Military Health Outcomes

Military Outcomes Research

Problem

The Military Health System’s (MHS) TRICARE health plan services 9.4 million active duty and retired military personnel and their dependents, a cohort of universally insured individuals that reflects the socioeconomic and racial demographics seen in the U.S. As healthcare costs continue to rise exponentially across the country, the Military Health System Data Repository (MDR) offers an opportunity to understand variations and drivers in healthcare utilization within the MHS and beyond, identifying areas for value optimization and better health outcomes.

Approach

The Comparative Effectiveness and Provider Induced Demand Collaboration (EPIC) formed in 2011 as a partnership between the CSPH and the Uniformed Services University (USU). The collaboration focuses on studying some of the most pressing healthcare challenges faced by military and civilian populations using the MDR. While initially established to identify drivers of increasing healthcare costs in the context of healthcare quality, utilization, and disparities, the collaboration has inspired a broader and deeper examination of contextual healthcare issues that impact military personnel and their dependents’ health outcomes. These include comparative effectiveness and outcomes, epidemiology, quality and practice improvement, healthcare disparities, provider-induced demand, and socioeconomic and geographic variation.

Impact

Through the EPIC collaboration, the Military Outcomes Research program is working to better the lives of military personnel and their families. The EPIC collaboration has brought the system to national attention comparing purchased and direct care, revealing the impact of provider-induced demand on healthcare costs. We have investigated opioid prescribing patterns in the MHS and demonstrated that under a universal healthcare scheme, racial disparities in outcomes disappear. Publishing articles across multiple research areas since 2016, the collaboration continues to inform discussions on healthcare reform for the MHS and the nation.

Affiliate Faculty

Andrew Schoenfeld, MD, MS

Staff

Dan Sturgeon, MS

Ginger (Zi) Jin, MSc

Fellows

Tomas Andriotti, MD, MPH

Michael Dalton, MD

2018 Reportable Outcomes

Black patients had higher rates of CRC screening and higher risk-adjusted odds of being screened compared to prior reports, and even compared to White patients within the population.

Orthopaedic outpatient care was associated with lower odds of ED use within 90 days and index hospital length of stay, medical comorbidities, and complications were associated with higher odds of ED use. Enhancing access to appropriate outpatient care with improved discharge planning may reduce ED use after total joint arthroplasties.

Laparoscopic inguinal repair is increasingly used and was preferred over open repair for younger, healthier, active-duty patients and those treated within the military (vs. non-military) care system.

Testicular atrophy is a rare complication following inguinal hernia repair, with children < 2 years and those with an undescended testis at highest risk. While 30% of cases were diagnosed within a year after repair, atrophy may be diagnosed substantially later.

The incidence of recurrence following inguinal hernia repair is 3.46 per 1000 person-years. The majority occurred within a year of repair. Children one year and under and those with multiple comorbidities were at increased risk.

Research Publication Highlights

Zogg CK, Jiang W, Chaudhary MA, Scott JW, Shah AA, Lipsitz SR, Weissman JS, Cooper Z, Salim A, Nitzschke SL, Nguyen LL. Racial disparities in emergency general surgery: do differences in outcomes persist among universally insured military patients? Journal of Trauma and Acute Care Surgery. 2016 May 1;80(5):764-77.

Nguyen LL, Smith AD, Scully RE, Jiang W, Learn PA, Lipsitz SR, Weissman JS, Helmchen LA, Koehlmoos T, Hoburg A, Kimsey LG. Provider-induced demand in the treatment of carotid artery stenosis: variation in treatment decisions between private sector fee-for-service vs salary-based military physicians. JAMA surgery. 2017 Jun 1;152(6):565-72.

Schoenfeld AJ, Jiang W, Harris MB, Cooper Z, Koehlmoos T, Learn PA, Weissman JS, Haider AH. Association between race and postoperative outcomes in a universally insured population versus patients in the State of California. Annals of surgery. 2017 Aug 1;266(2):267-73.

Schoenfeld AJ, Nwosu K, Jiang W, Yau AL, Chaudhary MA, Scully RE, Koehlmoos T, Kang JD, Haider AH. Risk factors for prolonged opioid use following spine surgery, and the association with surgical intensity, among opioid-naive patients. JBJS. 2017 Aug 2;99(15):1247-52.

Scully RE, Schoenfeld AJ, Jiang W, Lipsitz S, Chaudhary MA, Learn PA, Koehlmoos T, Haider AH, Nguyen LL. Defining optimal length of opioid pain medication prescription after common surgical procedures. JAMA surgery. 2018 Jan 1;153(1):37-43.