Analysis of Surgical Volume in Military Medical Treatment Facilities and Clinical Combat Readiness of US Military Surgeons
Low surgical volume in the US Military Health System (MHS) has been identified as a challenge to military surgeon readiness. The Uniformed Services University of Health Sciences, in partnership with the American College of Surgeons, developed the Knowledge, Skills, and Abilities (KSA) Clinical Readi...
Uloženo v:
| Vydáno v: | JAMA surgery Ročník 157; číslo 1; s. 43 |
|---|---|
| Hlavní autoři: | , , , , , , |
| Médium: | Journal Article |
| Jazyk: | angličtina |
| Vydáno: |
United States
01.01.2022
|
| Témata: | |
| ISSN: | 2168-6262, 2168-6262 |
| On-line přístup: | Zjistit podrobnosti o přístupu |
| Tagy: |
Přidat tag
Žádné tagy, Buďte první, kdo vytvoří štítek k tomuto záznamu!
|
| Abstract | Low surgical volume in the US Military Health System (MHS) has been identified as a challenge to military surgeon readiness. The Uniformed Services University of Health Sciences, in partnership with the American College of Surgeons, developed the Knowledge, Skills, and Abilities (KSA) Clinical Readiness Program that includes a tool for quantifying the clinical readiness value of surgeon workload, known as the KSA metric.
To describe changes in US military general surgeon procedural volume and readiness using the KSA metric.
This cohort study analyzed general surgery workload performed across the MHS, including military and civilian facilities, between fiscal year 2015 and 2019 and the calculated KSA metric value. The surgeon-level readiness among military general surgeons was calculated based on the KSA metric readiness threshold. Data were obtained from TRICARE, the US Department of Defense health insurance product.
The main outcomes were general surgery procedural volumes and the KSA metric point value of those procedures across the MHS as well as the number of military general surgeons meeting the KSA metric readiness threshold. Aggregate facility and regional market-level claims data were used to calculate the procedural volumes and KSA metric readiness value of those procedures. Annual adjusted KSA metric points earned were used to determine the number of individual US military general surgeons meeting the readiness threshold.
The number of general surgery procedures generating KSAs in military hospitals decreased 25.6%, from 128 377 in 2015 to 95 461 in 2019, with a 19.1% decrease in the number of general surgeon KSA points (from 7 155 563 to 5 790 001). From 2015 to 2019, there was a 3.2% increase in both the number of procedures (from 419 980 to 433 495) and KSA points (from 21 071 033 to 21 748 984) in civilian care settings. The proportion of military general surgeons meeting the KSA metric readiness threshold decreased from 16.7% (n = 97) in 2015 to 10.1% (n = 68) in 2019.
This study noted that the number of KSA metric points and procedural volume in military hospitals has been decreasing since 2015, whereas both measures have increased in civilian facilities. The findings suggest that loss of surgical workload has resulted in further decreases in military surgeon readiness and may require substantial changes in patient care flow in the MHS to reverse the change. |
|---|---|
| AbstractList | Low surgical volume in the US Military Health System (MHS) has been identified as a challenge to military surgeon readiness. The Uniformed Services University of Health Sciences, in partnership with the American College of Surgeons, developed the Knowledge, Skills, and Abilities (KSA) Clinical Readiness Program that includes a tool for quantifying the clinical readiness value of surgeon workload, known as the KSA metric.ImportanceLow surgical volume in the US Military Health System (MHS) has been identified as a challenge to military surgeon readiness. The Uniformed Services University of Health Sciences, in partnership with the American College of Surgeons, developed the Knowledge, Skills, and Abilities (KSA) Clinical Readiness Program that includes a tool for quantifying the clinical readiness value of surgeon workload, known as the KSA metric.To describe changes in US military general surgeon procedural volume and readiness using the KSA metric.ObjectiveTo describe changes in US military general surgeon procedural volume and readiness using the KSA metric.This cohort study analyzed general surgery workload performed across the MHS, including military and civilian facilities, between fiscal year 2015 and 2019 and the calculated KSA metric value. The surgeon-level readiness among military general surgeons was calculated based