Abstract:
INTRODUCTION:Within the Military Health System (MHS), facilities have struggled to meet minimum recommended volume thresholds for certain procedures. Understanding variations in complication rates and cost can help policymakers tailor policy to target improvement. Our objective was to quantify the variation in bariatric surgery complication rates and costs across a sample of military hospitals. MATERIALS AND METHODS:We study a retrospective cohort of 38 military surgeons practicing in 21 military treatment facilities from 2007 to 2014 who performed 1,277 bariatric surgeries. Data from the Centralized Credentials and Quality Assurance System, which provides education and training characteristics of physicians, were linked to patient encounter data from the MHS Data Repository. Physicians were included if they performed at least five bariatric surgeries over the study period. Patients were included if they had a diagnosis of obesity (body mass index > 30) and underwent a bariatric weight loss surgery. We calculated and summarized inpatient costs and complication rates across both surgeons and facilities using multivariable mixed-effects linear or logistic models. We used these models to calculate adjusted complication rates and average costs across both providers and hospitals to characterize variation in bariatric outcomes within the MHS. This study was considered exempt by the Uniformed Services University Institutional Review Board. RESULTS:We find evidence of large variations in both complication rates and costs per admission. Overall, we found a 15.5% complication rate across the sample. When comparing averages across facilities, we find large variation in complications (49.4% coefficient of variation [CV]) and procedure costs (25.9% CV). Controlling for patient comorbidities, BMI, and year attenuates much of the variation (12.6% CV complications, 4.4% CV cost), but cannot completely explain differences across facilities. Our model suggests that complications cost 32% more than complication-free surgeries on average suggesting that quality improvement efforts could potentially yield large savings. CONCLUSIONS:We find large variations in complication rates even after controlling for patient health. Furthermore, surgical complications are a significant determinant of cost. Policymakers should target efforts to improve surgical quality across facilities and physicians. Surgical quality improvement initiatives could produce savings to the MHS through reduced complications and improved surgical readiness.
journal_name
Mil Medjournal_title
Military medicineauthors
Luan WP,Leroux TC,Olsen C,Robb D,Skinner JS,Richard Pdoi
10.1093/milmed/usz454subject
Has Abstractpub_date
2020-08-14 00:00:00pages
e1057-e1064issue
7-8eissn
0026-4075issn
1930-613Xpii
5688861journal_volume
185pub_type
杂志文章abstract::The Assessment of Recruit Motivation and Strength (ARMS) project evaluated whether active duty Army enlistees who exceeded weight and body-fat standards but were able to pass the ARMS physical fitness test were at elevated risk of early attrition relative to the traditional recruit population. Attrition among 1146 ove...
journal_title:Military medicine
pub_type: 杂志文章
doi:10.7205/milmed-d-02-7508
更新日期:2009-07-01 00:00:00
abstract:OBJECTIVE:We assessed the relationship between active duty status and daily insufficient sleep in a telephone survey. METHODS:U.S. military service status (recent defined as past 12 months and past defined as >12 months ago) and daily insufficient sleep in the past 30 days were assessed among 566,861 adults aged 18 to...
journal_title:Military medicine
pub_type: 杂志文章
doi:10.7205/MILMED-D-14-00158
更新日期:2015-01-01 00:00:00
abstract:INTRODUCTION:Repetitive transcranial magnetic stimulation (rTMS) as a treatment for depression has been studied for over two decades. Repetitive TMS was approved by the Food and Drug Administration in 2008 for the treatment of depression after at least one failed trial of an antidepressant medication of adequate dose a...
journal_title:Military medicine
pub_type: 杂志文章
doi:10.1093/milmed/usaa148
更新日期:2020-09-18 00:00:00
abstract::One hundred six astronaut applicants who had passed initial screening were evaluated for Axis I and Axis II DSM-III-R diagnoses using a structured psychiatric interview. Nine of 106 candidates (8.5%) met diagnostic criteria for six Axis I (including V-code), or Axis II disorders. The use of the NASA structured intervi...
journal_title:Military medicine
pub_type: 杂志文章
doi:
更新日期:1993-01-01 00:00:00
abstract::The Israel Defense Forces (IDF) Medical Corps provides medical services-routine and emergency--to all IDF personnel (conscripts, career personnel, and reservists). Despite the fact that there are no differences in prevalence of disease in the IDF compared with the civil sector, health consumer appraisal, in the milita...
journal_title:Military medicine
pub_type: 杂志文章
doi:10.7205/milmed.169.4.282
更新日期:2004-04-01 00:00:00
abstract::This study compared general psychological symptoms measures on all Brief Symptom Inventory symptom dimensions and the Global Severity Index from samples of deployed and nondeployed U.S. Army soldiers. Psychological symptom measures were taken from samples of soldiers during deployment to operations in the Persian Gulf...
