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Research ArticleOriginal Research

The Military Health System: A Community of Solutions for Medical Education, Health Care Delivery, and Public Health

Robert P. Lennon, Aaron Saguil, Dean A. Seehusen, Brian V. Reamy and Mark B. Stephens
The Journal of the American Board of Family Medicine May 2013, 26 (3) 264-270; DOI: https://doi.org/10.3122/jabfm.2013.03.120192
Robert P. Lennon
From the Naval Hospital Jacksonville Family Medicine Residency Program, Jacksonville, FL (RPL); the National Capital Consortium Family Medicine Residency, Fort Belvoir Community Hospital, Fort Belvoir, VA (AS, DAS); the Department of Family Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD (BVR, MBS).
MD, JD
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Aaron Saguil
From the Naval Hospital Jacksonville Family Medicine Residency Program, Jacksonville, FL (RPL); the National Capital Consortium Family Medicine Residency, Fort Belvoir Community Hospital, Fort Belvoir, VA (AS, DAS); the Department of Family Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD (BVR, MBS).
MD
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Dean A. Seehusen
From the Naval Hospital Jacksonville Family Medicine Residency Program, Jacksonville, FL (RPL); the National Capital Consortium Family Medicine Residency, Fort Belvoir Community Hospital, Fort Belvoir, VA (AS, DAS); the Department of Family Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD (BVR, MBS).
MD
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Brian V. Reamy
From the Naval Hospital Jacksonville Family Medicine Residency Program, Jacksonville, FL (RPL); the National Capital Consortium Family Medicine Residency, Fort Belvoir Community Hospital, Fort Belvoir, VA (AS, DAS); the Department of Family Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD (BVR, MBS).
MD
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Mark B. Stephens
From the Naval Hospital Jacksonville Family Medicine Residency Program, Jacksonville, FL (RPL); the National Capital Consortium Family Medicine Residency, Fort Belvoir Community Hospital, Fort Belvoir, VA (AS, DAS); the Department of Family Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD (BVR, MBS).
MD, MS
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Article Figures & Data

Figures

  • Tables
  • Figure 1.
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    Figure 1.

    Old-school isolation (stakeholders are fragmented).

  • Figure 2.
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    Figure 2.

    Community of solution with a foundation of the patient-centered medical home (stakeholders are merged).

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    Figure 3.

    Community of solution methods.

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    Table 1. List of Likely Communities of Solution (COS) Stakeholders
    • Patients

    • Primary care physicians

    • Families

    • Base commanders

    • Public health officers

    • Insurers

    • Neighborhoods*

    • Businesses/business associations (on and off base)

    • Schools (on and off base)

    • Policy makers (base command, similar to a city government)

    • Regulatory bodies

    • Service providers†

    • Food providers ‡

    • Branch clinics

    • Unit physicians§

    • Managers of recreational spaces¶

    • ↵* Most base housing is a mix of apartment and single-family housing.

    • ↵† Emergency medical services, police, fire, water, sanitation (a mix of on- and off-base providers).

    • ↵‡ Restaurants, grocery stores, convenience stores on base.

    • ↵§ Many military units have a dedicated physician to provide their primary care.

    • ↵¶ Military bases offer an array of recreation, from golf courses to marinas.

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    Table 2. Brainstormed Goals Created During Communities of Solution (COS) Meetings
    • Have flu vaccines available at major command events

    • Widen all base roads to include bike lanes

    • Fix existing sidewalks to promote walking

    • Increase police presence in off-base neighborhoods with high crime

    • Tax unhealthy foods at point of purchase

    • Require providers to provide care in patient homes

    • View popup
    Table 3. Outcome Metrics to be Tracked for Process Improvements
    • HEDIS

    • ORYX

    • Percentages of immunization

    • Costs

    • Change in lost work days

    • Morbidity and mortality (all cause or specific cause)

    • Inpatient admissions

    • Emergency department visits

    • Arrests

    • Convictions

    • Teenage pregnancy

    • Alcohol use

    • Drug use

    • Citizen satisfaction

    • PCM satisfaction

    • Community, PCP, specialist revenue

    • HEDIS, Healthcare Effectiveness Data and Information Set; PCM, primary care manager; PCP, primary care physician.

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The Journal of the American Board of Family     Medicine: 26 (3)
The Journal of the American Board of Family Medicine
Vol. 26, Issue 3
May-June 2013
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The Military Health System: A Community of Solutions for Medical Education, Health Care Delivery, and Public Health
Robert P. Lennon, Aaron Saguil, Dean A. Seehusen, Brian V. Reamy, Mark B. Stephens
The Journal of the American Board of Family Medicine May 2013, 26 (3) 264-270; DOI: 10.3122/jabfm.2013.03.120192

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The Military Health System: A Community of Solutions for Medical Education, Health Care Delivery, and Public Health
Robert P. Lennon, Aaron Saguil, Dean A. Seehusen, Brian V. Reamy, Mark B. Stephens
The Journal of the American Board of Family Medicine May 2013, 26 (3) 264-270; DOI: 10.3122/jabfm.2013.03.120192
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    • Communities of Solution: Why Now?
    • What Makes a “Community”?
    • Creating Local Communities of Solution: The MHS-PCMH Model
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Keywords

  • Community Medicine
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  • Medical Education
  • Military Medicine
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