scholarly journals COVID-19 outcomes among U.S. Military Health System beneficiaries include complications across multiple organ systems and substantial functional impairment

2021 ◽  
Author(s):  
Stephanie A Richard ◽  
Simon D Pollett ◽  
Charlotte A Lanteri ◽  
Eugene V Millar ◽  
Anthony C Fries ◽  
...  
Keyword(s):  
United States ◽  
Risk Factors ◽  
Health System ◽  
Clinical Outcomes ◽  
Symptom Onset ◽  
The United States ◽  
Military Health System ◽  
Military Health ◽  
Patient Reported ◽  
The Impact

Abstract Background We evaluated the clinical outcomes, functional burden, and complications one month after COVID-19 infection in a prospective United States Military Health System (MHS) cohort of active duty, retiree, and dependent populations using serial patient-reported outcome surveys and electronic medical record (EMR) review. Methods MHS beneficiaries presenting at nine sites across the United States with a positive SARS-CoV-2 test, a COVID-19 like illness, or a high-risk SARS-CoV-2 exposure were eligible for enrollment. Medical history and clinical outcomes were collected through structured interviews and ICD-based EMR review. Risk factors associated with hospitalization were determined by multivariate logistic regression. Results A total of 1,202 participants were enrolled. There were 1,070 laboratory confirmed SARS-CoV-2 cases and 132 SARS-CoV-2 negative participants. In the first month post-symptom onset among the SARS-CoV-2 positive cases, there were 214 hospitalizations, 79% requiring oxygen, 22 ICU admissions, and 9 deaths. Risk factors for COVID-19 associated hospitalization included race (increased for Asian, Black, and Hispanic compared to non-Hispanic White), age (age 45-64 and 65+ compared to <45), and obesity (BMI>=30 compared to BMI<30). Over 2% of survey respondents reported the need for supplemental oxygen and 31% had not returned to normal daily activities at one-month post-symptom onset. Conclusions Older age, reporting Asian, Black or Hispanic race/ethnicity, and obesity are associated with SARS-CoV-2 hospitalization. A proportion of acute SARS-CoV-2 infections require long-term oxygen therapy; the impact of SARS-CoV-2 infection on short-term functional status was substantial. A significant number of MHS beneficiaries had not yet returned to normal activities by one month.

scholarly journals Examining Racial Disparities in Diabetes Readmissions in the United States Military Health System

2020 ◽  
Vol 185 (9-10) ◽  
pp. e1679-e1685
Author(s):  
Dianne Frankel ◽  
Amanda Banaag ◽  
Cathaleen Madsen ◽  
Tracey Koehlmoos
Keyword(s):  
United States ◽  
Health System ◽  
The United States ◽  
Direct Care ◽  
Diabetic Patients ◽  
Military Health System ◽  
Military Health ◽  
Alaskan Native ◽  
Care System ◽  
White Patients

ABSTRACT Introduction Diabetes is one of the most common chronic conditions in the United States and has a cost burden over $120 billion per year. Readmissions following hospitalization for diabetes are common, particularly in minority patients, who experience greater rates of complications and lower quality healthcare compared to white patients. This study examines disparities in diabetes-related readmissions in the Military Health System, a universally insured, population of 9.5 million beneficiaries, who may receive care from military (direct care) or civilian (purchased care) facilities. Methods The study identified a population of 7,605 adult diabetic patients admitted to the hospital in 2014. Diagnostic codes were used to identify hospital readmissions, and logistic regression was used to analyze associations among race, beneficiary status, patient or sponsor’s rank, and readmissions at 30, 60, and 90 days. Results A total of 239 direct care patients and 545 purchased care patients were included in our analyses. After adjusting for age and sex, we found no significant difference in readmission rates for black versus white patients; however, we found a statistically significant increase in the likelihood for readmission of Native American/Alaskan Native patients compared to white patients, which persisted in direct care at 60 days (adjusted odds ratio [AOR] 11.51, 95% CI 1.11–119.41) and 90 days (AOR 18.42, 95% CI 1.78–190.73), and in purchased care at 90 days (AOR 4.54, 95% CI 1.31–15.74). Conclusion Our findings suggest that universal access to healthcare alleviates disparities for black patients, while Native America/Alaskan Native populations may still be at risk of disparities associated with readmissions among diabetic patients in both the closed direct care system and the civilian fee for service purchased care system.