journal_title:Military medicine
pub_type: 杂志文章
doi:
更新日期:1997-11-01 00:00:00
abstract::This study was undertaken to determine why U.S. Marine Hospital #17, Port Townsend, Washington, closed at the peak of its utilization. A social history approach was taken, examining the hospital's developmental changes in the context of its role in the larger society. Both firsthand and interpretive sources were revie...
journal_title:Military medicine
pub_type: 历史文章,杂志文章
doi:10.7205/milmed.170.4.259
更新日期:2005-04-01 00:00:00
abstract::Thousands of military members self-medicate with dietary supplements containing unknown quantities of pharmacologically active compounds. These poorly regulated substances can cause real harm to the military population, especially when they contain stimulants such as caffeine. When taken regularly, caffeine has severa...
journal_title:Military medicine
pub_type: 杂志文章
doi:10.7205/MILMED-D-15-00045
更新日期:2015-08-01 00:00:00
abstract::A retrospective study reviewed medical records of military personnel who had participated in a vision readiness study the previous year. The review evaluated (1) the number of personnel who returned for an eye examination (as recommended), (2) the number of dilated eye examinations, (3) the number of optical devices o...
journal_title:Military medicine
pub_type: 杂志文章
doi:
更新日期:2003-10-01 00:00:00
abstract::Leishmania infections in American veterans of Iraq and Afghanistan have raised concern that veterans could serve as reservoirs of Old World parasites for domestic vector populations. A survey of sand flies on three U.S. Army facilities in the southern United States was conducted to identify potential vectors. Five spe...
journal_title:Military medicine
pub_type: 杂志文章
doi:10.7205/milmed-d-00-4309
更新日期:2009-11-01 00:00:00
abstract::The authors describe the case of a giant osteochondroma emanating from the L5 vertebral body and extending into the retroperitoneum of a 40-year-old man, causing low back pain. Osteochondromas are benign bony tumors that typically occur within the appendicular skeleton, although in the sporadic form, up to 4% occur in...
journal_title:Military medicine
pub_type: 杂志文章,评审
doi:10.7205/MILMED-D-14-00239
更新日期:2015-01-01 00:00:00
abstract:OBJECTIVE:A cavum septum pellucidum is an anatomical variant that is usually considered an incidental finding of little clinical significance. This is a fluid-containing structure between the lateral ventricles whose walls exhibit lateral bowing and are 10-mm apart or greater. It has been hypothesized that enlarged cys...
journal_title:Military medicine
pub_type: 杂志文章
doi:10.7205/milmed-d-11-00009
更新日期:2011-10-01 00:00:00
abstract:INTRODUCTION:Youth with autism spectrum disorder (ASD) face high rates of unemployment, with unique challenges for military-dependent and -connected youth with ASD. This paper reports preliminary findings from Year One of a randomized waitlist controlled trial investigating the efficacy of the Project SEARCH + ASD Supp...
journal_title:Military medicine
pub_type: 杂志文章,随机对照试验
doi:10.1093/milmed/usz224
更新日期:2020-01-07 00:00:00
abstract::Community-acquired, methicillin-resistant Staphylococcus aureus (cMRSA), soft tissue infections are becoming increasingly prevalent in the outpatient setting. Few studies have been specifically designed to examine the efficacy of oral antibiotic therapy for these infections. We performed an observational study to dete...
journal_title:Military medicine
pub_type: 杂志文章
doi:10.7205/milmed.171.6.504
更新日期:2006-06-01 00:00:00
abstract::The Military Health Services System (MHSS) is undergoing major modifications brought about by the Department of Defense health care reform program (TRICARE), a dynamic, multi-dimensional reform initiative affecting health care delivery to eligible beneficiaries. Military managers of the MHSS are currently being impact...
journal_title:Military medicine
pub_type: 杂志文章,评审
doi:
更新日期:1996-04-01 00:00:00
abstract:OBJECTIVE:To assess the impact of relaxed asthma recruitment standards adopted by the Australian Defence Force in 2007. METHODS:A retrospective audit was conducted on clinical and administrative data for recruits, with and without mild asthma, in their first year of service. RESULTS:There was no evidence that mild as...
journal_title:Military medicine
pub_type: 杂志文章
doi:10.7205/MILMED-D-14-00009
更新日期:2014-11-01 00:00:00
abstract::A retrospective study was performed to evaluate breast imaging in the Wilford Hall Medical Center, the largest medical facility in the U.S. Air Force, from the time period of October 1997 to October 2000, in comparison with its civilian counterparts. The results demonstrate that although Wilford Hall Medical Center br...
journal_title:Military medicine
pub_type: 杂志文章
doi:10.7205/milmed.169.5.361
更新日期:2004-05-01 00:00:00
abstract::A complete dental examination is the basis for identifying the dental readiness of Air Force Reserve Command members. Historically, these were done on an infrequent basis. Recently, an annual dental examination has been mandated for all military members. Current dental personnel manning and resources are not sufficien...
