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  1. Article ; Online: Analysis of Alcohol Use and Alcohol Use Disorder Trends in U.S. Active-Duty Service Women.

    Tower, Stephanie / Banaag, Amanda / Adams, Rachel Sayko / Janvrin, Miranda Lynn / Koehlmoos, Tracey Pérez

    Journal of women's health (2002)

    2024  

    Abstract: Introduction: ...

    Abstract Introduction:
    Language English
    Publishing date 2024-04-29
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1139774-3
    ISSN 1931-843X ; 1059-7115 ; 1540-9996
    ISSN (online) 1931-843X
    ISSN 1059-7115 ; 1540-9996
    DOI 10.1089/jwh.2023.0497
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  2. Article ; Online: Assessing mid-career female physician burnout in the military health system: finding joy in practice after the COVID-19 pandemic.

    Korona-Bailey, Jessica / Janvrin, Miranda Lynn / Shaw, Lisa / Koehlmoos, Tracey Perez

    BMC public health

    2024  Volume 24, Issue 1, Page(s) 862

    Abstract: Background: Rates of physician burnout increased during the COVID-19 pandemic and are expected to continue to rise. Mid-career physicians, female physicians, and military physicians have all been identified as potentially vulnerable populations to ... ...

    Abstract Background: Rates of physician burnout increased during the COVID-19 pandemic and are expected to continue to rise. Mid-career physicians, female physicians, and military physicians have all been identified as potentially vulnerable populations to experience burnout. We examine factors associated with physician burnout among this intersectional group through a qualitative key informant interview study.
    Methods: We developed a semi-structured interview guide using the Institute for Healthcare Improvement's Improving Joy in Work Framework and recruited military, mid-career female physicians who worked in the Military Health System(MHS) during the COVID-19 pandemic, (March 2020 -December 2021). Notes were collated and deductive thematic analysis was conducted.
    Results: We interviewed a total of 22 mid-career female physician participants. Participants were between 30 and 44 years of age and 7 were mothers during the pandemic. Most were White and served in the Army. All participants discussed the importance of building rapport and having a good relationship with coworkers. All participants also described their discontentment with the new MHS GENESIS electronic health record system. An emerging theme was military pride as most participants were proud to serve in and support the military population. Additionally, participants discussed the negative impact from not feeling supported and not feeling heard by leadership.
    Conclusions: Much like providers in other health systems during the pandemic, MHS physicians experienced burnout. This study allowed us to gather key insights to improve policies for active duty service mid-career female military physicians. Provider inclusion, autonomy, and work culture play critical roles in future systems improvement and workforce retention.
    MeSH term(s) Humans ; Female ; Child ; COVID-19/epidemiology ; Pandemics ; Military Health Services ; Burnout, Professional/epidemiology ; Physicians
    Language English
    Publishing date 2024-03-20
    Publishing country England
    Document type Journal Article
    ZDB-ID 2041338-5
    ISSN 1471-2458 ; 1471-2458
    ISSN (online) 1471-2458
    ISSN 1471-2458
    DOI 10.1186/s12889-024-18357-5
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  3. Article ; Online: The Impact of the COVID-19 Pandemic on the Military Health System's Care of Military Sexual Assault.

    Lorei, Nathan / Banaag, Amanda / Perez Koehlmoos, Tracey

    Military medicine

    2023  

    Abstract: Background: Sexual assault remains a high priority challenge for leaders in the U.S. military. The COVID-19 pandemic further complicated the issue by disrupting work and lifestyles, potentially affecting reporting and care-seeking by victims. To date, ... ...