on the KSA metric readiness threshold. Data were obtained from TRICARE, the US Department of Defense health insurance product.Design, Setting, and ParticipantsThis cohort study analyzed general surgery workload performed across the MHS, including military and civilian facilities, between fiscal year 2015 and 2019 and the calculated KSA metric value. The surgeon-level readiness among military general surgeons was calculated based on the KSA metric readiness threshold. Data were obtained from TRICARE, the US Department of Defense health insurance product.The main outcomes were general surgery procedural volumes and the KSA metric point value of those procedures across the MHS as well as the number of military general surgeons meeting the KSA metric readiness threshold. Aggregate facility and regional market-level claims data were used to calculate the procedural volumes and KSA metric readiness value of those procedures. Annual adjusted KSA metric points earned were used to determine the number of individual US military general surgeons meeting the readiness threshold.Main Outcomes and MeasuresThe main outcomes were general surgery procedural volumes and the KSA metric point value of those procedures across the MHS as well as the number of military general surgeons meeting the KSA metric readiness threshold. Aggregate facility and regional market-level claims data were used to calculate the procedural volumes and KSA metric readiness value of those procedures. Annual adjusted KSA metric points earned were used to determine the number of individual US military general surgeons meeting the readiness threshold.The number of general surgery procedures generating KSAs in military hospitals decreased 25.6%, from 128 377 in 2015 to 95 461 in 2019, with a 19.1% decrease in the number of general surgeon KSA points (from 7 155 563 to 5 790 001). From 2015 to 2019, there was a 3.2% increase in both the number of procedures (from 419 980 to 433 495) and KSA points (from 21 071 033 to 21 748 984) in civilian care settings. The proportion of military general surgeons meeting the KSA metric readiness threshold decreased from 16.7% (n = 97) in 2015 to 10.1% (n = 68) in 2019.ResultsThe number of general surgery procedures generating KSAs in military hospitals decreased 25.6%, from 128 377 in 2015 to 95 461 in 2019, with a 19.1% decrease in the number of general surgeon KSA points (from 7 155 563 to 5 790 001). From 2015 to 2019, there was a 3.2% increase in both the number of procedures (from 419 980 to 433 495) and KSA points (from 21 071 033 to 21 748 984) in civilian care settings. The proportion of military general surgeons meeting the KSA metric readiness threshold decreased from 16.7% (n = 97) in 2015 to 10.1% (n = 68) in 2019.This study noted that the number of KSA metric points and procedural volume in military hospitals has been decreasing since 2015, whereas both measures have increased in civilian facilities. The findings suggest that loss of surgical workload has resulted in further decreases in military surgeon readiness and may require substantial changes in patient care flow in the MHS to reverse the change.Conclusions and RelevanceThis study noted that the number of KSA metric points and procedural volume in military hospitals has been decreasing since 2015, whereas both measures have increased in civilian facilities. The findings suggest that loss of surgical workload has resulted in further decreases in military surgeon readiness and may require substantial changes in patient care flow in the MHS to reverse the change. Low surgical volume in the US Military Health System (MHS) has been identified as a challenge to military surgeon readiness. The Uniformed Services University of Health Sciences, in partnership with the American College of Surgeons, developed the Knowledge, Skills, and Abilities (KSA) Clinical Readiness Program that includes a tool for quantifying the clinical readiness value of surgeon workload, known as the KSA metric. To describe changes in US military general surgeon procedural volume and readiness using the KSA metric. This cohort study analyzed general surgery workload performed across the MHS, including military and civilian facilities, between fiscal year 2015 and 2019 and the calculated KSA metric value. The surgeon-level readiness among military general surgeons was calculated based on the KSA metric readiness threshold. Data were obtained from TRICARE, the US Department of Defense health insurance product. The main outcomes were general surgery procedural volumes and the KSA metric point value of those