Office of the Assistant Secretary of Defense

Falls Church, VA, United States

Office of the Assistant Secretary of Defense

Falls Church, VA, United States
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Rhon D.I.,U.S. Army | Rhon D.I.,Baylor University | Golden K.J.,Office of the Assistant Secretary of Defense | Trevino A.J.,Olympic Sports and Spine Rehabilitation | Hatler B.S.,U.S. Army
Military Medicine | Year: 2017

Background: The drowning impact that musculoskeletal injuries (MSI) have on Soldier readiness, deployability, and escalating health care costs is growing. These injuries are associated with approximately 25 million lost duty days each year. The need to curb costs and improve efficacy and efficiency of health care delivery is pressing. This requires the consideration of new paradigms for clinical pathways and health care delivery processes. Soldiers returning from a deployment go through a screening process to ensure any medical, dental, and administrative issues are adequately addressed. This is a great opportunity to influence optimal musculoskeletal (MSK) care, as nonbattle MSI are the most common injury sustained during a combat deployment. These screening processes usually consist of high throughput in short periods, taxing the usual flow of care through the associated medical clinic. Because the highest percentage of medical visits are related to MSK complaints, a dedicated clinic with specialty providers seeing these patients directly may improve the quality and efficiency of care. Methods: This report provides the details related to the implementation of a MSK specialty clinic such as this at Madigan Army Medical Center, for the return of a U.S. Army Reservist Brigade Combat Team of approximately 4,000 Soldiers. It provides a framework for determining patient flow and triaging of patients to expedited appropriate care directly from the screening site. We report on the demographics and types of injuries seen after deployment, and the patient satisfaction associated with those that were seen in this specialty clinic. Findings: Comparison to usual care were outside the scope of this report, however the patient satisfaction with the process was recorded, and was very high for all 284 patients that received care through this expedited care pathway. Discussion: This article provides a framework for an expedited clinical care pathway for patients returning from deployment that have MSI. It provides a platform for future feasibility testing and prospective studies related to the economic impact of this model when compared to usual care. © Association of Military Surgeons of the U.S. All rights reserved.


Linton A.,Pharmacy Outcomes Research Team PORT | Devine J.,Pharmacoeconomic Center | Cottrell L.,Kennell and Associates Inc. | McGinnis T.J.,Office of the Assistant Secretary of Defense | McAllister E.B.,Office of the Assistant Secretary of Defense
Journal of Managed Care Pharmacy | Year: 2010

BACKGROUND: Like many payers, the Department of Defense (DoD) has limited ability to work directly with prescribers to ensure appropriate medication use. Many older beneficiaries are prescribed multiple maintenance medications, placing them at higher risk for adverse drug interactions, contraindicated medication use, and other polypharmacy-related problems. Medication reviews may mitigate these risks, but the optimal venue for medication therapy management is unclear. OBJECTIVES: To (a) determine if beneficiaries will respond to a mailed request from the DoD to pursue a medication review; (b) identify medication review location and outcomes from the patient perspective; and (c) assess the statistical significance of changes in the number of prescription medications overall and for key categories, including maintenance medications and contraindicated medications, relative to a propensity-matched comparison group. METHODS: A total of 4,000 TRICARE beneficiaries aged 55 years or older, residing in North Carolina, who obtained 10 or more maintenance medications (defined by a unique combination of drug, strength, and dosage form) during the 90-day baseline period from May 3, 2008, to July 31, 2008, were mailed letters requesting their participation in the study. Consenting subjects received a personalized medication list to review with their physicians or pharmacists and a survey form to complete after the review. Survey results were compared by location of medication review (i.e., physician's office, pharmacy, or both). Changes from the 90-day baseline to 90-day post-intervention period were calculated for prescription utilization measures (total drug count, maintenance drug count, count of Beers list medications, and count of contraindicated drug combinations) for the subsample of subjects who completed the survey (n = 373) and for subjects who received the initial consent letter (n = 3,856) versus a propensity-matched comparison sample drawn from neighboring states. Variables included in the propensity score were gender, age group, military rank, catchment status indicating proximity to military pharmacies, enrollment status, number of pharmacy settings used, and each of 30 binary disease indicators. RESULTS: A total of 1,469 subjects responded to the consent letter (response rate = 38.1%); 606 subjects consented to participate (consent rate = 15.7%); and 373 subjects returned a completed survey (completion rate = 9.7%). Among those who completed the survey, 190 (50.9%) received reviews in a physician's office; 103 (27.6%) received reviews in a pharmacy; 60 (16.1%) received reviews in both locations; and 20 (5.4%) reported a different location or no location. 61 survey respondents (16.4%) indicated that they were told to stop a medication, and 77 (20.6%) reported a dosage change. Medication changes occurred significantly more frequently for reviews performed at a physician's office compared with other review locations. Therapeutic classes most frequently stopped or adjusted for dosage were antidiabetics, diuretics, antilipidemics, renin-angiotensin aldosterone system inhibitors, anticoagulants, nonsteroidal anti-inflammatory drugs, and beta-adrenergic blocking agents. 85% of respondents reported that the medication review was worth doing. In the assessments of changes in prescription utilization from the baseline to post-intervention periods, no significant by-group differences were noted among those who completed the study relative to their matched comparison subjects. In the comparison of subjects who received the initial consent letter with their matched counterparts, small but statistically significant differences were observed for several prescription utilization measures, including changes in use of high-risk Beers list medications (P = 0.033); use of electrolytic, caloric, and water balance medications (P = 0.038); and use of hypertension medications (P = 0.028). The magnitude of the decrease observed among comparison subjects, however, exceeded that observed among the case subjects. CONCLUSIONS: Response was poor to a mailing that promoted a beneficiary-initiated medication review. The absence of significant changes following the medication review suggests several possibilities: a mailed intervention is ineffective in promoting medication review; medication regimens for study subjects are already optimized to the extent obtainable through a routine medication review; or the study sample size was too small to detect relevant changes. Most drug regimen changes were dosage adjustments for current medications or substitutions within the same therapeutic class. The extent to which comprehensive assessment of a patient's medication regimen, including nonprescription and herbal agents, was performed is unclear. More intensive interventions may be required to ensure that medication regimens are being actively managed among those who use a large number of prescription medications. Copyright © 2010, Academy of Managed Care Pharmacy. All rights reserved.


