Session 11A - Increasing MTF Effectiveness & Efficiency


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Session 11A - Increasing MTF Effectiveness & Efficiency

  1. 1. Session 11a: Increasing MTFEffectiveness & Efficiency throughPopulation Health and MedicalManagement CDR James Ellzy, MD, CMQ Teaching Faculty, DeWitt Army Family Medicine Residency & Immediate Past Director of MHS Clinical Quality 11-1
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  3. 3. Functions of Medical Officers Misconceptions as to the functions of the Medical Department are not uncommon even in the Army. Since, in the time of peace, the medical officer is best known through his relation to the sick, his more important duties may be overlooked. His prime function is, in peace or war, not the cure, but the prevention of disease… The care of the sick, essential though it is from ethical and political considerations, thus assumes relative insignificance from the military standpoint. Military Hygiene (1914) by Frank Keefer 11-3
  4. 4. Levels of Prevention / Intervention True Prevention: Primary Remove risk Early detection Secondary and Treatment Reduce Tertiary complications 11-4
  5. 5. Disease Continuum Onset of pre- Diagnosis clinical Onset of Seek & disease Detectable symptoms care treatment OutcomeDisease free 1o 2o 3o 11-5
  6. 6. Definition of Epidemiology The study of the distribution and determinants of health related states or events in specified populations and its application to the control of health problems 11-6
  7. 7. Clinical Medicine vs. Epidemiology Clinical Medicine Epidemiology Focus Individuals Populations Diagnosis and Main Goal Prevention and Control Treatment What are the leading What is wrong with causes of death or this patient? Questions disability in this What treatment is population? What can be appropriate? done to reduce them? 11-7
  8. 8. Uses of Epidemiology • Identify the etiology or cause of disease and the relevant risk factors • Determine the extent of disease in the community • Study the natural history and prognosis of disease • Evaluate preventive and therapeutic measures and modes of health care delivery • Provide foundation for public policy relating to environmental and genetic issues, and other considerations regarding disease prevention and health promotion 11-8
  9. 9. Epidemiologic Triad of Disease Host Vector Agent Environment 11-9
  10. 10. What is the EpidemiologicTriad for AMI? 11-10
  11. 11. 1o 2o 3o11-11
  12. 12. Population Health Surveillance Its purpose is to provide a factual basis •Appropriately set priorities from which you can: • Plan programs • Take action to promote and protect the population’s health 11-12
  13. 13. Why Use Surveillance Systems? • Monitor trends of disease including the detection of epidemics or outbreaks • Assess your population’s health status • Guide the planning, implementation, and evaluation of programs to prevent and control disease, injury, or adverse exposure • Define your healthcare priorities • Evaluate health policies 11-13
  14. 14. No Vaccine = ARD Epidemics Vaccine year-round Vaccine given No Vaccine only 1 Sep-31Mar 11-14
  15. 15. 11-15Critical Decision Making for Medical11a -
  16. 16. DoD is Swimming in Data >22 applications and 25 interfaces to hundreds of MHS Systems 11-16 Critical Decision Making for Medical11a -
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  18. 18. Tools for MHS Leaders• TRICARE Operations Center• Population Health Portal• CarePoint Suite• AFHSC• 11-18
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  20. 20. CarePoint Suite 11-20
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  22. 22. Electronic Surveillance System for the EarlyNotification of Community-based Epidemics(ESSENCE) Standard Ambulatory Data Records ADM data is are archived at MTFs M sent to Tricare Prescription data for DOD T beneficiaries is captured by PDTS and sent to Tricare F Tricare updates ESSENCE Version 1B repository every 8 hours Version IV Data analyzed by syndrome and organized into alerts by MTFs Graphs of daily visit counts by syndrome 11-22
  23. 23. What Do You Want to Know About YourPopulation’s Health Status???• How sick or healthy is my population?• What are the disease states that require the most services and utilization?• What are their clinical preventive service and disease management needs?• Who are my high utilizers that may need case management?• How can I estimate demand for future services?• How can I most effectively use my providers to meet these needs? 11-23
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