Data-driven approaches to care delivery: Actionable informatics in the DoD's primary care behavioral health program.

INTRODUCTION: Transforming administrative health care data into meaningful metrics has been critical to the implementation of the Department of Defense's Primary Care Behavioral Health (PCBH) program. METHODS: Data from clinical encounters with PCBH providers are used to develop metrics of program performance collaboratively. Metrics focus on describing the PCBH program and patients, provider fidelity to the model, and provider performance. These metrics form two key deliverables: a monitoring dashboard for program managers and a training dashboard for expert trainers conducting site visits. RESULTS: Behavioral health consultants (BHCs) conducted nearly 200,000 encounters with more than 100,000 unique patients in fiscal year 2019 at more than 170 locations in 6 countries and 37 states. Administrative data derived from these encounters were used to create a variety of metrics that describe practice and performance at both the provider and program levels. These metrics are delivered through a variety of analytic products to stakeholders who use that information to make data-driven decisions about program direction and provider training. DISCUSSION: We discuss examples of program management decisions and expert trainer actions based on these dashboards, highlighting the benefits of continued collaboration between analysts and program managers. Specifically, excerpts from several dashboards illustrate how penetration and productivity metrics yield specific, tailored action plans to improve care delivery and provider performance. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Explosive ordnance disposal personnel in the U.S. military have higher risk of insomnia and post-traumatic stress disorder: a large retrospective cohort study.

PURPOSE: We examined the risk of post-traumatic stress disorder (PTSD), affective disorders, alcohol/substance-related disorders, traumatic brain injury (TBI) and insomnia, among explosive ordnance disposal (EOD) technicians compared to the general population of active-duty non-EOD personnel in the U.S. military. METHODS: We conducted a retrospective cohort study using administrative and healthcare utilization data from fiscal year 2004 (FY2004) to FY2015 for this comparison. We used propensity score matching to balance baseline covariates, and discrete-time hazard models to compare the odds of occurrence of the outcomes. RESULTS: EOD personnel had higher odds of having a new diagnosis of insomnia (odds ratio [OR] = 1.33; 95% confidence interval [CI]:1.22-1.45) and PTSD (OR = 1.23; 95% CI:1.08-1.41) than did non-EOD personnel. EOD technicians had lower odds of having a new diagnosis of affective disorders (OR = 0.83; 95% CI:0.79-0.87) and alcohol/substance-related disorders (OR = 0.59; 95% CI:0.54-0.64) than did non-EOD personnel. There was little evidence of a difference in the odds of a TBI diagnosis (OR = 1.07; 95% CI:0.99-1.16). CONCLUSIONS: As reliance on EOD forces continues, ongoing vigilance of the stressors, health sequelae and disincentives to access mental health care among this military occupation should be monitored and mitigated wherever possible.

Rates of prescription orders for United States active duty service members diagnosed with alcohol use disorder.

Background: Alcohol-use disorders (AUD) pose a significant challenge for the United States (US) military. The US Department of Defense has strongly recommended several medications for use in the treatment of patients with diagnosed AUD. This study assessed the prescription of medications for active duty service members (ADSMs) diagnosed with AUD in the US Military Health System (MHS). Methods: Rates of prescription orders were retrospectively examined from 2010 to 2017 among ADSMs with an incident diagnosis of moderate-to-severe AUD. The rate of prescription orders was defined as the proportion of ADSMs with an ICD-9 or ICD-10 diagnosis code of alcohol dependence who received an order for acamprosate, disulfiram, naltrexone, and/or topiramate at a military treatment facility in the year following their incident diagnosis. Results: ADSMs receiving an order for at least one medication in the year following their incident AUD diagnosis increased from 8.8% in 2010 to 16.2% in 2017 (RR = 1.84, 95% CI, 1.76, 1.93). Oral naltrexone was ordered most frequently among this patient population, while injectable naltrexone, a medication option meant to ease and improve adherence, was ordered for a smaller proportion of patients. Conclusions: Most ADSMs who might benefit from prescriptions for AUD are not receiving them as part of their treatment despite strong clinical evidence and Department of Defense policy support for their use among this cohort.