    Abstract Background: Sexual assault remains a high priority challenge for leaders in the U.S. military. The COVID-19 pandemic further complicated the issue by disrupting work and lifestyles, potentially affecting reporting and care-seeking by victims. To date, there are no studies addressing the impact of changes in access to health services and reporting of sexual assault by active duty service members to inform medical and public health interventions in a post-COVID-19 era and during future public health emergencies.
    Methods: Using the Military Health System Data Repository (MDR), we identified a retrospective open cohort of active duty servicemembers receiving care in the Military Health System (MHS) from fiscal years 2018 to 2021. Through the use of ICD-10 diagnostic codes, all corresponding sexual assault care was identified for the cohort before (October 1, 2017-February 28, 2020; pre-pandemic period) and after (March 1, 2020-September 30, 2021; pandemic period) the institution of COVID-19 pandemic protective measures. Pre-pandemic and pandemic period rates of sexual assault associated encounters per 10,000 total health encounters were calculated by geographic location and compared using Wilcoxon's sign rank test. Multivariate log binomial regression models were performed to estimate associated risk of sexual assault among active duty servicemembers and compared across both periods.
    Results: The study identified 47,067,073 encounters for servicemembers in the pre-pandemic period, of which 7,813 (0.016%) were associated with sexual assault. During the pandemic period, 4,377 (0.015%) of 28,926,480 encounters were associated with sexual assault, indicating a 44% reduction in total encounters and a 9% reduction in the proportion of encounters associated with sexual assault. Eighteen installations within the MHS had statistically significant increases in rates of encounters. Most sexual assault encounters occurred in the 20-24 year age, Female, White, Junior Enlisted, Army, and Unmarried categories. During both time-frames, younger age and being female were associated with an increased risk of sexual assault encounters. Race, service branch, and marital status were also associated with the risk of encounters.
    Conclusion: Contrary to reports indicating a modest increase in the number of sexual assaults reported within the DoD, we found a reduction in the frequency of healthcare encounters associated with sexual assault during the pandemic which may be related to reduced access to care. Men comprised approximately 22% of sexual assault encounters delivered through the MHS although the racial distribution of encounters approximates the estimates of the DoD-published demographic statistics. This study illustrates that COVID-19 measures appear to have reduced access to care for sexual assault within the MHS but did not demonstrably alter the demographics of servicemembers seeking care. These findings suggest that the MHS may require contingency plans for future disruptions to care and public health emergencies.
    Language English
    Publishing date 2023-11-30
    Publishing country England
    Document type Journal Article
    ZDB-ID 391061-1
    ISSN 1930-613X ; 0026-4075
    ISSN (online) 1930-613X
    ISSN 0026-4075
    DOI 10.1093/milmed/usad470
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    Un I Zs.546: Show issues Location:
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  4. Article ; Online: Telehealth in the Military Health System: Impact, Obstacles, and Opportunities.

    Madsen, Cathaleen / Poropatich, Ronald / Koehlmoos, Tracey Pérez

    Military medicine

    2023  Volume 188, Issue Suppl 1, Page(s) 15–23

    Abstract: Background: The U.S. Military Health System (MHS) pioneered the use of telehealth in deployed environments in the early 1990s. However, its use in non-deployed environments historically lagged behind that of the Veterans Health Administration (VHA) and ... ...

    Abstract Background: The U.S. Military Health System (MHS) pioneered the use of telehealth in deployed environments in the early 1990s. However, its use in non-deployed environments historically lagged behind that of the Veterans Health Administration (VHA) and comparable large civilian health systems, due to administrative, policy, and other obstacles that slowed or blocked its expansion in the MHS. A report was prepared in December 2016, which summarized past and then-present telehealth initiatives in the MHS; described the obstacles, opportunities, and policy environment; and provided three possible courses of action for expansion of telehealth in deployed and non-deployed settings.
    Methods: Gray literature, peer-reviewed literature, presentations, and direct input were aggregated under the guidance of subject matter experts.
    Results: Past and then-current efforts demonstrated significant telehealth capability in use and in development for the MHS, mainly in deployed or operational settings. Policy from 2011 to 2017 demonstrated an environment favorable for MHS expansion, while the review of comparable civilian and veterans' healthcare systems showed significant benefits including increased access and lower cost from use of telehealth in non-deployed settings. The 2017 National Defense Authorization Act charged the Secretary of Defense with promoting telehealth usage for the Department of Defense, including provisions for removing obstacles and reporting progress within 3 years. The MHS has the ability to reduce burdensome interstate licensing and privileging requirements, but still requires an increased level of cybersecurity, compared to civilian systems.
    Discussion: The benefits of telehealth fit with the MHS Quadruple Aim of improving cost, quality, access, and readiness. Readiness is particularly served by the use of "physician extenders," which allows nurses, physician assistants, medics, and corpsmen to provide hands-on care under remote oversight and to practice at the top of their licenses. Based on this review, three courses of action were recommended: to focus largely on developing telehealth in deployed environments; to maintain focus in deployed environments and increase telehealth development in non-deployed environments to keep pace with the VHA and private sector; or to use lessons learned from military and civilian telehealth initiatives to leapfrog the private sector.
    Conclusion: This review serves as a snapshot in time of the steps leading to telehealth expansion before 2017, which helped to set the stage for later use of telehealth in behavioral health initiatives and as a response to coronavirus disease 2019. The lessons learned are ongoing and further research is expected to inform additional development of telehealth capability for the MHS.
    MeSH term(s) United States ; Humans ; COVID-19 ; Military Health Services ; Telemedicine ; Hand ; Military Personnel
    Language English
    Publishing date 2023-02-28
    Publishing country England
    Document type Review ; Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, U.S. Gov't, Non-P.H.S.
    ZDB-ID 391061-1
    ISSN 1930-613X ; 0026-4075
    ISSN (online) 1930-613X
    ISSN 0026-4075
    DOI 10.1093/milmed/usac207
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  5. Article ; Online: Designing a knowledge translation tool for women's health research in the U.S. Military Health System.

