向人口研究,包括来自空军、陆军、海军陆战队和海军的 ADSM。通过查询军队治疗机构的电子健康记录、私营部门护理(PC)索赔以及2015年10月1日至2021年9月30日(16-21财年)的战区医疗数据,并使用军事健康系统数据存储库,获得了头颈部MSKI的流行率和发病率、相关医疗保健使用情况以及私营部门成本。与头颈部 MSKIs 相关的直接护理和 PC 环境下的使用情况被划分为相互排斥的门诊病人就诊类别和急性住院病人住院类别。每年与头颈部 MSKI 相关的 PC 成本也被记录在案:21 财政年度,109,683 名 ADSM 因头颈部 MSKI 寻求治疗,占美国武装部队总人数的 7.3%。在 16-21 财年期间,头颈部 MSKI 的发病率从 6.9% 到 7.8%不等,其中空军(8.0%-9.4%)和陆军(7.9%-8.8%)的年发病率最高。在各军种的直接护理中,士兵每年在头颈部 MSKI 门诊就诊的比例最高(45.9%-47.9%)。空军在头颈部 MSKI 门诊治疗中最依赖 PC,21 财年 PC 费用为 9,134,741 美元,占所有 PC 就诊人次的 37.2%:这项回顾性、描述性研究确定了 16-21 财年各军种头颈部 MSKI 的流行率/发病率、医疗保健利用率和 PC 成本,强调了头颈部 MSKI 对美国武装部队造成的负担,仅 21 财年的 PC 成本就高达 42,912,940 美元。
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引用次数: 0
High-Grade B-Cell Lymphoma: An Atypical Mass in the Colon. 高级别 B 细胞淋巴瘤:结肠中的非典型肿块
IF 1.2 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-21 DOI: 10.1093/milmed/usae488
Jessica Corder, Shira Paul, Joshua Dehart, Lindsay Jayne, Allison Bush

Masses in the colon can range from benign to malignant etiologies, with adenocarcinoma being the most common malignancy. Although the most frequently encountered hematologic malignancy in the military population, lymphoma is uncommonly identified during colonoscopy. We present a rare case of an active duty service member with abdominal pain and a large mesenteric mass with extension into the cecum that was a high-grade B-cell lymphoma diagnosed through endoscopy.

结肠肿块的病因有良性和恶性之分,其中腺癌是最常见的恶性肿瘤。淋巴瘤虽然是军人中最常见的血液系统恶性肿瘤,但在结肠镜检查中却很少被发现。我们介绍了一例罕见病例:一名现役军人因腹痛和肠系膜大肿块并延伸至盲肠,经内镜检查确诊为高级别 B 细胞淋巴瘤。
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引用次数: 0
Musculoskeletal Injury Surveillance in the U.S. Military: Analysis of the ICD-10-CM Transition and Descriptive Report of Health Care Utilization at Four Sites Adopting MHS GENESIS. 美国军队中的肌肉骨骼损伤监测:对 ICD-10-CM 过渡的分析和四个采用 MHS GENESIS 的医疗保健使用情况的描述性报告。
IF 1.2 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-21 DOI: 10.1093/milmed/usad462
Ben Hando, Veronika Pav, Brad Isaacson, Courtney Colahan, Wendy Funk, Xiaoning Yuan

Introduction: The U.S. Military Health System (MHS) transitioned to the ICD-10-CM coding scheme in October 2015 and began the phased rollout of a new electronic health record system, MHS GENESIS, in October 2017. Both changes have the potential to affect the observed prevalence and health care utilization associated with musculoskeletal injuries (MSKIs) in service members. The purpose of this article was to (1) determine the effect of the ICD-10-CM transition on the observed prevalence of select MSKI conditions and (2) describe MSKI-related health care utilization in four MTFs during the adoption of MHS GENESIS.

Materials and methods: We calculated monthly prevalence rates for six diagnostic groupings of MSKIs routinely seen in the MHS between October 2011 and February 2020. To determine if the transition to ICD-10-CM influenced prevalence rates, we performed an interrupted time series analysis, using the ICD-10-CM transition date (October 1, 2015) as the interruption point. To assess trends in direct and private sector care encounters during the MHS GENESIS transition, we calculated monthly MSKI-related encounters at four MTFs from November 1, 2015 through September 30, 2021.

