After COVID-19: Improving the Patient's Outpatient Appointment Experience.

As the COVID-19 pandemic diminishes, it is expected that patients will seek more outpatient appointments resulting in adverse patient and clinic experiences if there is a corresponding increase in missed appointments. This study's purpose was to determine if there was an association between advanced access scheduling, also known as open access or same day scheduling, and missed appointment rates for patients scheduled with preferred primary care physicians vis-a-vis nonpreferred primary care physicians. Patients prescheduled with primary care providers and over the age of 18 years were included in the study, which totaled 4815 visits. Study results demonstrated a statistically significant mean proportion difference between the national no-show rate and the study's no-show rate as well as a significant association between physician type and visit status. The results suggested the potential for improving the patient experience with advanced access scheduling if patients are scheduled with their preferred primary care physician. This study may promote positive patient experiences by providing patients and clinicians with an understanding of the significance surrounding advanced access scheduling thus decreasing missed appointments.

Enhanced Multi-Service Markets: An Evolution in Military Health System Governance.

Background: The evolution of governance models for the Military Health System's (MHS) large hospitals, called medical treatment facilities (MTFs), has culminated with the effort to implement Enhanced Multi-Service Markets (eMSM). The term eMSM refers to two separate concepts. First, MSM refers to those geographic areas, that is, markets, which have the following characteristics: they have MTFs that are operated by two or more Department of Defense (DoD) Services, that is, Army, Navy, or Air Force; there is a large beneficiary population; there is a substantial amount of direct care (i.e., beneficiaries are treated at MTFs instead of TRICARE's purchased care from civilian providers); and there is a substantial readiness and training platform. Second, the term "enhanced" refers to an increase in management authority over clinical and business operations, readiness, and MTF workload. Methods: A retrospective review was conducted to study the evolution of military and civilian health care delivery models for the purpose of understanding how governance models have changed since the 1980s to design and manage MTFs with overlapping catchments areas. Primary and secondary data sources were analyzed through a comprehensive literature review. Findings: Since the 1980s, the MHS governance models have evolved from testing various managed care models to a regionally focused TRICARE model and culminating with an overlapping catchment area model entitled eMSMs. The eMSM model partially fulfills the original vision because the eMSM leaders have limited budgetary and resource allocation authority. Discussion: The various models sought to improve governance of overlapping catchment areas with the intent to enhance medical readiness, community health, and individual health care while reducing costs. However, the success of the current model, that is, eMSMs, cannot be fully assessed because the eMSM model was not fully implemented as originally envisioned. Instead, the current eMSM model partially implements the eMSM model. As a result, the current eMSMs operate solely through cooperation and collaboration, without directive authority. Nevertheless, there have been some market-specific initiatives. Further analysis is necessary in the event that eMSM market managers are granted governance authority. This authority would include the ability to allocate the overall market's budget, determine common clinical and business functions, optimize the readiness of both the medical and the operational forces assigned to the market, and reallocate resources to optimize MTF workload. The results of this analysis may determine whether the fully implemented eMSMs optimize patient-centric initiatives as well as improve the market's efficiency and effectiveness.

Lessons Learned: Military Screening for Posttraumatic Stress Disorder.

The purpose of this study was to assist military communities of interest to more accurately identify service members who may have emotional and behavior disorders. Specifically, this study identifies service members' perceptions of the Department of Defense Post-Deployment Health Reassessment (PDHRA) screening instrument for posttraumatic stress disorder (PTSD). Findings were that responses to the PDHRA were related to how it was administered and the respondents' perceptions of how the PTSD diagnosis could affect the ability to obtain jobs and obtain promotions. Recommendations include implementing a screening environment free of distractions, involving family members, and assuring a confidential PTSD diagnosis.

Assessing the Effects of Financial Literacy on Patient Engagement.

OBJECTIVE: We investigated the relationship between financial literacy and patient engagement while considering the possible interaction effects due to patient financial responsibility and patient-physician shared decision making, and the impact of personal attributes. METHODS: Participants consisted of an Internet-based sample of American adults (N = 160). Hierarchical multiple linear regression analysis was conducted to examine the relationship of the study variables on patient engagement. RESULTS: We found that patient financial responsibility (ß = -.19, p < .05) and patient-physician shared decision-making (ß = .17, p < .05) predicted patient engagement. However, there was no statistically significant relationship between patient financial literacy and patient engagement; moreover, the moderation effects of patient financial responsibility and shared decision making with financial literacy also were not statistically significant. CONCLUSIONS: Increasing patient financial responsibility and patient-physician shared decision making can impact patient engagement. Understanding the predictors of patient engagement and the factors that influence financial behaviors may allow for the development of interventions to enable patients to make better healthcare decisions, and ultimately, improve health outcomes.

