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.
{"title":"Navigating the Leadership Tightrope: A Case Study in the Art of Following and Supporting.","authors":"Matthew C Pflipsen","doi":"10.1093/milmed/usae538","DOIUrl":"https://doi.org/10.1093/milmed/usae538","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142716435","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}
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.
{"title":"Dosimetry as a Lagging Indicator of Occupational Exposure to Nitrous Oxide in Pediatric Sedation: A Collaborative Process Improvement Project With Industrial Hygiene.","authors":"Jennifer S Kicker, Cynthia Y Timbie, Susan L Kline","doi":"10.1093/milmed/usae523","DOIUrl":"https://doi.org/10.1093/milmed/usae523","url":null,"abstract":"<p><strong>Introduction: </strong>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.</p><p><strong>Materials and methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142716431","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}
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.
{"title":"Utilization of Prognosis Assignment: A Cross-Sectional Survey of Military Periodontists.","authors":"Richard E Sawaya, Noel E Dickens, Keith R Merchant, John H Wilson, Caitlin D Darcey","doi":"10.1093/milmed/usae496","DOIUrl":"https://doi.org/10.1093/milmed/usae496","url":null,"abstract":"<p><strong>Introduction: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142687380","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}
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.
{"title":"Capturing and Categorizing the Burden of Musculoskeletal Injuries in U.S. Active Duty Service Members: A Comprehensive Methodology.","authors":"Veronika Pav, Xiaoning Yuan, Brad Isaacson, Wendy Funk, Ben Hando","doi":"10.1093/milmed/usae245","DOIUrl":"https://doi.org/10.1093/milmed/usae245","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>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 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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":"189 Supplement_4","pages":"70-77"},"PeriodicalIF":1.2,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142682112","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}
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。
{"title":"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.","authors":"Xiaoning Yuan, Emma Stewart, Courtney Colahan, Paul Pasquina, Brad Isaacson, Veronika Pav, Ben Hando","doi":"10.1093/milmed/usae045","DOIUrl":"https://doi.org/10.1093/milmed/usae045","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>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 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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":"189 Supplement_4","pages":"22-33"},"PeriodicalIF":1.2,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142682180","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}
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。
{"title":"High-Grade B-Cell Lymphoma: An Atypical Mass in the Colon.","authors":"Jessica Corder, Shira Paul, Joshua Dehart, Lindsay Jayne, Allison Bush","doi":"10.1093/milmed/usae488","DOIUrl":"https://doi.org/10.1093/milmed/usae488","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142682094","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}
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.
{"title":"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.","authors":"Ben Hando, Veronika Pav, Brad Isaacson, Courtney Colahan, Wendy Funk, Xiaoning Yuan","doi":"10.1093/milmed/usad462","DOIUrl":"https://doi.org/10.1093/milmed/usad462","url":null,"abstract":"<p><strong>Introduction: </strong>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.</p><p><strong>Materials and methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":"189 Supplement_4","pages":"78-86"},"PeriodicalIF":1.2,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142682184","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}
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.
{"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}
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.
{"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}
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。
{"title":"Lower 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/usae046","DOIUrl":"https://doi.org/10.1093/milmed/usae046","url":null,"abstract":"<p><strong>Introduction: </strong>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.</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 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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":"189 Supplement_4","pages":"56-69"},"PeriodicalIF":1.2,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142682116","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}