Linton A.,Pharmacy Outcomes Research Team PORT | Bacon T.A.,PORT | Trice S.,PORT | Devine J.,Pharmacoeconomic Center | And 3 more authors.
Journal of Managed Care Pharmacy | Year: 2010

BACKGROUND: Like many payers, the Department of Defense (DoD) has limited ability to work directly with prescribers to ensure appropriate medication use. Many older beneficiaries are prescribed multiple maintenance medications, placing them at higher risk for adverse drug interactions, contraindicated medication use, and other polypharmacy-related problems. Medication reviews may mitigate these risks, but the optimal venue for medication therapy management is unclear. OBJECTIVES: To (a) determine if beneficiaries will respond to a mailed request from the DoD to pursue a medication review; (b) identify medication review location and outcomes from the patient perspective; and (c) assess the statistical significance of changes in the number of prescription medications overall and for key categories, including maintenance medications and contraindicated medications, relative to a propensity-matched comparison group. METHODS: A total of 4,000 TRICARE beneficiaries aged 55 years or older, residing in North Carolina, who obtained 10 or more maintenance medications (defined by a unique combination of drug, strength, and dosage form) during the 90-day baseline period from May 3, 2008, to July 31, 2008, were mailed letters requesting their participation in the study. Consenting subjects received a personalized medication list to review with their physicians or pharmacists and a survey form to complete after the review. Survey results were compared by location of medication review (i.e., physician's office, pharmacy, or both). Changes from the 90-day baseline to 90-day post-intervention period were calculated for prescription utilization measures (total drug count, maintenance drug count, count of Beers list medications, and count of contraindicated drug combinations) for the subsample of subjects who completed the survey (n = 373) and for subjects who received the initial consent letter (n = 3,856) versus a propensity-matched comparison sample drawn from neighboring states. Variables included in the propensity score were gender, age group, military rank, catchment status indicating proximity to military pharmacies, enrollment status, number of pharmacy settings used, and each of 30 binary disease indicators. RESULTS: A total of 1,469 subjects responded to the consent letter (response rate = 38.1%); 606 subjects consented to participate (consent rate = 15.7%); and 373 subjects returned a completed survey (completion rate = 9.7%). Among those who completed the survey, 190 (50.9%) received reviews in a physician's office; 103 (27.6%) received reviews in a pharmacy; 60 (16.1%) received reviews in both locations; and 20 (5.4%) reported a different location or no location. 61 survey respondents (16.4%) indicated that they were told to stop a medication, and 77 (20.6%) reported a dosage change. Medication changes occurred significantly more frequently for reviews performed at a physician's office compared with other review locations. Therapeutic classes most frequently stopped or adjusted for dosage were antidiabetics, diuretics, antilipidemics, renin-angiotensin aldosterone system inhibitors, anticoagulants, nonsteroidal anti-inflammatory drugs, and beta-adrenergic blocking agents. 85% of respondents reported that the medication review was worth doing. In the assessments of changes in prescription utilization from the baseline to post-intervention periods, no significant by-group differences were noted among those who completed the study relative to their matched comparison subjects. In the comparison of subjects who received the initial consent letter with their matched counterparts, small but statistically significant differences were observed for several prescription utilization measures, including changes in use of high-risk Beers list medications (P = 0.033); use of electrolytic, caloric, and water balance medications (P = 0.038); and use of hypertension medications (P = 0.028). The magnitude of the decrease observed among comparison subjects, however, exceeded that observed among the case subjects. CONCLUSIONS: Response was poor to a mailing that promoted a beneficiary-initiated medication review. The absence of significant changes following the medication review suggests several possibilities: a mailed intervention is ineffective in promoting medication review; medication regimens for study subjects are already optimized to the extent obtainable through a routine medication review; or the study sample size was too small to detect relevant changes. Most drug regimen changes were dosage adjustments for current medications or substitutions within the same therapeutic class. The extent to which comprehensive assessment of a patient's medication regimen, including nonprescription and herbal agents, was performed is unclear. More intensive interventions may be required to ensure that medication regimens are being actively managed among those who use a large number of prescription medications. Copyright © 2010, Academy of Managed Care Pharmacy. All rights reserved.