The Influence of School-Based Health Centers on Adolescents' Youth Risk Behaviors.

INTRODUCTION: Youth risk behaviors that are developed during adolescence are likely to continue into adulthood, increasing chances of morbidity, mortality, and chronic health conditions. The Centers for Disease Control and Prevention identified six critical risk behaviors (unintentional injuries and violence, sexual behaviors leading to pregnancies and infections, alcohol and other drug use, tobacco use, poor dietary habits, and insufficient physical activities) and developed the Youth Risk Behavior Survey to monitor them. The purpose of this quantitative study was to investigate which health risk behaviors were affected by a new school-based health center (SBHC), using two urban school systems in the Mid-Atlantic region. METHOD: The Youth Risk Behavior Survey was administered at two schools in 2007 and 2011. Logistic regression was used to predict whether the dependent variables had changed based on the new SBHC. RESULTS: Overall, the new SBHC did not have a significant effect on the student's risk behaviors. DISCUSSION: Schools remain a critical part of adolescents' development, and access to SBHCs offers a safety net to students whose families may not have health insurance.

Religious Barriers to Health for Members of the Bronx Ghanaian Immigrant Muslim Community in New York City.

This research investigated the influence of religious beliefs, as well as education, immigration status, and health insurance status, on the perceived access and willingness to use healthcare services by the Bronx Ghanaian Immigrant Muslim Community (BGIMC) in New York City. A survey was administered to 156 male and female BGIMC members. Members with insurance were nine times more likely to report access to health care and almost seven times more likely to use healthcare services in the past 12 months. Immigration status, health insurance status, and education did not predict willingness to use health care for a broken arm nor for a severe fever but did predict willingness to use health care when experiencing dizziness. Understanding the social and religious factors related to the use of healthcare services should lead to tailored health insurance and access initiatives for the BGIMC and serve as a model for other immigrant communities in the USA.

The patient-centered medical home: a case study in transforming the military health system.

This case study describes the Military Health System's (MHS) patient-centered medical home (PCMH) initiative and how it is being delivered across the MHS by the Army, Navy, and Air Force. The MHS, an integrated delivery model that includes both military treatment facilities and civilian providers and health care institutions, is transforming its primary care platforms from the traditional acute, episodic system to the PCMH model of care to maximize patient experience, satisfaction, health care quality, and readiness and to control cost growth. Preliminary performance measures are analyzed to assess the impact of PCMH implementation on the core primary care processes of the MHS. This study also discusses lessons learned and recommendations for improving health care performance through the PCMH care model.

The U.S. Army Wounded Warrior Program (AW2): a case study in designing a nonmedical case management program for severely wounded, injured, and ill service members and their families.

This case study describes the innovative and unique U.S. Army Wounded Warrior Program (AW2), which provides nonmedical case management to the most severely wounded, injured, and ill soldiers and their families. The study describes the program and identifies the features for a successful nonmedical case management program of an identified population who has complex medical needs. Although the article focuses primarily on the role of the AW2 advocate, key components of the program are discussed, including successful initiatives as well as areas that required adjustment. The lessons learned are identified as well as recommendations for future nonmedical case management initiatives.

U.S. military service members' perceptions of the Anthrax Vaccine Immunization Program.

This research identifies the perceptions of U.S. military service members regarding the Department of Defense Anthrax Vaccine Immunization Program (AVIP). The service members' perceptions were addressed in the dimensions of ethics, effectiveness, and safety, as well as the overall perceptions of the AVIP. The study, conducted in October 2004, randomly selected active duty service members from the uniformed services assigned to a Caribbean military base who participated in the AVIP during the period of 1998 to 2000. Their perceptions were measured with a survey instrument with 14 closed-ended, Likert-scale questions. The research demonstrated that a substantial number of service members disagreed with issues regarding the ethics, safety, and efficacy of the AVIP. We recommend enhanced training and education to increase understanding of the benefits of the AVIP.

The design and implementation of a multidisciplinary prostate cancer clinic.

The authors describe how a "traditional" clinical center and research organization was transformed into a multidisciplinary clinic for patients with prostate cancer. How and why the clinic was designed and implemented, as well as benefits to patients, staff, and research initiatives, are detailed.

