Suchergebnisse

In 2014, a whistleblower reported that many U.S. veterans died while waiting for care at the Phoenix VHA. Problems with veteran's care through 2018 reveal ongoing and systematic problem. In March 2018, the VA Inspector General identified critical deficiencies at the Washington, DC VA Medical Center including failures to track patient safety events accurately, ineffective sterile processing and more than 10 thousand open or pending prosthetic/sensory aid consults. The VHA clearly has problems with access and quality in a budget-constrained environment. In this policy analysis, four separate interventions that address the gap between the magnitude as well as the use of the VHA's fixed budget versus access and cost expectations are explored. These policy interventions include maintaining the status quo, returning to a "VHA-only" option, transitioning to a CMS central payer system and consolidating care under the DoD TRICARE insurance plans. An objective evaluation suggests that extending TRICARE to veterans during the phasing out the VHA's care responsibilities, while politically unpalatable, would likely provide the best of four possible solutions under various criterion weighting schemes. A central payer solution under the CMS would also be a viable consideration. Results suggest that TRICARE patient perceptions of quality are superior to VHA and non-VHA/non-DoD, that access provided by the TRICARE program is ranked second in terms of venue acceptance only to the CMS solution set based on primary provider acceptance and that the cost per beneficiary of a TRICARE solution ($6.5 K/beneficiary) is far better than a VHA-only solution ($14.0 K/beneficiary), the CMS central payer solution ($12.2 K/beneficiary), or the status quo (between $12.2 K and $14.0 K/beneficiary). The intent of this paper is to provoke thoughtful consideration of solutions for providing access to high-quality healthcare for veterans within or outside of the VHA.

The United States Army recently implemented a policy aimed at quelling a large-scale exodus of captains. This policy included the provision of a Menu of Incentives Program targeting officers in year groups 1999--2005. This study details the captain attrition problem, evaluates literature regarding retention options, analyzes the efficacy of the Army's interventions by branch and by year group, and draws conclusions regarding future incentives. Methods used include chi-square and odds ratios analysis. Results reflect high acceptance rates for year groups 1999--2003; however, officers in these year groups may have remained in the service without any additional incentives because they were logically beyond the initial decision point. Findings suggest that seniority, skill, and adequate incentive pay are important considerations for future incentive programs. [Reprinted by permission; copyright Inter-University Seminar on Armed Forces and Society/Sage Publications Inc.]

The United States Army recently implemented a policy aimed at quelling a large-scale exodus of captains. This policy included the provision of a Menu of Incentives Program targeting officers in year groups 1999—2005. This study details the captain attrition problem, evaluates literature regarding retention options, analyzes the efficacy of the Army's interventions by branch and by year group, and draws conclusions regarding future incentives. Methods used include chi-square and odds ratios analysis. Results reflect high acceptance rates for year groups 1999—2003; however, officers in these year groups may have remained in the service without any additional incentives because they were logically beyond the initial decision point. Findings suggest that seniority, skill, and adequate incentive pay are important considerations for future incentive programs.

AbstractObjective:An effective response to a pandemic influenza assumes an adequate supply of a variety of skilled healthcare workers (HCWs). But what is known of HCWs' willingness to report to work?Method:We identified 206 relevant studies from 9 healthcare databases. Of 28 heterogeneous studies that met inclusion criteria, 18 used common methods for calculating percentages of HCWs willing to report to work. Their findings were evaluated in greater depth.Results:In 28 studies that summarized willingness to report to work of 31,633 workers, the percentage of HCWs willing to report to work varied between 23.10% and 93.10%. Scale type and dichotomization of self-report scales led to significantly different results. In 4 studies where 2097 workers responded to a survey during an actual event (2009 H1N1 pandemic influenza) percentage willing to report to work varied from 23.1% to 90.1%. In 6 studies with hypothetical scenarios of avian influenza 50%–82.50% of HCWs were willing to report to work.Conclusion:The studies we reviewed have methodological problems and inconsistencies in findings, even within relatively homogenous study subgroups. We caution emergency planners from relying on findings from any single study that estimates HCWs' mean willingness to report to work in a pandemic influenza outbreak.

