Introduction Understanding how soldiers die after separation from military service, particularly those who die shortly after separating from service, may help to identify opportunities to ease transitions to civilian life. Materials and Methods Mortality data were analyzed for male U.S. Army soldiers who died within 18 months of their separation from service (from 1999 to 2011). Descriptive statistics were calculated for natural, accidental, suicidal, homicidal, undetermined, and legal/operation of war deaths and were stratified by age, component, time in service, and type of discharge. Crude and age-adjusted mortality rates, standardized for all years using the 2004 Regular Army population, were also calculated. The Public Health Review Board of the U.S. Army Public Health Center approved this study as Public Health Practice. Results Of the 1,884,653 male soldiers who separated from service during the study period, 3,819 died within 18 months of separation. A majority of all separations were Reserve or National Guard (58%), and 62% of decedents were in the Reserve or National Guard. Deaths from natural causes (38%) were the most common, followed by accident deaths (34%), suicides (20%), homicides (6%), undetermined deaths (2%), and legal/operation of war deaths (<1%). For overall mortality, age-adjusted rates were higher among the male U.S. population when compared to male soldiers who had separated from the Army. Conclusions The time period immediately following separation from the Army presents a unique challenge for many soldiers. Developing more effective pre-separation prevention programs that target specific risks requires knowing the causes of death for natural deaths, suicides, and accidents. Over half of all deaths occurring shortly after separation from service are preventable. Continued surveillance of specific causes of preventable deaths following separation can improve pre-separation prevention programs and transitions to post-service care.
As part of the Medicare Hospice Benefit (MHB), hospices submit claims containing information that allows policy makers to assess hospice quality, help policy makers improve the MHB, and increase patients’ experiences of care. We examine ten different hospice quality indicators related to the provision of services and patterns of live discharge. We calculated indicators using 100% Medicare fee-for-service (FFS) claims from October 1, 2018 through September 30, 2019. A hospice’s total score among all ten indicators is referred to as their Hospice Care Index (HCI), with a possible high score of 10. We examined all hospices with at least 20 discharges. After exclusion, we examined 4,155 hospices representing 1,562,003 beneficiaries. Most hospices earn a high HCI score: over 85% of hospices had scores of eight or more. At the same time, there were some lower scoring hospices: one in ten hospices scored seven on the index, and the remaining 4.9% scored six or lower. We find that on average hospices with higher HCI scores have better Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Hospice ratings. Among hospices with a score of ten, 85.1% of caregivers reported they would definitely recommend the hospice vs. 82.9% of caregivers of patients receiving treatment from hospices with a score of seven or less. Using the HCI, the Centers for Medicare and Medicaid Services and hospice patient caregivers can assess hospices across a broad set of indicators. Policymakers and hospices should monitor these ten indicators to understand their performance relative to peers.
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