Operational Medicine: Transforming Active Duty Care Capt Erin Schmitz Mountain Home AFB 18 Feb 2020 I n t e g r i t y - S e r v i c e - E x c e l l e n c e I n t e g r i t y - S e r v i c e - E x c e l l e n c e 1
Objectives: • Discuss the current state of military medicine and what’s missing • Understand how OMRS began, how it evolved and lessons learned • Discuss how OMRS can meet DHA standards and the military medicine way forward I n t e g r i t y - S e r v i c e - E x c e l l e n c e I n t e g r i t y - S e r v i c e - E x c e l l e n c e 2
Current Status I n t e g r i t y - S e r v i c e - E x c e l l e n c e I n t e g r i t y - S e r v i c e - E x c e l l e n c e 3
Priorities I n t e g r i t y - S e r v i c e - E x c e l l e n c e I n t e g r i t y - S e r v i c e - E x c e l l e n c e 4
Where Are We? Dr Ward 4 Dec 2018 Capt America 08:50 Mrs. Smith 09:10 Mr. Stark (ret) 09:30 SSgt Wayne 09:50 Maj Payne 10:10 Mr. Doe 10:30 Mrs. Johnson (ret) 10:50 A1C Hills 11:10 Capt Marvel 11:30 SrA Hawk 13:15 I n t e g r i t y - S e r v i c e - E x c e l l e n c e
Disruptive Innovation: Fuel Understanding of Line Relationship with Line CCs Today’s apparent Tomorrow’s Squadron Missions Air Force Medical Home complexity simplicity Profile and MEB Decisions Management of “Down Attributes Method Airmen” Sub-population focused Care Patient centered Patient Subgroup Delivery Equivalent of 1041 Meeting Physician led 1 Models Management Care team executed Case Management Floundering Mission Mission Focused Direct Mission Essential HP Integration tm led 2 Tasks/Activities Extended team Support for Line Support executed Awareness of AFSCs Patient centered about to Cause Mission Scripted Technician led & Occupational Standardized 3 executed Failure Workflows Exams & Standards Provider supported Patient centered Airman Occupational 4 Occ Health Nurse led Disposition & Availability Management Team executed Rehabilitation Physician supported Levels of Population focused Public Health prevention & Risk group centered 5 Health HP Integration tm led Promotion Multi-disciplinary Models team executed I n t e g r i t y - S e r v i c e - E x c e l l e n c e
Simple But Powerful Idea Split Active Duty and Beneficiary Populations Two Squadron Model (Stand Down MDOS) AMDS Culture Absorbs All Active Duty Care: FLIGHT MED FLIGHT MED UCC LAB/RAD LAB/RAD BEE BEE PEDS LOGISTICS LOGISTICS PH PH WH PHARMACY PHARMACY TOPA TOPA BOMC BOMC FAMILY MED FAMILY MED AOP AOP PT RMO RMO SYSTEMS SYSTEMS IOS/HP IOS/HP MH DENTAL DENTAL IMMUNIZATIONS READINESS READINESS UCC UCC OPTOMETRY OPTOMETRY PEDS PEDS ½ FAMILY MED (AD CLINIC) ½ FAMILY MED (AD CLINIC) PT PT WH WH ½ FAMILY MED ½ FAMILY MED MH MH (TRICARE BENEFICIARY) (TRICARE BENEFICIARY) IMMUNIZATIONS IMMUNIZATIONS I n t e g r i t y - S e r v i c e - E x c e l l e n c e
Lines of Effort & Initial Results 45 Down SFS Amn: ACTIVE DUTY CLINIC MENTAL HEALTH OUTREACH Empaneled by SQs 32 Returned Individual Sq/CC engagement & rapport 5 MEB Increased PCM mission understanding 8 Case Managed Proactive “Down Amn ” Management K9 Handlers Weekly Amn Review & daily Sick Call Line CC Quotes: MENTAL HEALTH OUTREACH “ Complete Game Changer for My Getting “out from behind the glass” Mission ” Goal: Pre-establish Rapport & Earlier Intervention 70 Down EMS Amn: Outreach teams aligned by SQs 51 Returned (78%) Half “Hard Kills” INTEGRATED OPERATIONAL SUPPORT Customized 3 Mo Sq Interventions TriCare Clinic Multidisciplinary team of PT, HP , IOS 0.05 24 HR PT aligned by SQs 2.03 FTR I n t e g r i t y - S e r v i c e - E x c e l l e n c e
Effect of the Mountain Home Experiment On the Key SECDEF Metric: NMC Airmen On CY 2018 MHAFB saw a 33% reduction in the number of NMC Airmen — …a net of 134 MHAFB Airmen Back in the Fight! On CY 2019 MHAFB saw a 10% reduction in the number of NMC Airmen --- …a net of 34 MHAFB Airmen Back in the Fight! 500 MHAFB NMC Total 400 300 200 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2018 403 404 408 386 361 335 322 301 304 331 305 269 2019 331 317 346 347 348 328 308 328 328 336 318 297 2020 302 334 I n t e g r i t y - S e r v i c e - E x c e l l e n c e
AF-WIDE IMPACT On the Key SECDEF Metric: NMC Airmen AF-wide during the same 15 months — t here was only a 6% reduction in NMC Airmen 32,000 USAF NMC total 30,000 28,000 26,000 May Aug Sep Nov Dec May Mar 18 Apr 18 Jun 18 Jul 18 Oct 18 Jan 19 Feb 19 Mar 19 Apr 19 Jun 19 18 18 18 18 18 19 NMC Total 29308 29552 29330 28619 28183 28400 28735 29581 29754 28838 29738 30124 29651 29656 27893 27580 SECDEF Goal: 10% reduction I n t e g r i t y - S e r v i c e - E x c e l l e n c e
Video: In Their Words Youtube link I n t e g r i t y - S e r v i c e - E x c e l l e n c e
Where are We…Next Steps DHA's management of hospitals and clinics 'all about the patient' Great outcomes, a ready medical force, satisfied patients – all flow directly from a patient-centered approach. As DHA assumes responsibility for military health care facilities across the entire Department of Defense, we aim to operate each hospital and clinic so that it improves the lives and health of our patients. It’s more than a pledge – it’s our mission. (DoD photo) I n t e g r i t y - S e r v i c e - E x c e l l e n c e
Plateaus: Why The Whole System Matters NMC AIRMEN (Raw Numbers) Profile Cleanup “Easy Kills” Case Management We Are Here “Hard Kills” Initial MH & IOS Gains Current Baseline Injury/Turnover Rate Integration: AD Clinic, IOS, & MH Maturation: IOS & MH Pillars Future Baseline Injury/Turnover Rate & Resilience Gains Human Injury Reduction Factors True Baseline Turnover Rate I n t e g r i t y - S e r v i c e - E x c e l l e n c e
My Why I n t e g r i t y - S e r v i c e - E x c e l l e n c e I n t e g r i t y - S e r v i c e - E x c e l l e n c e 14
My Why I n t e g r i t y - S e r v i c e - E x c e l l e n c e I n t e g r i t y - S e r v i c e - E x c e l l e n c e 15
Capt Erin Schmitz has no financial interests to disclose with regard to this subject or the contents of the presentation. I n t e g r i t y - S e r v i c e - E x c e l l e n c e I n t e g r i t y - S e r v i c e - E x c e l l e n c e 16
Ready. Healthy. Gunfighters. Any Questions? 17
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