The current military assignment policy of United States prohibits the assignment of females to billets with high risk of combat exposure. As part of an Army review of this policy, the authors analyzed deployment and promotion risk for combat medics. The effect of current policy on male deployment and female promotion risk was unknown. In light of other countries' policies and current operational considerations, senior military leaders sought to understand the effects of existing policy on a low-density, high-value occupational specialty, the combat medic. The authors found evidence that male medics deployed 2.07 times more frequently than female medics. The authors also found evidence that senior male medics (staff sergeants) deployed even more frequently (3.65-1) than their female counterparts. Perhaps as a result, the male combat medics experience higher likelihood of promotion from staff sergeant (E-6) to the rank of sergeant first class (E-7); however, the magnitude of that benefit was about one-third of the deployment risk. The results confirm the existence of gender-based deployment risk and promotion disparity. Based upon this analysis, the authors recommended the deprecation of current gender coding for combat medics to the senior levels of the US Army. [Reprinted by permission; copyright Inter-University Seminar on Armed Forces and Society/Sage Publications Inc.]

The current military assignment policy of United States prohibits the assignment of females to billets with high risk of combat exposure. As part of an Army review of this policy, the authors analyzed deployment and promotion risk for combat medics. The effect of current policy on male deployment and female promotion risk was unknown. In light of other countries' policies and current operational considerations, senior military leaders sought to understand the effects of existing policy on a low-density, high-value occupational specialty, the combat medic. The authors found evidence that male medics deployed 2.07 times more frequently than female medics. The authors also found evidence that senior male medics (staff sergeants) deployed even more frequently (3.65–1) than their female counterparts. Perhaps as a result, the male combat medics experience higher likelihood of promotion from staff sergeant (E-6) to the rank of sergeant first class (E-7); however, the magnitude of that benefit was about one-third of the deployment risk. The results confirm the existence of gender-based deployment risk and promotion disparity. Based upon this analysis, the authors recommended the deprecation of current gender coding for combat medics to the senior levels of the US Army.

The obesity epidemic in the United States has been well documented and serves as the basis for a number of health interventions across the nation. However, those who have served in the U.S. military (Veteran population) suffer from obesity in higher numbers and have an overall disproportionate poorer health status when compared to the health of the older non-Veteran population in the U.S. which may further compound their overall health risk. This study examined both the commonalities and the differences in obesity rates and the associated co-morbidities among the U.S. Veteran population, utilizing data from the 2018 Behavioral Risk Factor Surveillance System (BRFSS). These data are considered by the Centers for Disease Control and Prevention (CDC) to be the nation's best source for health-related survey data, and the 2018 version includes 437,467 observations. Study findings show not only a significantly higher risk of obesity in the U.S. Veteran population, but also a significantly higher level (higher odds ratio) of the associated co-morbidities when compared to non-Veterans, including coronary heart disease (CHD) or angina (odds ratio (OR) = 2.63); stroke (OR = 1.86); skin cancer (OR = 2.18); other cancers (OR = 1.73); chronic obstructive pulmonary disease (COPD) (OR = 1.52), emphysema, or chronic bronchitis; arthritis (OR = 1.52), rheumatoid arthritis, gout, lupus, or fibromyalgia; depressive disorders (OR = 0.84), and diabetes (OR = 1.61) at the 0.95 confidence interval level.

The physical demands on U.S. service members have increased significantly over the past several decades as the number of military operations requiring overseas deployment have expanded in frequency, duration, and intensity. These elevated demands from military operations placed upon a small subset of the population may be resulting in a group of individuals more at-risk for a variety of debilitating health conditions. To better understand how the U.S Veterans health outcomes compared to non-Veterans, this study utilized the U.S. Centers for Disease Control and Prevention (CDC) Behavioral Risk Factor Surveillance System (BRFSS) dataset to examine 10 different self-reported morbidities. Yearly age-adjusted, population estimates from 2003 to 2019 were used for Veteran vs. non-Veteran. Complex weights were used to evaluate the panel series for each morbidity overweight/obesity, heart disease, stroke, skin cancer, cancer, COPD, arthritis, mental health, kidney disease, and diabetes. General linear models (GLM's) were created using 2019 data only to investigate any possible explanatory variables associated with these morbidities. The time series analysis showed that Veterans have disproportionately higher self-reported rates of each morbidity with the exception of mental health issues and heart disease. The GLM showed that when taking into account all the variables, Veterans disproportionately self-reported a higher amount of every morbidity with the exception of mental health. These data present an overall poor state of the health of the average U.S. Veteran. Our study findings suggest that when taken as a whole, these morbidities among Veterans could prompt the U.S. Department of Veteran Affairs (VA) to help develop more effective health interventions aimed at improving the overall health of the Veterans.