Pivoting to the QUAD AIM-Lessons Learned From the Central Texas Market.

Introduction: Since 2009, the Military Health System (MHS) has represented its mission as that of attaining the Quadruple Aim (QUAD AIM): increased readiness, better health, better care, and low per capita costs. The journey to reach the four goals is challenging and ongoing. Leaders in the MHS's Central Texas Market (CTM) sought to understand and overcome the root-cause obstacles that interfered with achieving the QUAD AIM.

QUiC Clinics in the Central Texas Market: Value-Based Primary Care in Military Medicine.

Introduction: For the past 16 years, Military Health System primary care providers have been incentivized to pursue work in a fee-for-service (FFS) model. The system values documentation of productivity to earn as many relative value units as possible. The result is densely packed clinic schedules that often lack the space or flexibility to accommodate patients when sick.

Oversight May Reduce Military Health System Leakage: Preventing Inappropriate Interhospital Transfers.

Introduction: The Military Health System (MHS) offers an example of a socialized healthcare model, operating within a larger "purchased care" civilian healthcare market. This arrangement has facilitated a trend wherein MHS clinicians often transfer moderate-to-complex patients to surrounding civilian hospitals, despite having the capability to care for such patients in-house. In an effort to stem this behavior, two initiatives were introduced at Carl R Darnall Army Medical Center (CRDAMC): A Transfer Policy Statement and Transfer Rounds.

Emergency Department Adaptations to COVID-19.

Background: The COVID-19 pandemic creates unique challenges for healthcare systems. While mass casualty protocols and plans exist for trauma-induced large-scale resource utilization events, contagious infectious disease mass casualty events do not have such rigorous procedures established. COVID-19 forces Emergency Departments (EDs) to simultaneously treat seriously ill patients and evaluate large influxes of 'worried well'-while maintaining both staff and patient safety.

Finding Opportunities for Health-Care System Advancement in the COVID-19 Crisis.

The coronavirus disease 2019 (COVID-19) pandemic forced American medical systems to adapt to high patient loads of respiratory disease. Its disruption of normal routines also brought opportunities for broader reform. The purpose of this article is to describe how the Carl R.

The Importance of the Study of Cognitive Performance Enhancement for U.S. National Security.

The American military is embarking on the 'Third Offset'-a strategy designed to produce seismic shifts in the future of warfare. Central to the approach is the conjoining of humans, technology, and machines to deliver a decisive advantage on the battlefield. Because technology will spread rapidly and globally, tactical overmatch will occur when American operators possess a competitive edge in cognition.

Capitation as an Incentive for Transitioning to Patient-Centered Medical Homes in the United States Army: A Brief Report.

The Army transitioned to a Patient-Centered Medical Home concept for primary care beginning in 2011. In spite of organizational commitment to the paradigm, the transition has not been without pitfalls. This performance improvement project operated under the hypothesis that focusing on the market-based incentives of a capitated system would result in a quantum leap toward the Patient-Centered Medical Home ideal.

Returning to duty from temporary disability in the U.S. Army: observational data and commentary for commanders, providers, and soldiers.

Before 2011, Army commanders were unable to achieve complete visibility of soldiers possessing temporary medical limitations. The creation of time-limited definitions and technical categorization of this group, now known as the medically not ready (MNR) population, eventually allowed its quantification. With heightened visibility of the group, leaders in the Fort Stewart community facilitated its management through soldier medical readiness councils.

The effectiveness of Soldier Medical Readiness Councils in reducing and shaping the population of soldiers not medically deployable.

The population of Soldiers not medically fit for deployment has created readiness problems for the U.S. Army in recent years.

Perceptions of frontline providers on the appropriate qualifications for battalion level care in United States Army ground maneuver forces.

Objectives: The U.S. Army emplaces physician assistants (PAs) in its maneuver battalions.

Potential roles of military-specific response to natural disasters -- analysis of the rapid deployment of a mobile surgical team to the 2007 Peruvian earthquake.

The August 2007 earthquake in Peru resulted in the loss of critical health infrastructure and resource capacity. A regionally located United States Military Mobile Surgical Team was deployed and operational within 48 hours. However, a post-mission analysis confirmed a low yield from the military surgical resource.

Military-civic action: lessons learned from a brigade-level aid project in the 2003 war with Iraq.

The primary mission of the military physician assigned to a combat-arms unit is to sustain the unit's fighting strength through prevention, primary medical care, and trauma resuscitation. Technical and organizational details of civic action assistance are not emphasized routinely during training. Real-world deployment, however, presents challenges approachable only with flexibility and improvisation.

Delayed drop zone evacuation: execution of the medical plan for an airborne operation into northern Iraq.

Flying directly from its home station in Vicenza, Italy, the 173rd Airborne Brigade committed itself to the invasion of Iraq on the night of March 26, 2003. Representing the establishment of a northern front, approximately 1,000 paratroopers jumped into an isolated valley on a mission to secure and to hold the Bashur airstrip. This article describes the unique challenges of medical preparation for the mission, injuries sustained on the jump, and lessons learned.