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This book makes a strong case for taking advantage of the best of two disciplines-health care and operational systems engineering (a combination of science and mathematics to describe, analyze, plan, design, and integrate systems with complex interactions among people, processes, materials, equipment, and facilities)-to improve the efficiency and quality of health care delivery, as well as health care outcomes. Those most interested in pursuing this approach include leaders in the U.S. Department of Defense (DOD) and Department of Veterans Affairs, who are committed to finding ways of improving the quality of care for military personnel, veterans, and their families. Intrigued by the possibilities, DOD decided to sponsor a series of workshops to explore the potential of operational systems engineering principals and tools for military health care, beginning with the diagnosis and care of traumatic brain injury (TBI), one of the most prevalent, difficult and challenging injuries suffered by warriors in Iraq and Afghanistan.
Advances in trauma care have accelerated over the past decade, spurred by the significant burden of injury from the wars in Afghanistan and Iraq. Between 2005 and 2013, the case fatality rate for United States service members injured in Afghanistan decreased by nearly 50 percent, despite an increase in the severity of injury among U.S. troops during the same period of time. But as the war in Afghanistan ends, knowledge and advances in trauma care developed by the Department of Defense (DoD) over the past decade from experiences in Afghanistan and Iraq may be lost. This would have implications for the quality of trauma care both within the DoD and in the civilian setting, where adoption of military advances in trauma care has become increasingly common and necessary to improve the response to multiple civilian casualty events. Intentional steps to codify and harvest the lessons learned within the military's trauma system are needed to ensure a ready military medical force for future combat and to prevent death from survivable injuries in both military and civilian systems. This will require partnership across military and civilian sectors and a sustained commitment from trauma system leaders at all levels to assure that the necessary knowledge and tools are not lost. A National Trauma Care System defines the components of a learning health system necessary to enable continued improvement in trauma care in both the civilian and the military sectors. This report provides recommendations to ensure that lessons learned over the past decade from the military's experiences in Afghanistan and Iraq are sustained and built upon for future combat operations and translated into the U.S. civilian system.
In this book, the IOM makes recommendations for permitting independent practice for mental health counselors treating patients within TRICARE-the DOD's health care benefits program. This would change current policy, which requires all counselors to practice under a physician's supervision without regard to their education, training, licensure or experience.
A guide to a holistic approach to healthcare measurement aimed at improving access and outcomes Healthcare System Access is an important resource that bridges two areas of research—access modeling and healthcare system engineering. The book’s mathematical modeling approach highlights fundamental approaches on measurement of and inference on healthcare access. This mathematical modeling facilitates translating data into knowledge in order to make data-driven estimates and projections about parameters, patterns, and trends in the system. The complementary engineering approach uses estimates and projections about the system to better inform efforts to design systems that will yield better outcomes. The author—a noted expert on the topic—offers an in-depth exploration of the concepts of systematic disparities, reviews measures for systematic disparities, and presents a statistical framework for making inference on disparities with application to disparities in access. The book also includes information health outcomes in the context of prevention and chronic disease management. In addition, this text: Integrates data and knowledge from various fields to provide a framework for decision making in transforming access to healthcare Provides in-depth material including illustrations of how to use state-of-art methodology, large data sources, and research from various fields Includes end-of-chapter case studies for applying concepts to real-world conditions Written for health systems engineers, Healthcare System Access: Measurement, Inference, and Intervention puts the focus on approaches to measure healthcare access and addresses important enablers of such change in healthcare towards improving access and outcomes.
Traumatic brain injury (TBI) accounts for up to one-third of combat-related injuries in Iraq and Afghanistan, according to some estimates. TBI is also a major problem among civilians, especially those who engage in certain sports. At the request of the Department of Defense, the IOM examined the potential role of nutrition in the treatment of and resilience against TBI.
An argument that understanding healthcare delivery as a complex adaptive system will help us design a system that yields better health outcomes. Breakthroughs in medical science, innovations in medical technologies, and improvements in clinical practices occur today at an increasingly rapid rate. Yet because of a fragmented healthcare delivery system, many Americans are unable to benefit from these developments. How can we design a system that can provide high-quality, affordable healthcare for everyone? In this book, William Rouse and Nicoleta Serban introduce concepts, principles, models, and methods for understanding, and improving, healthcare delivery. Approaching the topic from the perspectives of engineering and statistics, they argue that understanding healthcare delivery as a complex adaptive system will help us design a system that is more efficient, effective, and equitable. The authors use multilevel simulation models as a quantitative tool for evaluating alternate ways of organizing healthcare delivery. They employ this approach, for example, in their discussions of affordability, a prevention and wellness program, chronic disease management, and primary care accessibility for children in the Medicaid program. They also consider possible benefits from a range of technologies, including electronic health records and telemedicine; data mining as an alternative to randomized trials; conceptual and analytical methodologies that address the complexity of the healthcare system; and how these principles, models, and methods can enable transformational change.
This anthology of articles on causal inference and scientific paradigms in epidemiology covers several important topics including the search for causal explanations, the strengths and limitations of causal criteria, quantitative approaches for assessing causal relationships that are relevant to epidemiology and emerging paradigms in epidemiologic research. In order to provide historical context, an overview of philosophical and historical developments relevant to causal inference in epidemiology and public health is also provided. Several theoretical and applied aspects of causal inference are dealt with. The aim of this Ebook is not only to summarize important developments in causal inference in epidemiology but also to identify possible ways to enhance the search for causal explanations for diseases and injuries. Examples are provided from such fields as chronic disease epidemiology, Veterans health, and environmental epidemiology. A particular goal of the Ebook is to provide ideas for strengthening causal inference in epidemiology in the context of refined research paradigms. These topics are important because the results of epidemiologic studies contribute to generalizable knowledge by clarifying the causes of diseases, by combining epidemiologic data with information from other disciplines (for example, psychology and industrial hygiene), by evaluating the consistency of epidemiologic data with etiological hypotheses about causation, and by providing the basis for evaluating procedures for health promotion and prevention and public health practices.
In the last six years, Colorado has seen a population boom reminiscent of the state's first few years of settlement. But rather than staking mining claims or establishing homesteads, these new pioneers are on the frontier of an emerging science: marijuana as treatment for various debilitating conditions. This book contains personal accounts from doctors, researchers, and patients--self-proclaimed "refugees" seeking treatment unavailable elsewhere--who are at the forefront of medical marijuana practice. Their stories provide unique insights into a social, political and medical revolution.
Military operations produce a great deal of trash in an environment where standard waste management practices may be subordinated to more pressing concerns. As a result, ground forces have long relied on incineration in open-air pits as a means of getting rid of refuse. Concerns over possible adverse effects of exposure to smoke from trash burning in the theater were first expressed in the wake of the 1990â€"1991 Gulf War and stimulated a series of studies that indicated that exposures to smoke from oil-well fires and from other combustion sources, including waste burning, were stressors for troops. In January 2013, Congress directed the Department of Veterans Affairs (VA) to establish and maintain a registry for service members who may have been exposed to toxic airborne chemicals and fumes generated by open burn pits. Assessment of the Department of Veterans Affairs Airborne Hazards and Open Burn Pit Registry analyzes the initial months of data collected by the registry and offers recommendations on ways to improve the instrument and best use the information it collects. This report assesses the effectiveness of the VA's information gathering efforts and provides recommendations for addressing the future medical needs of the affected groups, and provides recommendations on collecting, maintaining, and monitoring information collected by the VA's Airborne Hazards and Open Burn Pit Registry.