Operational Medicine: Transforming Active Duty Care Capt Erin - - PowerPoint PPT Presentation

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Operational Medicine: Transforming Active Duty Care

Capt Erin Schmitz Mountain Home AFB 18 Feb 2020

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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

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Current Status

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Priorities

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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 Dr Ward 4 Dec 2018

Where Are We?

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• Awareness of AFSCs

about to Cause Mission Failure

• Management of “Down

Airmen”

• Equivalent of 1041 Meeting
• Case Management
• Floundering
• Understanding of Line

Squadron Missions

• Profile and MEB Decisions
• Relationship with Line CCs

Today’s apparent complexity

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Patient Subgroup Management Direct Mission Support Occupational Exams & Standards Airman Availability Management Public Health Tomorrow’s simplicity

Disruptive Innovation: Fuel

Air Force Medical Home

Method Attributes Care Delivery Models Sub-population focused Patient centered Physician led Care team executed Mission Essential Tasks/Activities for Line Support Mission Focused HP Integration tm led Extended team executed Scripted Standardized Workflows Patient centered Technician led & executed Provider supported Occupational Disposition & Rehabilitation Patient centered Occ Health Nurse led Team executed Physician supported Levels of prevention & Health Promotion Models Population focused Risk group centered HP Integration tm led Multi-disciplinary team executed

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Simple But Powerful Idea

FLIGHT MED BEE PH BOMC AOP IOS/HP DENTAL LAB/RAD LOGISTICS PHARMACY TOPA RMO READINESS SYSTEMS UCC PEDS WH FAMILY MED PT MH IMMUNIZATIONS OPTOMETRY PT MH ½ FAMILY MED (AD CLINIC) IMMUNIZATIONS UCC PEDS WH ½ FAMILY MED (TRICARE BENEFICIARY)

• Split Active Duty and Beneficiary Populations
• Two Squadron Model (Stand Down MDOS)
• AMDS Culture Absorbs All Active Duty Care:

FAMILY MED LAB/RAD LOGISTICS PHARMACY TOPA RMO SYSTEMS UCC PEDS WH ½ FAMILY MED (TRICARE BENEFICIARY) READINESS FLIGHT MED BEE PH BOMC AOP IOS/HP DENTAL OPTOMETRY PT MH ½ FAMILY MED (AD CLINIC) IMMUNIZATIONS

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32 Returned 5 MEB 8 Case Managed

K9 Handlers Line CC Quotes: “Complete Game Changer for My Mission” TriCare Clinic 0.05 24 HR 2.03 FTR 70 Down EMS Amn: 51 Returned (78%) Half “Hard Kills”

Lines of Effort & Initial Results

MENTAL HEALTH OUTREACH

• Getting “out from behind the glass”
• Goal: Pre-establish Rapport &

Earlier Intervention

• Outreach teams aligned by SQs

MENTAL HEALTH OUTREACH

ACTIVE DUTY CLINIC

• Empaneled by SQs
• Individual Sq/CC engagement & rapport
• Increased PCM mission understanding
• Proactive “Down Amn” Management
• Weekly Amn Review & daily Sick Call

INTEGRATED OPERATIONAL SUPPORT

• Customized 3 Mo Sq Interventions
• Multidisciplinary team of PT, HP

, IOS

• PT aligned by SQs

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Effect of the Mountain Home Experiment

On the Key SECDEF Metric: NMC Airmen

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

200 300 400 500 MHAFB NMC Total

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!

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AF-wide during the same 15 months — there was only a 6% reduction in NMC Airmen

AF-WIDE IMPACT

On the Key SECDEF Metric: NMC Airmen

Mar 18 Apr 18 May 18 Jun 18 Jul 18 Aug 18 Sep 18 Oct 18 Nov 18 Dec 18 Jan 19 Feb 19 Mar 19 Apr 19 May 19 Jun 19 NMC Total 29308 29552 29330 28619 28183 28400 28735 29581 29754 28838 29738 30124 29651 29656 27893 27580 26,000 28,000 30,000 32,000

USAF NMC total

SECDEF Goal: 10% reduction

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Video: In Their Words

Youtube link

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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)

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Plateaus: Why The Whole System Matters

Profile Cleanup Case Management Initial MH & IOS Gains Integration: AD Clinic, IOS, & MH Maturation: IOS & MH Pillars Human Factors

“Easy Kills” “Hard Kills” Current Baseline Injury/Turnover Rate Future Baseline Injury/Turnover Rate & Resilience Gains

True Baseline Turnover Rate

NMC AIRMEN (Raw Numbers)

Injury Reduction

We Are Here

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My Why

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My Why

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Capt Erin Schmitz has no financial interests to disclose with regard to this subject or the contents of the presentation.

• Ready. Healthy. Gunfighters.

Any Questions?

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