Results: Three diagnoses had a significant (P < .05) change in the slope, or rate of change, for their monthly prevalence after the introduction of ICD-10-CM (patellofemoral pain syndrome, -0.18; stress fractures, 0.12; subacromial pain, 0.03). These diagnoses also had a significant level change or immediate change in monthly prevalence following the ICD-10-CM transition (patellofemoral pain syndrome, 24.2; stress fractures, 0.16; subacromial pain, 0.36). Three of the four sites adopting MHS GENESIS showed reduced 3-month averages (range: -7.1-13.0%) of MSKI-related encounters following the electronic health record transition. For two of the four MTFs, we observed an increased reliance on private sector immediately leading up to and following the change to MHS GENESIS.

Conclusions: The observed differences in monthly prevalence for certain MSKIs could be because of the changes in the amount and/or specificity of available codes in ICD-10-CM. Within the six selected diagnostic groupings of MSKIs, we found that patellofemoral pain syndrome, stress fractures, and subacromial pain syndrome demonstrated the greatest changes in prevalence during the ICD-10-CM transition. Those involved in MSKI surveillance should exercise caution when evaluating MSKI prevalence that spans the ICD-10-CM transition. Changes in health care utilization patterns in two of the four MTFs during their adoption of MHS GENESIS suggest that MSKI care may have transferred from direct to private sector care during this period. Future research will be required to validate this finding and determine the impacts on clinical outcomes and military readiness.

导言:美国军事卫生系统(MHS)于 2015 年 10 月过渡到 ICD-10-CM 编码方案,并于 2017 年 10 月开始分阶段推出新的电子健康记录系统 MHS GENESIS。这两项变化都有可能影响观察到的与军人肌肉骨骼损伤(MSKIs)相关的患病率和医疗保健利用率。本文的目的是:(1)确定 ICD-10-CM 过渡对选定 MSKI 病症的观察流行率的影响;(2)描述在采用 MHS GENESIS 期间,四个 MTF 中与 MSKI 相关的医疗保健利用情况:我们计算了 2011 年 10 月至 2020 年 2 月期间在医疗服务系统中常规就诊的 MSKI 六种诊断分组的月流行率。为确定向 ICD-10-CM 过渡是否会影响患病率,我们以 ICD-10-CM 过渡日期(2015 年 10 月 1 日)为中断点,进行了中断时间序列分析。为了评估 MHS GENESIS 过渡期间直接和私营部门护理就诊的趋势,我们计算了从 2015 年 11 月 1 日到 2021 年 9 月 30 日期间四家 MTF 的每月 MSKI 相关就诊情况:结果显示:三种诊断的患病率有显著差异(P 结论:这三种诊断的患病率有显著差异:观察到的某些 MSKI 每月患病率的差异可能是由于 ICD-10-CM 中可用代码的数量和/或特异性发生了变化。在 MSKI 的六个选定诊断分组中,我们发现髌骨股骨疼痛综合征、应力性骨折和肩峰下疼痛综合征在 ICD-10-CM 过渡期间的患病率变化最大。参与 MSKI 监测的人员在评估跨越 ICD-10-CM 过渡期的 MSKI 流行率时应谨慎行事。四家 MTF 中的两家在采用 MHS GENESIS 期间医疗保健使用模式的变化表明,在此期间 MSKI 护理可能已从直接护理转移到私人护理。未来的研究将需要验证这一发现,并确定其对临床结果和军事准备的影响。
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引用次数: 0
Upper Extremity Musculoskeletal Injuries in United States Active Duty Service Members: Prevalence/Incidence, Health Care Utilization, and Cost Analysis Spanning Fiscal Years 2016-2021. 美国现役军人上肢肌肉骨骼损伤:美国现役军人上肢肌肉骨骼损伤:2016-2021 财年流行率/发病率、医疗保健利用率和成本分析》(Prevalence/Incidence, Health Care Utilization, and Cost Analysis spanning Fiscal Years 2016-2021.
IF 1.2 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-21 DOI: 10.1093/milmed/usae047
Brad Isaacson, Ben Hando, Veronika Pav, Linzie Wagner, Courtney Colahan, Paul Pasquina, Xiaoning Yuan

Introduction: Upper Extremity musculoskeletal injuries (UE MSKIs) represent a major threat to the overall health and readiness of U.S. active duty service members (U.S. ADSMs). However, a lack of prior research and inconsistent study and surveillance methodology has limited Department of Defense (DoD) leaders from assessing and addressing the burden of these conditions. The purpose of this study was to report the incidence, prevalence, and types of UE MSKIs sustained by ADSMs across four branches of service and describe associated health care utilization and private sector costs.

