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Moving more military patients out of MTFs could cause them “significant discomfort”, study finds


Transferring more military patients to local civilian hospitals could result in “significant damage” for those patients, according to a new study funded by the Department of Defense.

This was the conclusion of the researchers after comparing the quality and safety of patient care in military treatment facilities with that of local civilian hospitals – facility by facility. The researchers found that, on average, military patients performed better in MTFs, compared to military patients treated in local civilian hospitals.

This is the first time that researchers have conducted an in-depth analysis to compare the quality of care in MTFs and local civilian hospitals, said Tracey Perez Koehlmoos, professor of preventive medicine and biostatistics at the Uniformed Services University of the Health. Sciences, and Principal Research Investigator. .

And that could put an obstacle in the way of ongoing reform efforts within the military healthcare system, which have included moving an unknown number of patients to the healthcare system purchased by civilians as part of Tricare.

The research “is really good news that highlights the high quality of care available at our military treatment facilities,” said Koehlmoos, director of the USUHS Center for Health Services Research.

“Military treatment facilities as a whole remain among the best performing hospitals for patient safety in the United States,” said Koehlmoos. The study also highlights an area where the Defense Health Agency could work to “encourage better quality of care through the Tricare benefit,” she said, which would benefit all patients in the community. local, and not just to Tricare beneficiaries.

According to the study, reducing access to military treatment facilities to as little as 10% of the current population could result in “dramatically worse” surgical mortality rates, medical death rates and patient safety.

The study, titled “In Defense of Direct Care: Limiting Access to Military Hospitals Could Worsen Quality and Safety,” was published Oct. 4 in the journal Health Services Research.

Researchers from Yale and Harvard also worked on the analysis.

The researchers were tasked with examining how reforms within the military health care system are likely to affect the quality of care in the system. They looked at current data from MTFs and civilian hospitals in local areas that treated Tricare patients; as well as national requests for hospitalization for adult civilians. They only included patients aged 18 to 64.

Then they ran simulations of what the quality indicators might look like in various proposed scenarios of reduced access to military processing facilities.

“It’s gratifying to see that MTFs compare favorably to civilian hospitals when it comes to patient outcomes,” said Eileen Huck, senior deputy director of government relations for the National Military Family Association. “However, the report raises concerns about the impact on beneficiaries as more of them are transferred to the purchased care system.”

The researchers compared data from 502,252 admissions of adult military recipients to 37 military treatment facilities (326,076 admissions) and surrounding civilian hospitals (179,176 admissions under the purchased Tricare care system). They used military health system data from exercises 2016 to 2018 to compare patient outcomes in MTFs with those of Tricare military patients treated in local civilian hospitals.

The researchers also compared MTF patient outcomes with the broader national admissions of adult civilian inpatients, using hospital data from the 2017 calendar, which fell within this period of military inpatient data.

The researchers performed simulations for patient outcomes in what-if scenarios where defense officials reduced patient access by 10 percent, 20 percent, or 50 percent nationwide. In the 10% scenario, the researchers estimated that 170,000 to 190,000 beneficiaries aged 18 to 64 could be transferred from MTFs to civilian hospitals.

They also simulated the outcome if access to the MTF was restricted to active duty only, without retirees, reservists, or dependents. In this most extreme scenario, the researchers estimated that up to 1.9 million adult beneficiaries between the ages of 18 and 64 would be affected.

The researchers also simulated the result if the worst performing MTFs were removed. The study does not name these MTFs, but the information could be provided internally only to the DoD, upon request, Koehlmoos said.

“This research highlights a risk that concerns us, namely that when beneficiaries leave MTFs, they may not have access to quality care,” said Karen Ruedisueli, director of health affairs at the MTF. Military Officers Association of America. The point the MOAA tried to make, she said, is that “access to care is not the same as access to quality care.

“If military families and retirees are to be removed from MTF in order to improve the focus on preparedness, this should only be done in areas where we know beneficiaries can still access quality care in the civilian community. “

The research “points out that it’s very complicated, and it’s not something that is going to be done quickly,” she said.

Among the discoveries:

* In regional comparisons, in 30 out of 37 regions, beneficiaries enjoyed better patient safety in MTFs, compared to local civilian hospitals. The study does not specify these regions.

* MTFs performed better on four of 11 inpatient quality indicators and in five of nine patient safety indicators on average, compared to local civilian hospitals. Most of the other indicators were roughly the same. “It really highlights the quality of care at military treatment facilities,” Koehlmoos said.

One example was the death rate from heart failure. In local civilian hospitals, the rate was 32.3 deaths per 1,000 admissions, compared to 27 per 1,000 in MTFs.

* In the broader comparison with hospitals nationwide, the study found that MTFs had “significantly better” condition-specific rates in eight of 11 inpatient quality measures; and in seven of the nine patient safety indicators. Again, most of the other metrics were roughly the same.

The civilian hospital data analyzed came from the National Readmission Database, which includes hospitalizations of patients in the 28 participating states, regardless of age or insurance. These records represent more than 18 million annual hospitalizations, 60 percent of the U.S. population and 58 percent of all hospital admissions in the United States, the researchers noted.

* The simulations estimated that reducing access to MTFs to as little as 10 percent of the beneficiary population nationwide “could lead to significantly worse surgical mortality, such as an increase of 0.7 per cent. hundred of the [coronary artery bypass graft] mortality. ”This could lead to an increase in medical mortality, such as a 1.3 percent increase in heart failure mortality.

* Simulations showed that limiting access to active duty military only could increase patient safety adverse events by 23% for the rest of the beneficiary population. For example, researchers predicted that postoperative respiratory failure rates could increase by 13.6%.

The researchers measured the quality and safety parameters of inpatients, using the quality parameters approved by the United States Agency for Research and Quality of Health Care.

In 2016, Congress enacted major reforms to the military health care system, including organizational changes. The DoD informed Congress in 2020 of plans to realign MTFs and move to active-service-only access to certain MTFs, which has already happened.

Defense officials also plan to reduce the number of medical housing, “to increase the number of operational housing needed for lethality,” according to DoD documents. In August, a DoD report to Congress said they had cut numbers they planned to cut.

This study did not examine the issue of the number of suppliers.

The researchers excluded beneficiaries aged 65 and over because they receive health insurance through Medicare. They also excluded children because of the insufficient number of cases.

Previous research has shown that the quality of care is the same or better in MTFs compared to civilian hospitals, whether the volume of cases is high, medium or low. “This work supports this original work, that things are either the same or better in direct care,” said Koehlmoos.

“People often get a rainy day when they talk about the military health care system, but we are truly a role model for the nation on how to provide equitable and affordable health care to your people,” Koehlmoos said. “For those of us who have studied this, there are so many great lessons that can be learned from the military health care system and shared with the rest of America.”

Karen has covered military families, quality of life and consumer issues for Military Times for over 30 years, and is co-author of a chapter on media coverage of military families in the book “A Battle Plan for Supporting Military Families “. She previously worked for newspapers in Guam, Norfolk, Jacksonville, Florida, and Athens, Georgia.

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