    Janvrin, Miranda Lynn / Korona-Bailey, Jessica / Koehlmoos, Tracey Perez

    Health research policy and systems

    2023  Volume 21, Issue 1, Page(s) 47

    Abstract: Background: Current United States Department of Defense (DoD) estimates indicate that women comprise 17% of the total active duty component. Despite this, the specific health needs of service women have often been neglected. The Center for Health ... ...

    Abstract Background: Current United States Department of Defense (DoD) estimates indicate that women comprise 17% of the total active duty component. Despite this, the specific health needs of service women have often been neglected. The Center for Health Services Research (CHSR) at the Uniformed Services University (USU) has been working to create a portfolio of rapid research synthesis briefs on topics including, but not limited to reproductive health, infertility, pregnancy loss, and contraceptive use among active duty service women. The goal of these briefs is to condense and translate the existing research literature for a non-academic audience. The aim of this study is to evaluate the utility of the research briefs to inform decision making around service women's health issues and impart an overall understanding of the current literature surrounding these topics to a non-academic audience.
    Methods: Adopting a previously tested knowledge translation evaluation tool, we conducted a series of key informant interviews in July-August 2022 with decision makers in the Military Health System and the US DoD to elicit feedback regarding the overall utility of the research brief, as well as its ability to meet standards of usefulness, usability, desirability, credibility, and value.
    Results: We interviewed a total of 17 participants of a diverse range of healthcare occupations and educational backgrounds, but all currently were working within the Department of Defense in support of the Military Health System. User feedback on the research brief was thematically evaluated based on the predetermined themes of usefulness, desirability, credibility, value, and two emergent themes-findability and language.
    Conclusions: This study allowed us to gather key insights from decision makers to better tailor future iterations of our research brief toward rapidly disseminating information for improving the healthcare and policy of active duty service women. The key themes ascertained from this study may help others when adapting their own knowledge translation tools.
    MeSH term(s) Pregnancy ; Humans ; Female ; Military Health Services ; Translational Science, Biomedical ; Women's Health ; Abortion, Induced ; Delivery of Health Care
    Language English
    Publishing date 2023-06-08
    Publishing country England
    Document type Journal Article
    ZDB-ID 2101196-5
    ISSN 1478-4505 ; 1478-4505
    ISSN (online) 1478-4505
    ISSN 1478-4505
    DOI 10.1186/s12961-023-01002-9
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  6. Article: Association between body composition standards and eating disorder medical claims among active-duty service women.

    Korona-Bailey, Jessica / Banaag, Amanda / Walker, Jasmine / Fortin, Stephanie / Eyeler, Megan / Koehlmoos, Tracey Pérez

    Journal of eating disorders

    2024  Volume 12, Issue 1, Page(s) 29

    Abstract: Introduction: Eating disorders are a worldwide public health concern with the United States having a particularly high prevalence. Eating disorders are of particular concern to the Department of Defense and Military Health System (MHS) because body ... ...

    Abstract Introduction: Eating disorders are a worldwide public health concern with the United States having a particularly high prevalence. Eating disorders are of particular concern to the Department of Defense and Military Health System (MHS) because body composition standards are in place for active-duty service members.
    Methods: We conducted a cross-sectional study of active-duty service women (ADSW) ages 18 and older in the U.S. Army, Air Force, Navy, and Marine Corps during fiscal years (FY) 2018-2019. Utilizing claims data from the MHS Data Repository (MDR), we identified ADSW with a Body Mass Index (BMI) measure during the study period and compared their BMI to Service-specific requirements and diagnosis of an eating disorder.
    Results: We identified a total of 161,209 ADSW from the MDR in FYs 2018-2019 with a recorded BMI, of whom 61,711 (38.3%) had a BMI exceeding the maximum BMI Service-specific standards during the study period and 0.5% had an eating disorder diagnosis. Increased risk of an eating disorder was found in ADSW with an Underweight BMI. Further, we found that there was no association of disordered eating diagnoses among ADSW who were near the maximum height/weight standard set by their Service.
    Conclusion: There appears to be no association between body composition standards of the Services and eating disorder diagnoses in ADSW. We were not able to investigate unhealthy habits around diet or exercise directly related to body composition standards.
    Language English
    Publishing date 2024-02-19
    Publishing country England
    Document type Journal Article
    ZDB-ID 2699357-0
    ISSN 2050-2974
    ISSN 2050-2974
    DOI 10.1186/s40337-024-00990-5
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  7. Article ; Online: Avoidable Hospitalizations in the Military Health System, Fiscal Years 2018-2019.