Materials and methods: This was a retrospective, longitudinal population study, including ADSMs from the Air Force, Army, Marine Corps, and Navy. Prevalence and incidence rates for UE MSKIs, associated health care utilization, and private sector costs were obtained by querying electronic health records from military treatment facilities (MTF), private sector care (PC) claims, and theater medical data from the Military Health System Data Repository from October 1, 2015 to September 30, 2021 (Fiscal Years [FYs] 16-21). Utilization associated with UE MSKIs in both the direct care (DC) and PC settings was classified into mutually exclusive outpatient encounter categories and acute inpatient stays. PC costs related to UE MSKIs were captured for each year.

Results: In FY21, UE MSKIs occurred in 15.0% of ADSMs (n = 224,842). From FY16-21, the Army had the highest annual prevalence of UE MSKIs (16.7-18.8%), followed by the Air Force (15.2-17.6%), Marine Corps (13.2-14.7%), and Navy (11.1-12.6%). Incidence rate patterns were similar, with the Army sustaining UE MSKIs at 172 to 199 injuries per 1,000 person-years, followed by the Air Force (150-181), Marines (140-157), and Navy (113-130). Overuse/non-specific MSKIs of the shoulder were the most common UE injury type and body region affected, respectively. There were 5,641,191 DC and 1,290,153 PC outpatient encounters from FY16-21 with a primary or secondary diagnosis of UE MSKI. The Air Force was most reliant on PC, with 31.5% of their UE MSKI-related encounters occurring outside MTFs during FY16-21.

Conclusions: Among U.S. ADSMs, UE MSKIs are both highly prevalent and financially burdensome. We observed variation across the Services in the prevalence and incidence of UE MSKIs, and their respective reliance on the private sector for management of these conditions. Findings from this work may support military leaders and MSKI researchers who seek to reduce the impact of UE MSKIs on the readiness and overall health of the U.S. Military.