Perception of managerial and administrative competencies of professional pharmacists in the U.S. Department of Defense.

OBJECTIVE: To determine whether executive and junior pharmacists perceive skills, knowledge, and abilities (SKA) items differently. DESIGN: Two-factor split-plot analysis of variance (ANOVA) mixed design with repeated measures. SETTING: U.S. Department of Defense (DoD). PARTICIPANTS: One hundred fifty-one active duty pharmacy officers in DoD, classified as either executive pharmacists (serving in the military grades of lieutenant colonel/commander [0-5] and colonel/captain [0-6], as well as pharmacists selected for promotion to those grades) or junior pharmacists (serving in the military grades of second lieutenant/ensign [0-1], first lieutenant/lieutenant junior grade [0-2], and captain/lieutenant [0-3], as well as pharmacists selected for promotion to those grades). INTERVENTION: Seven-point relative importance rating scales, with 1 = extremely unimportant to 7 = extremely important, were used to assess respondents' judgments of SKAs. MAIN OUTCOME MEASURES: Main effects of group membership (executive versus junior pharmacists), differences among items within eight specific domains, and assessment of potential interaction effects for the dependent variable of SKA item importance ratings. RESULTS: No main effects for overall rating differences between pharmacist groups were found for any of the eight domains; however, statistically significant and systematic within-main-effect differences were detected for SKA items in all domains. Additionally, statistically significant interaction effects emerged in five of the eight domains. CONCLUSION: The importance ratings given SKAs in the domains of human resources, pharmacy operations and business practices, drug therapy management, and leadership were highly similar between the two groups. However, executive pharmacists tended to place a much greater emphasis on the importance of SKAs within the financial resources and the pharmacy benefit management domains.

Pharmacy executives: leadership issues and associated skills, knowledge, and abilities in the U.S. Department of Defense.

OBJECTIVES: To identify the issues or problems that current and aspiring U.S. Department of Defense (DoD) pharmacy executives will face in the future and to define the skills, knowledge, and abilities (SKAs) required to successfully address these issues. DESIGN: Delphi method for executive decision making. SETTING: DoD. PARTICIPANTS: Ninety-three pharmacists serving in the military grades of lieutenant colonel/commander and colonel/captain, as well as pharmacists selected for promotion to those grades. INTERVENTIONS: iterations of the Delphi method for executive decision making separated by an expert panel content analysis. MAIN OUTCOME MEASURES: Round 1--participants identified five major issues believed to be of greatest importance to pharmacy executives and reported specific SKAs that might be needed to successfully manage those issues. An expert panel sorted these issues into meaningful domains, then provided an appropriate title for each domain. Round 2--on a 7-point scale, respondents rated the SKA items according to their assessment of how much a future DoD pharmacy executive would need each SKA. RESULTS: Response rates were 44.1% and 46.2% for Delphi rounds 1 and 2, respectively. The first round generated 62 unique issues facing pharmacy executives. The expert panel reviewed and sorted the issues into eight domains and selected an appropriate title for each domain. The domains identified by the panel were human resources, pharmacy operations/business practices, information management and technology, financial resources, formulary management, drug therapy management, pharmacy benefit management, and leadership. During round 2, 73.3% of the top 15 rated SKAs came from the drug therapy management, leadership, and formulary management domains. The three highest-rated SKAs were "ability to see the big picture," "ability to build strong relations with medical staffs," and "skills in both writing and verbal communication." CONCLUSION: The issues facing future DoD pharmacy executives will require them to expand their clinical abilities as well as their ability to collaborate and communicate with other professionals.

A theoretical perspective using resource dependency to predict the potential migration of Medicare-eligible military beneficiaries into the Department of Defense's Managed Care System.

TRICARE for Life (TFL) became effective on October 1, 2001. On that date, approximately 1.5 million Medicare-eligible military beneficiaries (MEMB) regained health care reimbursement privileges resulting in significantly reduced individual out-of-pocket costs. TFL acts as a secondary payer to an eligible beneficiary's Medicare or other health insurance. Currently, TFL beneficiaries are allowed to remain in their current health care system. However, early discussions of Public Law 106-398 recommended that MEMB seek care at military treatment facilities. The return of MEMB to military treatment facilities may have presented a number of management challenges to leaders of the Military Health System. This article applies resource dependence theory to the issue of MEMB returning to military treatment facilities under the TFL program. Resource dependency theory and a conceptual model assist in identifying a number of challenges that may adversely affect MEMB in future years should this option ever become a reality.