journal_title:Military medicine
pub_type: 杂志文章
doi:10.7205/milmed.170.1.26
更新日期:2005-01-01 00:00:00
abstract:OBJECTIVE:Altered body structures that occur with the loss of a lower limb can impact mobility and quality of life. Specifically, biomechanical changes that result from wearing a prosthesis have been associated with an increased risk of falls or joint degeneration, as well as increased energy demands. While previous st...
journal_title:Military medicine
pub_type: 杂志文章
doi:10.7205/MILMED-D-16-00356
更新日期:2017-07-01 00:00:00
abstract:OBJECTIVES:Military medical subspecialists consult with referring physicians, direct patient care and education, support isolated subspecialists, and maintain cohesive readiness plans. The World Wide Web appears promising in fulfilling these roles. METHODS:A website providing directed resources, the Walter Reed Army M...
journal_title:Military medicine
pub_type: 杂志文章
doi:
更新日期:2000-03-01 00:00:00
abstract:Introduction:To introduce a trabectome-initiated gonioscopy-assisted transluminal trabeculotomy (TIGATT) procedure and to report preliminary results. Materials and Methods:A preliminary case series of eight patients who have undergone the newly proposed TIGATT procedure is presented. TIGATT is a new concept that modif...
journal_title:Military medicine
pub_type: 杂志文章
doi:10.1093/milmed/usx174
更新日期:2018-03-01 00:00:00
abstract::The results from a study undertaken to assess the smoking behavior of Greek warship personnel found that of the 274 participants, ages 19 to 38 years, 59.5% were current smokers who started the habit between the ages of 15 and 21 years. However, 33.1% of these current smokers started smoking after entering the Greek N...
journal_title:Military medicine
pub_type: 杂志文章
doi:
更新日期:2003-11-01 00:00:00
abstract::The U.S. military may consider exploring the inclusion of the long-chain omega-3 fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), in the diets of active duty military personnel. To be successful, certain challenges must be overcome including determining appropriate dosage, ensuring cost efficie...
journal_title:Military medicine
pub_type: 杂志文章,评审
doi:10.7205/MILMED-D-14-00148
更新日期:2014-11-01 00:00:00
abstract::Several biochemical tests are available to screen for heavy drinking in patients. Most of these (e.g., liver function tests and macrocytic volume) rise due to adverse effects of alcohol on organs or the organ's functions. Carbohydrate-deficient transferrin, however, seems to elevate because of the direct action of alc...
journal_title:Military medicine
pub_type: 杂志文章,评审
doi:
更新日期:2003-05-01 00:00:00
abstract::Rapid user-friendly ABO-Rh blood typing kits (Eldon Home Kit 2511, ABO-Rh Combination Blood Typing Experiment Kit) were evaluated to determine their accuracy when used under simulated military field conditions and after long-term storage at various temperatures and humidities. Rates of positive tests between control g...
journal_title:Military medicine
pub_type: 杂志文章
doi:10.7205/milmed-d-10-00339
更新日期:2011-04-01 00:00:00
abstract::Recent interest in the relevancy of near vision tests for presbyopic aircrew members has led to the development of a photographic cockpit model. This model is used to prescribe more accurately for flying personnel. Prescriptions can be evaluated by use of trial lenses. This allows the aircrew members to experience the...
journal_title:Military medicine
pub_type: 杂志文章
doi:
更新日期:1992-01-01 00:00:00
abstract::Testicular pain has a wide differential and the nonspecific presentation should be triaged rapidly for urgent diagnosis and treatment. Scrotal pyoceles are uncommon collections of purulent fluid between the visceral and parietal tunica vaginalis, usually secondary to acute epididymo-orchitis, intra-abdominal infection...
journal_title:Military medicine
pub_type: 杂志文章
doi:10.1093/milmed/usz316
更新日期:2020-06-08 00:00:00
abstract::Rhabdomyolysis is a painful and potentially life-threatening injury in which muscle breaks down in response to an insult. In this case report, we describe the clinical course of a 22-year-old man who developed paraspinal muscle rhabdomyolysis and possible compartment syndrome in association with strenuous activity and...
journal_title:Military medicine
pub_type: 杂志文章
doi:10.7205/MILMED-D-14-00647
更新日期:2015-07-01 00:00:00
abstract::The establishment of the first dental office of the Croatian Dental Corps (CDC) in the city of Zadar represented at the same time the beginning of the CDC. This article describes the front-line experience of a dentist who volunteered to provide basic medical help, which eventually laid the groundwork for providing gen...
journal_title:Military medicine
pub_type: 杂志文章
doi:
更新日期:1997-01-01 00:00:00
abstract::Anthrax is occasionally encountered by U.S. military physicians in the deployed setting, where limited resources make it difficult to obtain laboratory confirmation. We present a case of cutaneous anthrax diagnosed using a ruggedized polymerase chain reaction device in austere combat conditions. ...
journal_title:Military medicine
pub_type: 杂志文章
doi:10.7205/MILMED-D-13-00062
更新日期:2013-08-01 00:00:00