导言:上肢肌肉骨骼损伤(UE MSKIs)对美国现役军人(U.S. ADSMs)的整体健康和战备状态构成重大威胁。然而,由于缺乏先前的研究以及研究和监测方法的不一致,限制了国防部(DoD)领导对这些状况的负担进行评估和解决。本研究的目的是报告美国海军陆战队员在四个军种中遭受的 UE MSKIs 的发生率、流行率和类型,并描述相关的医疗保健使用情况和私营部门成本:这是一项回顾性纵向人口研究,包括来自空军、陆军、海军陆战队和海军的助理海军陆战队员。通过查询2015年10月1日至2021年9月30日(16-21财年)期间军事治疗设施(MTF)的电子健康记录、私营部门护理(PC)索赔以及军事卫生系统数据存储库中的战区医疗数据,获得了UE MSKI的流行率和发病率、相关医疗保健利用率以及私营部门成本。与直接医疗(DC)和PC环境中的UE MSKIs相关的使用情况被划分为相互排斥的门诊就诊类别和急性住院治疗。每年与超常医疗服务相关的个人护理成本均有记录:21 财政年度,15.0% 的 ADSM(n = 224,842 人)发生了 UE MSKI。16-21 财年,陆军的 UE MSKI 年度发病率最高(16.7-18.8%),其次是空军(15.2-17.6%)、海军陆战队(13.2-14.7%)和海军(11.1-12.6%)。发病率模式相似,陆军的非特异性 MSKI 受伤率为每千人年 172 至 199 例,其次是空军(150-181 例)、海军陆战队(140-157 例)和海军(113-130 例)。肩部的过度使用/非特异性 MSKI 分别是最常见的 UE 损伤类型和受影响的身体区域。在 16-21 财政年度,有 5,641,191 例 DC 和 1,290,153 例 PC 门诊病人的主要或辅助诊断为 UE MSKI。空军最依赖 PC,16-21 财政年度期间,31.5% 的 UE MSKI 相关就诊发生在 MTF 以外:结论:在美国助理医疗服务人员中,UE MSKI 的发生率很高,而且造成了沉重的经济负担。我们观察到各军种在 UE MSKI 的流行率和发病率方面存在差异,而且他们各自都依赖私营部门来管理这些病症。这项工作的研究结果可以为军队领导和 MSKI 研究人员提供支持,帮助他们降低 UE MSKI 对美军战备和整体健康的影响。
{"title":"Upper Extremity Musculoskeletal Injuries in United States Active Duty Service Members: Prevalence/Incidence, Health Care Utilization, and Cost Analysis Spanning Fiscal Years 2016-2021.","authors":"Brad Isaacson, Ben Hando, Veronika Pav, Linzie Wagner, Courtney Colahan, Paul Pasquina, Xiaoning Yuan","doi":"10.1093/milmed/usae047","DOIUrl":"https://doi.org/10.1093/milmed/usae047","url":null,"abstract":"<p><strong>Introduction: </strong>Upper Extremity musculoskeletal injuries (UE MSKIs) represent a major threat to the overall health and readiness of U.S. active duty service members (U.S. ADSMs). However, a lack of prior research and inconsistent study and surveillance methodology has limited Department of Defense (DoD) leaders from assessing and addressing the burden of these conditions. The purpose of this study was to report the incidence, prevalence, and types of UE MSKIs sustained by ADSMs across four branches of service and describe associated health care utilization and private sector costs.</p><p><strong>Materials and methods: </strong>This was a retrospective, longitudinal population study, including ADSMs from the Air Force, Army, Marine Corps, and Navy. Prevalence and incidence rates for UE MSKIs, associated health care utilization, and private sector costs were obtained by querying electronic health records from military treatment facilities (MTF), private sector care (PC) claims, and theater medical data from the Military Health System Data Repository from October 1, 2015 to September 30, 2021 (Fiscal Years [FYs] 16-21). Utilization associated with UE MSKIs in both the direct care (DC) and PC settings was classified into mutually exclusive outpatient encounter categories and acute inpatient stays. PC costs related to UE MSKIs were captured for each year.</p><p><strong>Results: </strong>In FY21, UE MSKIs occurred in 15.0% of ADSMs (n = 224,842). From FY16-21, the Army had the highest annual prevalence of UE MSKIs (16.7-18.8%), followed by the Air Force (15.2-17.6%), Marine Corps (13.2-14.7%), and Navy (11.1-12.6%). Incidence rate patterns were similar, with the Army sustaining UE MSKIs at 172 to 199 injuries per 1,000 person-years, followed by the Air Force (150-181), Marines (140-157), and Navy (113-130). Overuse/non-specific MSKIs of the shoulder were the most common UE injury type and body region affected, respectively. There were 5,641,191 DC and 1,290,153 PC outpatient encounters from FY16-21 with a primary or secondary diagnosis of UE MSKI. The Air Force was most reliant on PC, with 31.5% of their UE MSKI-related encounters occurring outside MTFs during FY16-21.</p><p><strong>Conclusions: </strong>Among U.S. ADSMs, UE MSKIs are both highly prevalent and financially burdensome. We observed variation across the Services in the prevalence and incidence of UE MSKIs, and their respective reliance on the private sector for management of these conditions. Findings from this work may support military leaders and MSKI researchers who seek to reduce the impact of UE MSKIs on the readiness and overall health of the U.S. Military.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":"189 Supplement_4","pages":"34-44"},"PeriodicalIF":1.2,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142682191","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Musculoskeletal Spine Injuries in U.S. Active Duty Service Members: Prevalence/Incidence, Healthcare Utilization, and Cost Analysis Spanning Fiscal Years 2016-2021. 美国现役军人的肌肉骨骼脊柱损伤:2016-2021财年的流行率/发病率、医疗保健使用率和成本分析》(Prevalence/Incidence, Healthcare Utilization, and Cost Analysis spanning Fiscal Years 2016-2021)。
IF 1.2 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-21 DOI: 10.1093/milmed/usae248
Xiaoning Yuan, Emma Stewart, Courtney Colahan, Paul Pasquina, Brad Isaacson, Veronika Pav, Ben Hando

Background: Low back pain and musculoskeletal injuries (MSKIs) of the Spine are the most common reason for U.S. active duty service members (ADSMs) to seek medical care. The purposes of this descriptive study were to report the prevalence/incidence, health care utilization, and health care costs attributable to Spine (thoracic, lumbar, sacral, and pelvic) MSKIs across the four major branches of service from Fiscal Years (FY) 2016 to 2021.