News Article | October 28, 2016
Site: www.marketwired.com

VANCOUVER, BC--(Marketwired - October 27, 2016) - Mission Ready Services Inc. ("Mission Ready" or the "Company") (TSX VENTURE: MRS) is pleased to announce that its subsidiary Protect The Force Inc. is the winner of the US DoD's Defense to Response (D2R) Technology Program. D2R is the Domestic Preparedness Support Initiative's (DPSI) Technology Transition Program that identifies three technologies, annually, and provides the full services of Texas A&M Engineering Extension Service's Product Development Center (TEEX PDC) to commercialize these technologies to enhance public safety and homeland security. Protect the Force traveled as one of 11 Finalists to College Station, Texas to participate in the Defense to Response Technology Showcase. After two rounds of judging, Protect the Force presented their Flex9Armor™ technology to a final panel of judges and was selected to receive $110,000 worth of services from TEEX PDC. Flex9Armor™, first developed and adopted by the U.S. Military, is comprised of a family of protective garments that provide stringent levels of ballistic protection and are simultaneously lightweight and flexible. Traditional Armor lacks coverage of the arms, chest and neck region of the body, and current additional protection for these areas adds weight and reduces mobility. Flex9Armor™ incorporates a network of NIJ Level II and IIIA body armor panels into a breathable anti-microbial material that is 30% lighter than conventional armor. Integrating all of these features into one combined garment makes Flex9Armor™ a superior option for first responders. Last year alone, Texas A&M Engineering Extension Service ("TEEX") served more than 168,000 people from every U.S. state and territory and 82 countries worldwide. TEEX is a leader in the delivery of emergency response, homeland security and workforce training and exercises, technical assistance, and economic development. The Product Development Center at TEEX utilizes these resources and networks to test, develop and launch products using the proven Think, Build, Sell method. Through the D2R Program, PDC will provide Protect the Force with market intelligence, product testing and a TEEX TESTED® report, business and responder mentors, and access to investors. The Department of Defense (DoD) Domestic Preparedness Support Initiative (DPSI), in the Office of the Assistant Secretary of Defense for Homeland Defense and Global Security, coordinates DoD efforts to identify, evaluate, deploy and transfer technology, items and equipment to Federal, state and local first responders. The Defense to Response Technology Program is sponsored and supported by DPSI. "We are extremely honored to have been chosen for this program and proud of a product that we believe will make a difference to the first responder community here at home and around the world," states Francisco Martinez, Chief Technology Officer, MRS. This news release contains "forward-looking information" within the meaning of applicable Canadian securities legislation. Generally, forward-looking information can be identified by the use of forward-looking terminology such as "anticipate", "believe", "plan", "expect", "intend", "estimate", "forecast", "project", "budget", "schedule", "may", "will", "could", "might", "should" or variations of such words or similar words or expressions. Forward-looking information is based on reasonable assumptions that have been made by Mission Ready Services Inc. as at the date of such information and is subject to known and unknown risks, uncertainties and other factors that may cause the actual results, level of activity, performance or achievements of Mission Ready Services Inc. to be materially different from those expressed or implied by such forward-looking information. Forward-looking statements are based on assumptions management believes to be reasonable. Although Mission Ready Services Inc. has attempted to identify important factors that could cause actual results to differ materially from those contained in forward-looking information, there may be other factors that cause results not to be as anticipated, estimated or intended. There can be no assurance that such information will prove to be accurate, as actual results and future events could differ materially from those anticipated in such information. Accordingly, readers should not place undue reliance on forward-looking information. Mission Ready Services Inc. does not undertake to update any forward-looking information that is included herein, except in accordance with applicable securities laws. Neither TSX Venture Exchange nor its Regulation Services Provider (as that term is defined in the policies of the TSX Venture Exchange) accepts responsibility for the adequacy or accuracy of this release.


PubMed | Office of the Assistant Secretary of Defense
Type: Historical Article | Journal: Military medicine | Year: 2010

The Department of Defense (DoD) Military Health System (MHS) embodies decades of health care practice that has evolved in scope and complexity to meet the demands for quality care to which its beneficiaries are entitled. War, Base Realignment and Closure (BRAC), and other dynamic forces require the ongoing review and revision of health care policy and practice in military hospitals as well as the expanded network of civilian providers who care for our nations soldiers, sailors, airmen, and marines and their families. The result has been an incrementally constructed quality assurance (QA) program with emphasis on organizational structures, programs, and systems, and the use of robust data sources and standard measures to analyze and improve processes, manage disease, assess patient perceptions of care, and ensure that a uniform health care benefit and high quality health care is accessible to all MHS beneficiaries.

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