    Koehlmoos, Tracey Pérez / Banaag, Amanda / Korona-Bailey, Jessica / Schoenfeld, Andrew J / Weissman, Joel S

    Military medicine

    2024  

    Abstract: Introduction: Ongoing health reforms in the Military Health System (MHS) are expected to shift locations of ambulatory care for up to 1.9 million beneficiaries. We sought to model the impact of this policy by determining potentially avoidable ... ...

    Abstract Introduction: Ongoing health reforms in the Military Health System (MHS) are expected to shift locations of ambulatory care for up to 1.9 million beneficiaries. We sought to model the impact of this policy by determining potentially avoidable hospitalizations in the MHS based on different primary care settings.
    Materials and methods: We used the MHS Data Repository to conduct a retrospective cross-sectional study of TRICARE Prime and Prime Plus beneficiaries aged 18 to 64 years during fiscal years 2018-2019. Crude and adjusted risk ratios for each Agency for Healthcare Research and Quality prevention quality indicator based on primary care setting were calcualated to determine the total probability of admission for any of the Agency for Healthcare Research and Quality prevention indicators.
    Results: We identified a total of 260,690 hospital admissions by patients in the MHS with a designated primary care manager (PCM) from fiscal year 2018 to 2019. Of the total admissions, 11,067 (4.25%) were for Agency for Healthcare Research and Quality prevention quality indicators, 3.63% by direct care PCM at a military treatment facility, and 0.61% by a civilian private sector PCM. Risk of admission was lower for private sector PCMs for urinary tract infection, hypertension, perforated appendix, and angina without the procedure. We did not observe a statistically significant adjusted odds ratio of admission in patients managed by private sector PCMs (1.04 adjusted odds ratio; 95% CI, 0.97-1.11).
    Conclusions: Our findings indicate no difference in the likelihood of avoidable hospitalizations for beneficiaries with a private sector PCM when looking at all conditions together. Patients with a private sector PCM are protected against hospitalization for several conditions. Our findings indicate no adverse impact on avoidable hospitalizations for beneficiaries transitioned to private sector care from direct care.
    Language English
    Publishing date 2024-04-24
    Publishing country England
    Document type Journal Article
    ZDB-ID 391061-1
    ISSN 1930-613X ; 0026-4075
    ISSN (online) 1930-613X
    ISSN 0026-4075
    DOI 10.1093/milmed/usae137
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  8. Article ; Online: Correction: The response of the Military Health System (MHS) to the COVID-19 pandemic: a summary of findings from MHS reviews.

    Pomer, Alysa / Munigala, Satish / Coles, Christian L / Mitro, Jessica Pope / Schoenfeld, Andrew J / Weissman, Joel S / Koehlmoos, Tracey Perez

    Health research policy and systems

    2024  Volume 22, Issue 1, Page(s) 18

    Language English
    Publishing date 2024-01-30
    Publishing country England
    Document type Published Erratum
    ZDB-ID 2101196-5
    ISSN 1478-4505 ; 1478-4505
    ISSN (online) 1478-4505
    ISSN 1478-4505
    DOI 10.1186/s12961-024-01109-7
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  9. Article: Fetal alcohol spectrum disorders prevention and clinical guidelines research-workshop report.

    Koehlmoos, Tracey Pérez / Lee, Elizabeth / Wisdahl, Jennifer / Donaldson, Tom

    BMC proceedings

    2023  Volume 17, Issue Suppl 12, Page(s) 19

    Abstract: It is estimated that up to 1 in 20 people in the United States are affected by fetal alcohol spectrum disorders (FASD), an array of cognitive, emotional, physical and social disorders caused by exposure to alcohol during prenatal development. Common ... ...