Materials and methods: This was a retrospective, longitudinal population study, including ADSMs from the Air Force, Army, Marine Corps, and Navy. Prevalence and incidence rates for Spine MSKIs, associated health care utilization, and costs were obtained by querying electronic health records (EHRs) from military treatment facilities, private sector care (PC) claims, and theater medical data from the Military Health System Data Repository from October 1, 2015 to September 30, 2021 (FY16-21). Utilization associated with Spine MSKIs in both the direct care (DC) and PC settings was classified into mutually exclusive outpatient encounter categories and acute inpatient stays. PC costs related to Spine MSKIs were captured per year.

Results: In FY21, 269,301 ADSMs sought care for Spine MSKI, representing 18.0% of the U.S. Armed Forces. The prevalence of Spine MSKIs ranged from 17.4 to 19.5% during FY16-21, with the highest annual prevalence among the Army (20.7-22.9%) and Air Force (19.0-22.6%). Across the study period, Soldiers had the highest share (47.8-50.4%) of DC outpatient encounters for Spine MSKI (primary or secondary diagnosis). The Air Force relied most heavily on PC for outpatient Spine MSKI care across the study period, where in FY21 Airmen accounted for 36.5% of the outpatient PC Spine MSKI encounters totaling $21,140,935 in PC costs. In FY21, total PC costs for Spine MSKI totaled $99,317,832.

Conclusions: This retrospective, descriptive study establishes prevalence/incidence, health care utilization, and PC costs for Spine MSKIs across the Services from FY16-21 and highlights the burden of Spine MSKIs among the U.S. Armed Forces, with costs amounting to over $99 million in PC reliance in FY21 alone.