procedures across the MHS as well as the number of military general surgeons meeting the KSA metric readiness threshold. Aggregate facility and regional market-level claims data were used to calculate the procedural volumes and KSA metric readiness value of those procedures. Annual adjusted KSA metric points earned were used to determine the number of individual US military general surgeons meeting the readiness threshold. The number of general surgery procedures generating KSAs in military hospitals decreased 25.6%, from 128 377 in 2015 to 95 461 in 2019, with a 19.1% decrease in the number of general surgeon KSA points (from 7 155 563 to 5 790 001). From 2015 to 2019, there was a 3.2% increase in both the number of procedures (from 419 980 to 433 495) and KSA points (from 21 071 033 to 21 748 984) in civilian care settings. The proportion of military general surgeons meeting the KSA metric readiness threshold decreased from 16.7% (n = 97) in 2015 to 10.1% (n = 68) in 2019. This study noted that the number of KSA metric points and procedural volume in military hospitals has been decreasing since 2015, whereas both measures have increased in civilian facilities. The findings suggest that loss of surgical workload has resulted in further decreases in military surgeon readiness and may require substantial changes in patient care flow in the MHS to reverse the change. |
| Author | Remick, Kyle N Elster, Eric A Dalton, Michael K Cooper, Zara Trinh, Quoc-Dien Mathias, Michael Weissman, Joel S |
| Author_xml | – sequence: 1 givenname: Michael K surname: Dalton fullname: Dalton, Michael K organization: Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey – sequence: 2 givenname: Kyle N surname: Remick fullname: Remick, Kyle N organization: Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, Maryland – sequence: 3 givenname: Michael surname: Mathias fullname: Mathias, Michael organization: Deloitte Consulting LLP, Arlington, Virginia – sequence: 4 givenname: Quoc-Dien surname: Trinh fullname: Trinh, Quoc-Dien organization: Center for Surgery and Public Health, Harvard Medical School, Harvard T. H. Chan School of Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts – sequence: 5 givenname: Zara surname: Cooper fullname: Cooper, Zara organization: Center for Surgery and Public Health, Harvard Medical School, Harvard T. H. Chan School of Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts – sequence: 6 givenname: Eric A surname: Elster fullname: Elster, Eric A organization: Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, Maryland – sequence: 7 givenname: Joel S surname: Weissman fullname: Weissman, Joel S organization: Center for Surgery and Public Health, Harvard Medical School, Harvard T. H. Chan School of Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/34705038$$D View this record in MEDLINE/PubMed |
| BookMark | eNpNkE1PwkAQhjcGI4j8AQ9mj16K-9V2eySNqAnERMBrM21nzZJ2i932gL9eQIzOZSZ5nzwzmWsycI1DQm45m3LG-MMWavB9-zEVTPBpKCW_ICPBIx1EIhKDf_OQTLzfskNpxpRMrshQqpiFTOoR-Zo5qPbeetoYujr4bAEVfW-qvkZqHV3aynbQ7ukSy1O0bhG6Gl1H51AcQ4uegitpWll3ItKmzqGjbwildehP5s3qz3Tcgo3zN-TSQOVxcu5jspk_rtPnYPH69JLOFgEolXRBEed5xBkvtYlyJUEqY2SiQoFoEpEkBgyXSsgYIOIICmRZ6hLjQmvQaLQYk_sf765tPnv0XVZbX2BVgcOm95kIdZQkIgyP6N0Z7fMay2zX2vpwcvb7L_ENVohysA |
| CitedBy_id | crossref_primary_10_1111_trf_17929 crossref_primary_10_1093_milmed_usac316 crossref_primary_10_1097_TA_0000000000004423 crossref_primary_10_1097_TA_0000000000004742 crossref_primary_10_1093_milmed_usaf348 crossref_primary_10_1097_TA_0000000000004422 crossref_primary_10_1097_TA_0000000000004741 crossref_primary_10_1097_AS9_0000000000000308 crossref_primary_10_1097_AJN_0000000000000005 crossref_primary_10_1097_CORR_0000000000003290 crossref_primary_10_1093_milmed_usaf473 crossref_primary_10_1016_j_injury_2024_111320 crossref_primary_10_1136_tsaco_2024_001609 crossref_primary_10_1007_s00464_023_10150_6 crossref_primary_10_1016_j_jss_2023_09_051 crossref_primary_10_1097_CORR_0000000000002676 crossref_primary_10_1097_XCS_0000000000001371 crossref_primary_10_1097_TA_0000000000003700 crossref_primary_10_1097_TA_0000000000004678 crossref_primary_10_1136_tsaco_2024_001555 crossref_primary_10_1093_milmed_usae425 crossref_primary_10_1093_milmed_usad218 crossref_primary_10_1093_milmed_usae308 crossref_primary_10_3390_ecm2030040 crossref_primary_10_1097_TA_0000000000004394 crossref_primary_10_1136_tsaco_2023_001177 crossref_primary_10_1093_milmed_usae508 crossref_primary_10_1136_tsaco_2023_001332 crossref_primary_10_1097_TA_0000000000004040 crossref_primary_10_1093_milmed_usad262 crossref_primary_10_1093_milmed_usae113 