    Abstract It is estimated that up to 1 in 20 people in the United States are affected by fetal alcohol spectrum disorders (FASD), an array of cognitive, emotional, physical and social disorders caused by exposure to alcohol during prenatal development. Common diagnoses encompassed within FASD include mood and behavioral disorders, memory and central nervous system deficits, attention-deficit/hyperactivity disorder (ADHD), slow growth and low body weight. While this condition affects a broad range of individuals and families, it is of particular concern in the military community, where cultural factors including an increased prevalence of alcohol misuse pose a unique set of challenges. To shed light on these issues and provide an overview of the existing research, programs, and clinical practice guidelines surrounding FASD, the Uniformed Services University of the Health Sciences (USUHS), in conjunction with FASD United, hosted the Workshop on Fetal Alcohol Spectrum Disorders Prevention and Clinical Guidelines Research on 21 September 2022 in Washington, DC. More than 50 attendees from academia, healthcare, federal agencies, and consumer advocacy organizations gathered to share research findings, lived experiences, and strategies for improving FASD prevention, diagnosis, interventions, and support.The workshop began with a series of presentations on FASD risk factors and causes, strategies for diagnosis and interventions, and impacts and lived experiences. Individuals and families affected by FASD spoke about the ways FASD, its symptoms, and the social stigma associated with it influences their daily lives, experiences at school and work, and access to healthcare. Several speakers highlighted the work of non-profit organizations and advocacy groups in supporting families affected by FASD and other challenges faced by military families more broadly. The workshop closed with a discussion of federal agency perspectives highlighting initiatives aimed at advancing research and access to care for women and families at-risk and those currently affected by FASD.
    Language English
    Publishing date 2023-08-15
    Publishing country England
    Document type Journal Article
    ZDB-ID 2411867-9
    ISSN 1753-6561
    ISSN 1753-6561
    DOI 10.1186/s12919-023-00272-z
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  10. Article ; Online: Changes in body mass index and behavioral health among adolescents in military families during the COVID-19 pandemic: a retrospective cohort study.

    Koehlmoos, Tracey Pérez / Madsen, Cathaleen / Banaag, Amanda / Adirim, Terry

    BMC public health

    2023  Volume 23, Issue 1, Page(s) 1615

    Abstract: Background: Widely published findings from the COVID-19 pandemic show adverse effects on body mass index (BMI) and behavioral health in both adults and children, due to factors such as illness, job loss, and limited opportunity for physical and social ... ...

    Abstract Background: Widely published findings from the COVID-19 pandemic show adverse effects on body mass index (BMI) and behavioral health in both adults and children, due to factors such as illness, job loss, and limited opportunity for physical and social activity. This study investigated whether these adverse effects were mitigated in adolescents from military families, who are universally insured with consistent access to healthcare, and who generally have at least one parent who must adhere to physical and mental fitness as a condition of employment.
    Methods: We conducted a cohort study using two groups of adolescents receiving care in the U.S. Military Health System during the COVID-19 pandemic; one for changes in Body Mass Index (BMI) and the second for changes in behavioral health diagnoses, using TRICARE claims data. Beneficiaries (160,037) ages 13 to 15 years in fiscal years 2017-2018, were followed up during October 2020 to June 2021.
    Results: Among the BMI cohort, 44.32% of underweight adolescents moved to healthy weight, 28.48% from overweight to obese, and 3.7% from healthy weight to underweight. Prevalence of behavioral disorders showed an overall 29.01% percent increase during the study period, which included in mood (86.75%) and anxiety (86.49%) disorders, suicide ideation (42.69%), and suicide attempts (77.23%). Decreases in percent change were observed in conduct disorders (-15.93%) and ADD/ADHD (-8.61%).
    Conclusions: Adolescents in military families experienced adverse health outcomes during the pandemic at approximately the same rates as those in non-military families, suggesting that universal insurance and military culture were not significantly mitigating factors. Obesity and underweight present significant opportunities to intervene in areas such as exercise and food access. Decreased conduct disorders and ADD/ADHD may reflect lower prevalence due to favorable home environment, or lower rates of diagnosis and referral; however, increased rates of anxiety, mood disorders, suicide ideation and attempt are especially concerning. Care should be taken to ensure that adolescents receive consistent opportunity for physical activity and social interaction, and those at risk for suicide should receive active monitoring and appropriate referral to behavioral healthcare providers.
    MeSH term(s) Adult ; Child ; Humans ; Adolescent ; COVID-19/epidemiology ; Body Mass Index ; Pandemics ; Cohort Studies ; Retrospective Studies ; Thinness ; Drug-Related Side Effects and Adverse Reactions
    Language English
    Publishing date 2023-08-24
    Publishing country England
    Document type Journal Article ; Research Support, U.S. Gov't, Non-P.H.S.
    ZDB-ID 2041338-5
    ISSN 1471-2458 ; 1471-2458
    ISSN (online) 1471-2458
    ISSN 1471-2458
    DOI 10.1186/s12889-023-16548-0
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