背景:腰痛和脊柱肌肉骨骼损伤(MSKIs)是美国现役军人(ADSMs)就医的最常见原因。这项描述性研究的目的是报告 2016 至 2021 财政年度(FY)四大兵种脊柱(胸椎、腰椎、骶椎和骨盆)MSKI 的患病率/发病率、医疗保健利用率和医疗保健成本:这是一项回顾性纵向人群研究,包括来自空军、陆军、海军陆战队和海军的 ADSM。通过查询2015年10月1日至2021年9月30日(FY16-21)期间军队治疗机构的电子健康记录(EHR)、私营部门护理(PC)索赔以及军事卫生系统数据存储库中的战区医疗数据,获得了脊柱MSKI的流行率和发病率、相关医疗保健使用情况和成本。与脊柱 MSKIs 相关的直接护理(DC)和 PC 环境下的使用情况被划分为相互排斥的门诊就诊类别和急性住院治疗。与脊柱 MSKIs 相关的 PC 成本按年计算:21 财政年度,269,301 名 ADSM 因脊柱 MSKI 就医,占美国武装部队人数的 18.0%。在 16-21 财年期间,脊柱 MSKI 的发病率在 17.4% 到 19.5% 之间,其中陆军和空军的年发病率最高,分别为 20.7% 到 22.9%(19.0% 到 22.6%)。在整个研究期间,士兵在脊柱 MSKI(主要或辅助诊断)的 DC 门诊就诊人次中所占比例最高(47.8%-50.4%)。在整个研究期间,空军在脊柱 MSKI 门诊治疗中最依赖 PC,21 财年,空军占脊柱 MSKI 门诊 PC 就诊人次的 36.5%,PC 费用总计 21 140 935 美元。21 财政年度,脊柱 MSKI 的 PC 费用总额为 99,317,832 美元:这项回顾性、描述性研究确定了 16-21 财年各军种脊柱 MSKI 的流行率/发病率、医疗保健利用率和 PC 成本,并强调了脊柱 MSKI 给美国武装部队造成的负担,仅 21 财年的 PC 费用就超过了 9900 万美元。
{"title":"Musculoskeletal Spine Injuries in U.S. Active Duty Service Members: Prevalence/Incidence, Healthcare Utilization, and Cost Analysis Spanning Fiscal Years 2016-2021.","authors":"Xiaoning Yuan, Emma Stewart, Courtney Colahan, Paul Pasquina, Brad Isaacson, Veronika Pav, Ben Hando","doi":"10.1093/milmed/usae248","DOIUrl":"https://doi.org/10.1093/milmed/usae248","url":null,"abstract":"<p><strong>Background: </strong>Low back pain and musculoskeletal injuries (MSKIs) of the Spine are the most common reason for U.S. active duty service members (ADSMs) to seek medical care. The purposes of this descriptive study were to report the prevalence/incidence, health care utilization, and health care costs attributable to Spine (thoracic, lumbar, sacral, and pelvic) MSKIs across the four major branches of service from Fiscal Years (FY) 2016 to 2021.</p><p><strong>Materials and methods: </strong>This was a retrospective, longitudinal population study, including ADSMs from the Air Force, Army, Marine Corps, and Navy. Prevalence and incidence rates for Spine MSKIs, associated health care utilization, and costs were obtained by querying electronic health records (EHRs) from military treatment facilities, private sector care (PC) claims, and theater medical data from the Military Health System Data Repository from October 1, 2015 to September 30, 2021 (FY16-21). Utilization associated with Spine MSKIs in both the direct care (DC) and PC settings was classified into mutually exclusive outpatient encounter categories and acute inpatient stays. PC costs related to Spine MSKIs were captured per year.</p><p><strong>Results: </strong>In FY21, 269,301 ADSMs sought care for Spine MSKI, representing 18.0% of the U.S. Armed Forces. The prevalence of Spine MSKIs ranged from 17.4 to 19.5% during FY16-21, with the highest annual prevalence among the Army (20.7-22.9%) and Air Force (19.0-22.6%). Across the study period, Soldiers had the highest share (47.8-50.4%) of DC outpatient encounters for Spine MSKI (primary or secondary diagnosis). The Air Force relied most heavily on PC for outpatient Spine MSKI care across the study period, where in FY21 Airmen accounted for 36.5% of the outpatient PC Spine MSKI encounters totaling $21,140,935 in PC costs. In FY21, total PC costs for Spine MSKI totaled $99,317,832.</p><p><strong>Conclusions: </strong>This retrospective, descriptive study establishes prevalence/incidence, health care utilization, and PC costs for Spine MSKIs across the Services from FY16-21 and highlights the burden of Spine MSKIs among the U.S. Armed Forces, with costs amounting to over $99 million in PC reliance in FY21 alone.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":"189 Supplement_4","pages":"45-55"},"PeriodicalIF":1.2,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142682186","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Lower Extremity Musculoskeletal Injuries in United States Active Duty Service Members: Prevalence/Incidence, Health Care Utilization, and Cost Analysis Spanning Fiscal Years 2016-2021. 美国现役军人的下肢肌肉骨骼损伤:美国现役军人下肢肌肉骨骼损伤:2016-2021 财年流行率/发病率、医疗保健利用率和成本分析》(Prevalence/Incidence, Health Care Utilization, and Cost Analysis spanning Fiscal Years 2016-2021.
IF 1.2 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-21 DOI: 10.1093/milmed/usae046
Brad Isaacson, Ben Hando, Veronika Pav, Linzie Wagner, Courtney Colahan, Paul Pasquina, Xiaoning Yuan

Introduction: Lower Extremity musculoskeletal injuries (LE MSKIs) represent a significant portion of overuse injuries in active duty service members (ADSMs). However, variations in study methods and research gaps related to LE MSKIs have prevented Department of Defense (DoD) leaders from assessing the burden of these conditions. The purpose of this study was to report the incidence, prevalence, and types of LE MSKIs sustained by ADSMs across four branches of service and describe associated health care utilization and private sector costs.

Materials and methods: This was a retrospective, longitudinal population study, including ADSMs from the Air Force, Army, Marine Corps, and Navy. Prevalence and incidence rates for LE MSKIs, associated health care utilization, and costs were obtained by querying electronic health records (EHR) from military treatment facilities (MTFs), private sector care (PC) claims, and theater medical data from the Military Health System Data Repository (MDR) from October 1, 2015 to September 30, 2021 (FY16-21). Utilization associated with LE MSKIs in both the direct care (DC) and PC settings was classified into mutually exclusive outpatient encounter categories and acute inpatient stays. PC costs related to LE MSKIs were captured for each year.

