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BackgroundWith the continued spread of COVID-19 in the United States, identifying potential outbreaks before infected individuals cross the clinical threshold is key to allowing public health officials time to ensure local health care institutions are adequately prepared. In response to this need, researchers have developed participatory surveillance technologies that allow individuals to report emerging symptoms daily so that their data can be extrapolated and disseminated to local health care authorities. ObjectiveThis study uses a framework synthesis to evaluate existing self-reported symptom tracking programs in the United States for COVID-19 as an early-warning tool for probable clusters of infection. This in turn will inform decision makers and health care planners about these technologies and the usefulness of their information to aid in federal, state, and local efforts to mobilize effective current and future pandemic responses. MethodsPrograms were identified through keyword searches and snowball sampling, then screened for inclusion. A best fit framework was constructed for all programs that met the inclusion criteria by collating information collected from each into a table for easy comparison. ResultsWe screened 8 programs; 6 were included in our final framework synthesis. We identified multiple common data elements, including demographic information like race, age, gender, and affiliation (all were associated with universities, medical schools, or schools of public health). Dissimilarities included collection of data regarding smoking status, mental well-being, and suspected exposure to COVID-19. ConclusionsSeveral programs currently exist that track COVID-19 symptoms from participants on a semiregular basis. Coordination between symptom tracking program research teams and local and state authorities is currently lacking, presenting an opportunity for collaboration to avoid duplication of efforts and more comprehensive knowledge dissemination.

Genetic counseling and genetic testing are important tools for diagnosis, screening, and employment of effective medical management strategies for hereditary cardiovascular diseases. Despite widespread recognition of the benefits of genetic counseling and testing in cardiovascular care, little is published regarding their use in large healthcare systems. We conducted a retrospective cross‐sectional study using administrative claims data in the US Military Health System to assess the state of recommended genomic counseling in clinical cardiovascular care. Logistic regression models were used to examine associations of genetic counseling among beneficiaries with hereditary cardiovascular conditions. Approximately 0.44% of beneficiaries in fiscal year 2018 had a diagnosis of a hereditary cardiovascular condition. Among the 23,364 patients with a diagnosis of hereditary cardiovascular disease, only 175 (0.75%) had documented genetic counseling and 196 (0.84%) had documented genetic testing. Genetic counseling did not differ by race, sex, service, or diagnosis. Age group, Active Duty status, rank as a proxy for socioeconomic status, and geographic location contributed significantly to the likelihood of receiving genetic counseling. These findings suggest that genetic counseling is underutilized in clinical cardiovascular care in the Military Health System and may be more broadly, despite expert consensus recommendations for its use and potential life‐saving benefits. Unlike previous studies in the US civilian health sector, there did not appear to be disparities in genetic counseling by race or sex in the Military Health System. Strategies to improve care for cardiovascular disease should address the underutilization of recommended genetics evaluations for heritable diagnoses and the challenges of assessing use in large health systems studies. [ABSTRACT FROM AUTHOR]

Background: Previous studies have found that unintended pregnancy rates are higher among racial minorities and active duty servicewomen (ADSW), correlating with lower rates of effective contraceptive use. The Military Health System (MHS) provides universal health care benefit coverage for all ADSW, including access to all highly effective contraceptive (HEC) methods. This study investigated the association between race and HEC use among ADSW. Materials and Methods: We conducted a cross-sectional study using fiscal year 2016–2019 data from the MHS Data Repository for all ADSW ages 18–45 years. Statistical analyses included descriptive statistics and logistic regression models, adjusted and unadjusted, determining the odds of HEC use, overall and by method. Results: Of the 729,722 ADSW included in the study, 59.7% used at least one HEC during the study period. The highest proportions of users were aged 20–24 years, White, single, Junior Enlisted, and serving in the Army. Lower odds of HEC use were demonstrated in Black (odds ratio [OR] = 0.94, 95% confidence interval [CI] = 0.92–0.95), American Indian/Alaska Native (OR = 0.85, 95% CI = 0.82–0.89), Asian/Pacific Islander (OR = 0.81, 95% CI = 0.80–0.83), and Other (OR = 0.97, 95% CI = 0.94–0.99) ADSW compared with White ADSW. Conclusions: Universal coverage of this optional preventive service did not guarantee its use. The MHS can serve as a model for monitoring racial disparities in HEC use. [ABSTRACT FROM AUTHOR]

