Leveraging the Military Health System as a Laboratory for Health Care Reform

Dorrance, Kevin A.; Ramchandani, Suneil R.; Neil, Nancy; Fisher, Harry J

doi:10.7205/milmed-d-12-00168

Cited by 27 publications

(27 citation statements)

References 1 publication

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“…The DoD database comprises information from a single-payer healthcare system for active military personnel, their dependents and retirees. Although it is smaller than the other databases, it is the largest cradle-to-grave healthcare database in the USA 17 . It also offers the unique advantage of containing data on mortality and, therefore, can be linked directly to the National Death Index to provide information on the cause of death for all individuals enrolled in the database.…”

Section: Data Sourcesmentioning

confidence: 99%

Expanding the use of administrative claims databases in conducting clinical real-world evidence studies in multiple sclerosis

Capkun

Lahoz

Verdun

et al. 2015

Current Medical Research and Opinion

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Section: Data Sourcesmentioning

confidence: 99%

Expanding the use of administrative claims databases in conducting clinical real-world evidence studies in multiple sclerosis

Capkun

Lahoz

Verdun

et al. 2015

Current Medical Research and Opinion

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“…Salutary factors associated with pre-ESRD nephrology care and permanent arteriovenous access may possibly contribute to lower mortality rates among MHS patients during the 12 months after dialysis initiation, although unobserved patient characteristics likely play a role as well. The patient population served by the MHS has been reported to be similar to the general population in the United States in terms of the prevalence of common clinical conditions and overall health [27]. Therefore, there is a strong potential for early survival benefit in the general ESRD population if greater access to pre-ESRD care can be implemented more broadly.…”

Section: Discussionmentioning

confidence: 99%

“…The MHS' patient population, delivery systems, and quality of care parallel those found in private sector health systems in the United States [27,28]. This integrated and “closed” system allows its beneficiaries to be followed longitudinally, regardless of location [27].…”

Section: Discussionmentioning

confidence: 99%

“…This integrated and “closed” system allows its beneficiaries to be followed longitudinally, regardless of location [27]. An important basis of integration and coordination of care in the MHS is a well-developed electronic health record system that allows provider access to patients' clinical information worldwide.…”

Section: Discussionmentioning

confidence: 99%

“…The MHS is a global, comprehensive, integrated medical network within the US Department of Defense (DoD) that serves a diverse beneficiary population of 9.6 million active and retired service members and their families [26,27]. The MHS beneficiaries enjoy a comprehensive health care benefit, with access to primary and subspecialty care through both a direct and purchased network worldwide [28].…”

Section: Introductionmentioning

confidence: 99%

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Pre-End-Stage Renal Disease Care and Early Survival among Incident Dialysis Patients in the US Military Health System

Nee¹,

Fisher²,

Yuan³

et al. 2017

Am J Nephrol

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Background: Previous reports showed an increased early mortality after chronic dialysis initiation among the end-stage renal disease (ESRD) population. We hypothesized that ESRD patients in the Military Health System (MHS) would have greater access to pre-ESRD care and hence better survival rates during this early high-risk period. Methods: In this retrospective cohort study, using the US Renal Data System database, we identified 1,256,640 patients initiated on chronic dialysis from January 2, 2004 through December 31, 2014, from which a bootstrap sample of 3,984 non-MHS incident dialysis patients were compared with 996 MHS patients. We assessed care by a nephrologist and dietitian, erythropoietin administration, and vascular access use at dialysis initiation as well as all-cause mortality as outcome variables. Results: MHS patients were significantly more likely to have had pre-ESRD nephrology care (adjusted OR [aOR] 2.9; 95% CI 2.3-3.7) and arteriovenous fistula used at dialysis initiation (aOR 2.2; 95% CI 1.7-2.7). Crude mortality rates peaked between the 4th and the 8th week for both cohorts but were reduced among MHS patients. The baseline adjusted Cox model showed significantly lower death rates among MHS vs. non-MHS patients at 6, 9, and 12 months. This survival advantage among MHS patients was attenuated after further adjustment for pre-ESRD nephrology care and dialysis vascular access. Conclusions: MHS patients had improved survival within the first 12 months compared to the general ESRD population, which may be explained in part by differences in pre-ESRD nephrology care and vascular access types.

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Development and validation of algorithms to identify newly diagnosed type 1 and type 2 diabetes in pediatric population using electronic medical records and claims data

Teltsch¹,

Farsani

Swain

et al. 2019

Pharmacoepidemiology and Drug

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Purpose: To develop and validate algorithms to classify diabetes type in newly diagnosed pediatric patients with DM. Method: Data from the United States Department of Defense health system were used to identify patients aged 10 to 18 years with incident DM. Two independent sets of 200 children were randomly sampled for algorithm development and validation. Algorithms were developed based on clinical insight, published literature, and quantitative approaches. The actual DM type was ascertained via chart review.Finally, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were evaluated.Results: Among the 400 patients, mean age was 14.2 (±2.5 years), and 50% were female. The best performing algorithms were based on data available in claims. They consisted of several logical expressions based on one predictor or more, which classified patients by use of glucose-lowering drugs or testing, DM ICD-9 diagnosis codes, and comorbidities. The best performing T2DM and T1DM algorithms achieved 90% and 98% sensitivity, 95% and 95% specificity, 87% and 98% PPV, and 96% and 96% NPV, respectively. Conclusions:Our results suggest that claims algorithms can accurately identify newly diagnosed T1DM and T2DM pediatric patients, which can facilitate large database studies in children with T1DM and T2DM. However, external validation in other data sources is needed. KEYWORDS administrative electronic health data, algorithm, classification, pharmacoepidemiology, type 1 diabetes mellitus, type 2 diabetes mellitus

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Leveraging the Military Health System as a Laboratory for Health Care Reform

Cited by 27 publications

References 1 publication

Expanding the use of administrative claims databases in conducting clinical real-world evidence studies in multiple sclerosis

Expanding the use of administrative claims databases in conducting clinical real-world evidence studies in multiple sclerosis

Pre-End-Stage Renal Disease Care and Early Survival among Incident Dialysis Patients in the US Military Health System

Development and validation of algorithms to identify newly diagnosed type 1 and type 2 diabetes in pediatric population using electronic medical records and claims data

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