Results: In FY21, LE MSKIs occurred in 25.3% of ADSMs (n = 378,615). A higher proportion of females sustained an LE MSKI (33.3%), compared to males (23.7%). From FY16-21, the Army had the highest annual prevalence of LE MSKIs (30.9-35.5%), followed by the Air Force (23.8-31.0%), Marine Corps (23.4-27.0%), and Navy (17.2-19.8%). Incidence rate patterns were similar, with the Army sustaining LE MSKIs at 320 to 377 injuries per 1,000 person-years, followed by the Air Force (241-318), Marines (255-288), and Navy (173-203). Overuse/non-specific MSKIs of the knee were the most common injury type and body region affected, respectively. There were 10,675,543 DC and 1,875,307 PC outpatient encounters from FY16-21 with a primary or secondary diagnosis of LE MSKI. The Air Force was most reliant on PC, with 21.5 to 36.8% of LE MSKI-related encounters occurring outside MTFs during FY16-21. Over $99 million was paid by TRICARE on LE MSKI in FY21 alone with Same Day Surgeries accounting for almost half ($48 million) of this total.

Conclusions: Among U.S. ADSMs, LE MSKIs remain highly prevalent and costly. We observed disparities across the Services in the prevalence and incidence of LE MSKIs, and their respective reliance on the private sector for management of these conditions. Findings from this work may support military leaders and MSKI researchers who seek to reduce the impact of LE MSKIs on the readiness and overall health of the U.S. Military.

导言:下肢肌肉骨骼损伤(LE MSKIs)占现役军人(ADSMs)过度劳损的很大一部分。然而,与下肢肌肉骨骼损伤相关的研究方法和研究缺口的差异阻碍了国防部(DoD)领导对这些病症的负担进行评估。本研究的目的是报告四个军种的 ADSM 所患 LE MSKI 的发病率、流行率和类型,并描述相关的医疗保健使用情况和私营部门成本:这是一项回顾性纵向人口研究,包括来自空军、陆军、海军陆战队和海军的 ADSM。通过查询2015年10月1日至2021年9月30日(16-21财年)期间军事治疗设施(MTF)的电子健康记录(EHR)、私营部门护理(PC)索赔以及军事卫生系统数据存储库(MDR)的战区医疗数据,获得了LE MSKI的流行率和发病率、相关医疗保健使用情况和成本。与 LE MSKIs 相关的直接护理 (DC) 和 PC 环境的使用情况被划分为相互排斥的门诊病人就诊类别和急性住院病人住院类别。每年与 LE MSKIs 相关的 PC 成本均有记录:21财年,25.3%的ADSM(n = 378,615)发生了LE MSKI。与男性(23.7%)相比,女性发生 LE MSKI 的比例更高(33.3%)。16-21 财政年度,陆军的 LE MSKI 年度发病率最高(30.9%-35.5%),其次是空军(23.8%-31.0%)、海军陆战队(23.4%-27.0%)和海军(17.2%-19.8%)。发病率模式类似,陆军的致命性 MSKI 伤害发生率为每千人年 320-377 例,其次是空军(241-318 例)、海军陆战队(255-288 例)和海军(173-203 例)。膝关节的过度使用/非特异性 MSKI 分别是最常见的受伤类型和受影响的身体部位。在 16-21 财政年度,有 10,675,543 例 DC 和 1,875,307 例 PC 门诊病人的主要或辅助诊断为 LE MSKI。空军最依赖 PC,16-21 财政年度期间,21.5% 到 36.8% 的 LE MSKI 相关就诊发生在 MTF 之外。仅在 21 财政年度,TRICARE 就为 LE MSKI 支付了超过 9,900 万美元,其中当日手术几乎占了一半(4,800 万美元):结论:在美国的 ADSM 中,LE MSKI 仍然非常普遍且费用高昂。我们观察到各军种在 LE MSKI 的流行率和发病率方面存在差异,而且各军种都依赖私营部门来管理这些病症。这项工作的研究结果可以为军队领导和 MSKI 研究人员提供支持,帮助他们减少 LE MSKI 对美军战备和整体健康的影响。
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引用次数: 0
期刊
Military Medicine
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