Introduction:As a result of the COVID-19 pandemic, telehealth use became widespread, allowing for continued health care while minimizing COVID-19 transmission risk for patients and providers. This rapid scale-up highlighted shortcomings of the current telehealth infrastructure in many health systems. We aimed to identify and address gaps in the United States Military Health System (MHS) response to the COVID-19 pandemic related to the implementation and utilization of telehealth. Methods:We conducted semistructured key informant interviews of MHS stakeholders, including policymakers, program managers, and health care providers. We recruited respondents using purposive and snowball sampling until we reached thematic saturation. Interviews were conducted virtually from December 2022 to March 2023 and coded by deductive thematic analysis using NVivo. Results:We interviewed 28 key informants. Several themes emerged from the interviews and were categorized into four defined areas of obstacles to the effective utilization of telehealth: administrative, technical, organizational, and quality issues. While respondents had positive perceptions of telehealth, issues such as billing, licensure portability, network connectivity and technology, and ability to monitor health outcomes represent major barriers in the current system, preventing the potential for further expansion. Conclusions:While the shift to telehealth during the COVID-19 pandemic demonstrated robust potential within the MHS, it highlighted shortcomings that impair the utility and expansion of telehealth on a level comparable to that of other large health systems. Future focus should be directed toward generating and implementing actionable recommendations that target these identified challenges in the MHS. [ABSTRACT FROM AUTHOR]

Introduction Like civilian health systems, the United States Military Health System (MHS) confronts challenges in achieving the aims of reducing cost, and improving quality, access, and safety, but historically has lacked coordinated health services research (HSR) capabilities that enabled knowledge translation and iterative learning from its wealth of data. A military–civilian academic partnership called the Comparative Effectiveness and Provider-Induced Demand Collaboration (EPIC), formed in 2011, demonstrated early proof-of-concept in using the MHS claims database for research focused on drivers of variation in health care. This existing partnership was reorganized in 2015 and its topics expanded to meet the need for HSR in support of emerging priorities and to develop current and HSR capacity within the MHS. Materials and Methods A Donabedian framework of structure, process, and outcomes was applied to support the project, through a core of principal investigators, researchers, analysts, and administrators. Within this framework, new researchers and student trainees learn foundations of HSR while performing secondary analysis of claims data from the MHS Data Repository (MDR) focusing on Health and Readiness, Pediatrics, Policy, Surgery, Trauma, and Women's Health. Results Since 2015, the project has trained 25 faculty, staff, and providers; 51 students and residents; 21 research fellows across multiple disciplines; and as of 2022, produced 107 peer-reviewed publications and 130 conference presentations, across all five themes and six cores. Research results have been incorporated into Federal and professional policy guidelines. Major research areas include opioid usage and prescribing, value-based care, and racial disparities. EPIC researchers provide direct support to MHS leaders and enabling expertise to clinical providers. Conclusions EPIC, through its Donabedian framework and utilization of the MHS Data Repository as a research tool, generates actionable findings and builds capacity for continued HSR across the MHS. Eight years after its reorganization in 2015, EPIC continues to provide a platform for capacity building and knowledge translation. [ABSTRACT FROM AUTHOR]

Introduction: Over‐prescription of opioids has diminished in recent years; however, certain populations remain at high risk. There is a dearth of research evaluating prescription rates using specific multimorbidity patterns. Objective: To identify distinct clinical profiles associated with opioid prescription and evaluate their relative odds of receiving long‐term opioid therapy. Design: Retrospective analysis of the complete military electronic health record. We assessed demographics and 26 physiological, psychological, and pain conditions present during initial opioid prescription. Latent class analysis (LCA) identified unique clinical profiles using diagnostic data. Logistic regression measured the odds of these classes receiving long‐term opioid therapy. Setting: All electronic health data under the TRICARE network. Participants: All servicemembers on active duty during fiscal years 2016 through 2019 who filled at least one opioid prescription. Main Outcome Measures: Number and qualitative characteristics of LCA classes; odds ratios (ORs) from logistic regression. We hypothesized that LCA classes characterized by high‐risk contraindications would have significantly higher odds of long‐term opioid therapy. Results: A total of N = 714,446 active duty servicemembers were prescribed an opioid during the study window, with 12,940 (1.8%) receiving long‐term opioid therapy. LCA identified five classes: Relatively Healthy (82%); Musculoskeletal Acute Pain and Substance Use Disorders (6%); High Pain, Low Mental Health Burden (9%); Low Pain, High Mental Health Burden (2%), and Multisystem Multimorbid (1%). Logistic regression found that, compared to the Relatively Healthy reference, the Multisystem Multimorbid class, characterized by multiple opioid contraindications, had the highest odds of receiving long‐term opioid therapy (OR = 9.24; p <.001; 95% confidence interval [CI]: 8.56, 9.98). Conclusion: Analyses demonstrated that classes with greater multimorbidity at the time of prescription, particularly co‐occurring psychiatric and pain disorders, had higher likelihood of long‐term opioid therapy. Overall, this study helps identify patients most at risk for long‐term opioid therapy and has implications for health care policy and patient care. [ABSTRACT FROM AUTHOR]

