Rhon Daniel I, Golden Kerrie J, Trevino Amy J, Hatler Brian S
Center for the Intrepid, 3551 Roger Brooke Drive, Brooke Army Medical Center, JBSA Fort Sam Houston, TX, 78234.
Office of the Assistant Secretary of Defense, Undersecretary of Defense for Personnel and Readiness, Office of the Secretary of Defense, The Pentagon, 2 North Rotary Road, Arlington, VA, 22202.
Mil Med. 2017 Mar;182(3):e1569-e1574. doi: 10.7205/MILMED-D-16-00124.
The drowning impact that musculoskeletal injuries (MSI) have on Soldier readiness, deployability, and escalating health care costs is growing. These injuries are associated with approximately 25 million lost duty days each year. The need to curb costs and improve efficacy and efficiency of health care delivery is pressing. This requires the consideration of new paradigms for clinical pathways and health care delivery processes. Soldiers returning from a deployment go through a screening process to ensure any medical, dental, and administrative issues are adequately addressed. This is a great opportunity to influence optimal musculoskeletal (MSK) care, as nonbattle MSI are the most common injury sustained during a combat deployment. These screening processes usually consist of high throughput in short periods, taxing the usual flow of care through the associated medical clinic. Because the highest percentage of medical visits are related to MSK complaints, a dedicated clinic with specialty providers seeing these patients directly may improve the quality and efficiency of care.
This report provides the details related to the implementation of a MSK specialty clinic such as this at Madigan Army Medical Center, for the return of a U.S. Army Reservist Brigade Combat Team of approximately 4,000 Soldiers. It provides a framework for determining patient flow and triaging of patients to expedited appropriate care directly from the screening site. We report on the demographics and types of injuries seen after deployment, and the patient satisfaction associated with those that were seen in this specialty clinic.
Comparison to usual care were outside the scope of this report, however the patient satisfaction with the process was recorded, and was very high for all 284 patients that received care through this expedited care pathway.
This article provides a framework for an expedited clinical care pathway for patients returning from deployment that have MSI. It provides a platform for future feasibility testing and prospective studies related to the economic impact of this model when compared to usual care.
肌肉骨骼损伤（MSI）对士兵战备状态、部署能力以及不断攀升的医疗保健成本的影响日益增大。这些损伤每年导致约2500万个工作日的损失。控制成本以及提高医疗保健服务的效果和效率的需求迫在眉睫。这需要考虑临床路径和医疗保健服务流程的新范式。从部署任务中归来的士兵要经过一个筛查过程，以确保所有医疗、牙科和行政问题都能得到妥善解决。这是影响最佳肌肉骨骼（MSK）护理的绝佳机会，因为非战斗性MSI是战斗部署期间最常见的损伤。这些筛查过程通常在短时间内处理大量病例，给相关医疗诊所的常规护理流程带来压力。由于最高比例的就诊与MSK问题相关，由专科医生直接诊治这些患者的专门诊所可能会提高护理质量和效率。
本报告详细介绍了在马迪根陆军医疗中心设立此类MSK专科诊所的情况，该诊所面向一个约有4000名士兵的美国陆军后备役旅战斗队的归来人员。它提供了一个确定患者流程和对患者进行分诊的框架，以便能直接从筛查地点加快提供适当护理。我们报告了部署后所见患者的人口统计学特征和损伤类型，以及该专科诊所患者的满意度。
与常规护理的比较不在本报告范围内，但记录了患者对该流程的满意度，通过这种快速护理途径接受治疗的所有284名患者的满意度都非常高。
本文为从部署任务中归来且患有MSI的患者提供了一个快速临床护理路径的框架。它为未来与该模式与常规护理相比的经济影响相关的可行性测试和前瞻性研究提供了一个平台。
