to the DeploymentRelated Healthcare Track

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Welcome

• to the Deployment-Related Healthcare Track

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Thank You!

• Vivian Sheliga Track Coordinator
• Those who helped her
• Jannette Brown-McIntosh
• Cheryl Blount
• USA CHPPM
• FHP Conference Organizers
• COL Ciesla
• Ms Gervasoni

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Deployment-Related Healthcare Track

• A forum for presentations and workshops related
  to pre-, during- and post-deployment health care
  delivery. Emphasis is on military primary or
  emergency care settings and multidisciplinary
  collaboration.

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Why Focus On Deployment-Related
Healthcare?(Isnt it just routine healthcare
in a slightly different uniform?)
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Casualties of WarWashington Post May 31, 2004

• Conflict Period WIA KIA Ratio
• Revolutionary War 1775-1783 6,188 4,435 1.4
  
• War of 1812 1812-1815 4,505 2,260 2.0
• Mexican War 1846-1848 4,152 13,283 0.3
• Civil War 1861-1865 781,881 364,511 2.1
• Span-Am War 1898-1902 1,662 2,446 0.7
• Philippines War 1899-1902 2,818 4,374 0.6
• World War I 1917-1918 204,002 116,516 1.8
• World War II 1941-1945 671,846 405,399 1.7
• Korean War 1950-1953 103,284 36,576 2.8
• Vietnam War 1964-1973 153,303 58,200 2.6
• Persian Gulf War 1990-1991 467 382 1.2
• Iraq War 2003-2004 4,682 802 5.8
• TOTAL 1,938,790 1,009,184 1.9

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Some Clinical Challenges in the Global War On
Terrorism

• Traumatic distress psychological barriers to
  care (Hoge et al, NEJM, 2004)
• Low dose exposure related concerns (eg,
  depleted uranium)
• Infectious diseases related concerns
• Surgical trauma continuum of amputee care
• Care of women before, during, and after
  deployment
• Care of the military provider
• Safety Net the reserve component Soldier
  family
• Continuity within DoD and across DoD VA
• Trust balancing Soldier military needs

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Richardson et al. Arch Intern Med 2001
1611289-94
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How Can We Do Better?
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Quality in General PracticeDonabedian Criteria

• Technical care scientific and technological
  aspects of care.
• Interpersonal relations between providers and
  patients and within the health care team.
• Practice amenities practice arrangements that
  enable patients to feel at ease.

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Collaborative Management

• Collaborative provider-patient problem
  definition
• Negotiated targeting, goal setting, and planning
• Medical importance of the problem
• Patient motivation and readiness for self-care
• Continuum of support services
• Sustained, active follow-up

Von Korff et al, Ann Intern Med,
19971271097-1102
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Toward Collaborative Deployment-Related
Healthcare

• Practice guidelines
• Clinical information systems
• Performance indicators and incentives
• Science-based technical assistance
• Stakeholder involvement

Von Korff et al, Ann Intern Med,
19971271097-1102
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Schematic for Post-War Prevention of Symptoms
Disability
Engel et al, 2004, Can We Prevent A Second Gulf
War Syndrome? Advances in Psychosomatic Medicine
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Stepped Care Approach for Post-War Symptoms
Disability
Engel et al, 2004, Can We Prevent A Second Gulf
War Syndrome? Advances in Psychosomatic Medicine
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Toward Collaborative Deployment-Related
Healthcare

• Practice guidelines
• Clinical information systems
• Performance indicators and incentives
• Science-based technical assistance
• Stakeholder involvement

Von Korff et al, Ann Intern Med,
19971271097-1102
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Deployment-Related Healthcare Track

• A forum for presentations and workshops related
  to pre-, during- and post-deployment health care
  delivery. Emphasis is on military primary or
  emergency care settings and multidisciplinary
  collaboration.

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Relevant topics

• Post-deployment health
• Identification management of concerns
• Measuring, improving, and evaluating quality
• Technology, automation, information systems
• Health services research epidemiology
• Skill-building to improve deployment-related
  healthcare

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Intended audience

• Clinicians (particularly those practicing in
  primary care)
• Clinical epidemiologists
• Health service researchers
• Healthcare administrators
• Healthcare policy makers

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Some Track Highlights

• Patricia Resick, Director of Womens Health,
  National Center for PTSD
• Wayne Jonas, MD, Director, Samueli Institute
  Former Dir, NCAM
• Mark Zamorski, MD, Canadian National Defence
  Force
• Melissa McDiarmid, MD, VA DU Program University
  of MD
• Dr. Alfonso Batras, Department of Veterans
  Affairs
• COL John Kugler, OTSG Family Practice Consultant
• COL Naomi Aronson, Uniformed Services University
  WRAMC
• LTC Pat OMalley, Walter Reed Army Medical Center

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Questions?