Objective The aim of the study is to evaluate the prevalence and factors associated with opioid prescriptions to postpartum patients among TRICARE beneficiaries receiving care in the civilian health care system versus a military health care facility. Study Design We evaluated postpartum opioid prescriptions filled at discharge among patients insured by TRICARE Prime/Prime Plus using the Military Health System Data Repository between fiscal years 2010 to 2015. We included women aged 15 to 49 years old and excluded abortive pregnancy outcomes and incomplete datasets. The primary outcome investigated mode of delivery and demographics for those filling an opioid prescription. Secondary outcomes compared prevalence of filled opioid prescription at discharge for postpartum patients within civilian care and military care. Results Of a total of 508,258 postpartum beneficiaries, those in civilian health care were more likely to fill a discharge opioid prescription compared with those in military health care (OR 3.9, 95% CI 3.8–3.99). Cesarean deliveries occurred less frequently in military care (26%) compared with civilian care (30%), and forceps deliveries occurred more frequently in military care (1.38%) compared with civilian care (0.75%). Women identified as Asian race were least likely to fill an opioid prescription postpartum (OR 0.79, 95% CI 0.75–0.83). Women aged 15 to 19 years had a lower odds of filling an opioid prescription (OR 0.83, 95% CI 0.80–0.86). Women associated with a senior officer rank were less likely to fill an opioid prescription postpartum (OR 0.83, 95% CI 0.73–0.91), while those associated with warrant officer rank were more likely to fill an opioid prescription (OR 1.14, 95% CI 1.06–1.23). Conclusion Our data indicates that women who received care in civilian facilities were more likely to fill an opioid prescription at discharge when compared with military facilities. Factors such as race and age were associated with opioid prescription at discharge. This study highlights areas for improvement for potential further studies. Key Points Opioid prescription patterns for postpartum women may vary across the country. Our study indicates postpartum patients in civilian care are more likely to fill opioids postpartum. This study highlights a population which may have an improved opioid prescribing pattern. [ABSTRACT FROM AUTHOR]

Background:Telehealth care expanded during the COVID-19 pandemic, although previous studies show racial, gender, and socioeconomic inequalities in its usage. Racial disparities are known to be mitigated in the Military Health System (MHS), whose 9.6 million beneficiaries are universally insured and nationally representative. This study investigated whether known disparities in telehealth usage were mitigated in the MHS. Methods:This study performed a retrospective cross-sectional study of TRICARE telehealth claims data from January 2020 to December 2021. Beneficiaries aged 0 to 64 years were identified with Common Procedural Terminology code modifiers 95, GT, and GQ, which indicated procedures that were delivered through either synchronous or asynchronous telecommunication services. Visits were defined as one encounter per patient per day. Analyses included descriptive statistics of patient demographics, number of telehealth visits, and differences between military-provided and private sector care (PSC). Military rank was used as a proxy for socioeconomic status (SES), generally combining income, education, and occupation type. Results:A total of 917,922 beneficiaries received telehealth visits during the study period: 25% in direct care, 80% in PSC, and 4% in both care settings. The majority of visits were received by females (57%) and associated with a Senior Enlisted rank (66%). The visits by racial category were proportional to the percentage of each category in the population. The lowest number of visits was for those older than 60 years, potentially receiving Medicare instead, and those associated with Junior Enlisted rank, a potential disparity that may also reflect access to leave or smaller family size. Conclusions and Relevance:Within the MHS, telehealth visits were equitable by race, in line with previous findings, but not by gender, SES, or age. Findings by gender are reflected in the greater U.S. population. Further research is needed to assess and address potential disparities associated with Junior Enlisted rank as proxy for low SES. [ABSTRACT FROM AUTHOR]