scholarly journals An Editorial Review of Mobile Health: Implications for the US Military Health System

2019 ◽  
Vol 184 (7-8) ◽  
pp. e253-e258
Author(s):  
Daniel J Selig ◽  
Jeannette Collins ◽  
Tyler L Church ◽  
Joseph Zeman
Keyword(s):  
United States ◽  
Health System ◽  
Access To Care ◽  
Mobile Health ◽  
The United States ◽  
United States Military ◽  
Military Health System ◽  
Military Health ◽  
Mobile Health Applications ◽  
Treatment Facilities

Abstract Introduction The United States Military Health System provides healthcare to a diverse patient population throughout the world. There are three distinct challenges that the Military Health System faces. (1) Providers have varying degrees of clinical training expertise and may be called upon to practice outside their usual scope of care. (2) There is geographic isolation of patients and providers with limited resources while stationed overseas. (3) Patients are at higher risk of breaks in continuity of care because of permanent change of duty stations, deployments, and retirement. Materials and Methods In this article we review the history of mobile health in both the civilian and military sectors, and how mobile health may be used to address the challenges unique to the United States Military Health System. Results There are many good initiatives in military mobile health, however they are decentralized and different across the services and military treatment facilities. We describe some military specific success stories with improving patient access to care and disease specific mobile health applications implemented. Conclusions Mobile health is a powerful platform which can help deliver standardized care in missions around the world and improve access to care for patients at military treatment facilities in the United States. The United States Military Health System would benefit greatly from creating universal mobile health applications to assist providers in patient access to care, military mission readiness, and disease specific modules. Future resources should be dedicated to the development of a mobile health application pool that is universally implemented across services to improve quality of care delivered at home and in theater by military providers.

scholarly journals A scoping review of female drowning: an underexplored issue in five high-income countries

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kym Roberts ◽  
Ogilvie Thom ◽  
Susan Devine ◽  
Peter A. Leggat ◽  
Amy E. Peden ◽  
...  
Keyword(s):  
United States ◽  
Risk Factors ◽  
United Kingdom ◽  
New Zealand ◽  
Clinical Outcomes ◽  
Scoping Review ◽  
The United States ◽  
Clinical Treatment ◽  
High Income ◽  
Public Health Issue

Abstract Background Drowning is a significant public health issue, with females accounting for one third of global drowning deaths. The rate of female drowning has not decreased within high-income countries and presentations to hospital have increased. This scoping review aimed to explore adult female unintentional drowning, including risk factors, clinical treatment and outcomes of females hospitalised for drowning. Methods A systematic search of the literature following the PRISMA-ScR framework was undertaken. The databases OVID MEDLINE, Embase, CINAHL, OVID Emcare, Web of Science, Informit and Scopus were accessed. Study locations of focus were Australia, Canada, New Zealand, the United Kingdom, and the United States. Studies from January 2003 to April 2019 were included. The quality of evidence of included studies was assessed using GRADE guidelines. Results The final search results included 14 studies from Australia (n = 4), Canada (n = 1), New Zealand (n = 1), United States (n = 6), United Kingdom (n = 1), and one study reporting data from both Australia and United States. Nine studies reported risk factors for female drowning including age, with the proportion of female drowning incidence increasing with age. Although females are now engaging in risk-taking behaviours associated with drowning that are similar to males, such as consuming alcohol and swimming in unsafe locations, their exposure to risky situations and ways they assess risk, differ. Females are more likely to drown from accidental entry into water, such as in a vehicle during a flood or fall into water. This review found no evidence on the clinical treatment provided to females in hospital after a drowning incident, and only a small number of studies reported the clinical outcomes of females, with inconsistent results (some studies reported better and some no difference in clinical outcomes among females). Conclusion Adult females are a group vulnerable to drowning, that have lacked attention. There was no single study found which focused solely on female drowning. There is a need for further research to explore female risk factors, the clinical treatment and outcomes of females hospitalised for drowning. This will not only save the lives of females, but also contribute to an overall reduction in drowning.

Sign in / Sign up

Export Citation Format

Share Document