crossref_primary_10_1093_milmed_usaf368 crossref_primary_10_1093_milmed_usae357 crossref_primary_10_1093_milmed_usac135 crossref_primary_10_1097_XCS_0000000000001445 crossref_primary_10_1093_milmed_usac336 crossref_primary_10_1093_milmed_usae314 crossref_primary_10_1097_TA_0000000000004047 crossref_primary_10_1136_bmjmilitary_2022_002112 crossref_primary_10_1097_TA_0000000000004051 crossref_primary_10_1093_milmed_usae242 crossref_primary_10_1093_milmed_usae045 crossref_primary_10_1093_milmed_usac300 crossref_primary_10_1097_SLA_0000000000005606 crossref_primary_10_1093_milmed_usad033 crossref_primary_10_1001_jamanetworkopen_2021_42843 crossref_primary_10_1093_milmed_usac229 crossref_primary_10_1097_TA_0000000000004415 crossref_primary_10_1097_AS9_0000000000000395 crossref_primary_10_1016_j_injury_2023_02_026 crossref_primary_10_1097_TA_0000000000004379 crossref_primary_10_1177_00031348221109451 crossref_primary_10_1093_milmed_usae403 crossref_primary_10_1227_neu_0000000000002595 crossref_primary_10_1097_TA_0000000000004381 crossref_primary_10_1136_military_2022_002286 crossref_primary_10_1108_JHLSCM_04_2022_0047 crossref_primary_10_1093_milmed_usad441 crossref_primary_10_1016_j_clineuro_2023_107742 crossref_primary_10_1093_milmed_usae576 crossref_primary_10_1097_XCS_0000000000001069 crossref_primary_10_4037_ccn2024428 crossref_primary_10_1097_XCS_0000000000000697 crossref_primary_10_1093_milmed_usad280 |
| ContentType | Journal Article |
| DBID | CGR CUY CVF ECM EIF NPM 7X8 |
| DOI | 10.1001/jamasurg.2021.5331 |
| DatabaseName | Medline MEDLINE MEDLINE (Ovid) MEDLINE MEDLINE PubMed MEDLINE - Academic |
| DatabaseTitle | MEDLINE Medline Complete MEDLINE with Full Text PubMed MEDLINE (Ovid) MEDLINE - Academic |
| DatabaseTitleList | MEDLINE - Academic MEDLINE |
| Database_xml | – sequence: 1 dbid: NPM name: PubMed url: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed sourceTypes: Index Database – sequence: 2 dbid: 7X8 name: MEDLINE - Academic url: https://search.proquest.com/medline sourceTypes: Aggregation Database |
| DeliveryMethod | no_fulltext_linktorsrc |
| EISSN | 2168-6262 |
| ExternalDocumentID | 34705038 |
| Genre | Research Support, U.S. Gov't, Non-P.H.S Journal Article |
| GeographicLocations | United States |
| GeographicLocations_xml | – name: United States |
| GroupedDBID | 0R~ 4.4 53G AAWTL ABBLC ABJNI ACDNT ACGFS ADBBV AENEX AHMBA ALMA_UNASSIGNED_HOLDINGS AMJDE ANMPU BRYMA C45 CGR CUY CVF EBD EBS ECM EIF EMOBN EX3 GX1 H13 NPM OB2 OBH OHH OVD PQQKQ RAJ SV3 TEORI WOW 7X8 |
| ID | FETCH-LOGICAL-a449t-c7bb6101d8f6b43a34ff39452eef9299faf134237aa61ea4a3dd8de7c88a8ef82 |
| IEDL.DBID | 7X8 |
| ISICitedReferencesCount | 68 |
| ISICitedReferencesURI | http://www.webofscience.com/api/gateway?GWVersion=2&SrcApp=Summon&SrcAuth=ProQuest&DestLinkType=CitingArticles&DestApp=WOS_CPL&KeyUT=000724220200003&url=https%3A%2F%2Fcvtisr.summon.serialssolutions.com%2F%23%21%2Fsearch%3Fho%3Df%26include.ft.matches%3Dt%26l%3Dnull%26q%3D |
| ISSN | 2168-6262 |
| IngestDate | Fri Jul 11 15:18:00 EDT 2025 Thu Jan 02 22:54:52 EST 2025 |
| IsDoiOpenAccess | false |
| IsOpenAccess | true |
| IsPeerReviewed | true |
| IsScholarly | true |
| Issue | 1 |
| Language | English |
| LinkModel | DirectLink |
| MergedId | FETCHMERGED-LOGICAL-a449t-c7bb6101d8f6b43a34ff39452eef9299faf134237aa61ea4a3dd8de7c88a8ef82 |
| Notes | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
| OpenAccessLink | https://www.ncbi.nlm.nih.gov/pmc/articles/8552115 |
| PMID | 34705038 |
| PQID | 2586992558 |
| PQPubID | 23479 |
| ParticipantIDs | proquest_miscellaneous_2586992558 pubmed_primary_34705038 |
| PublicationCentury | 2000 |
| PublicationDate | 2022-01-01 |
| PublicationDateYYYYMMDD | 2022-01-01 |
| PublicationDate_xml | – month: 01 year: 2022 text: 2022-01-01 day: 01 |
| PublicationDecade | 2020 |
| PublicationPlace | United States |
| PublicationPlace_xml | – name: United States |
| PublicationTitle | JAMA surgery |
| PublicationTitleAlternate | JAMA Surg |
| PublicationYear | 2022 |
| References | 34705040 - JAMA Surg. 2022 Jan 1;157(1):50-51 |
| References_xml | – reference: 34705040 - JAMA Surg. 2022 Jan 1;157(1):50-51 |
| SSID | ssj0000800439 |
| Score | 2.5868094 |
| Snippet | Low surgical volume in the US Military Health System (MHS) has been identified as a challenge to military surgeon readiness. The Uniformed Services University... |
| SourceID | proquest pubmed |
| SourceType | Aggregation Database Index Database |
| StartPage | 43 |
| SubjectTerms | General Surgery - statistics & numerical data Humans Military Health Services United States Work Capacity Evaluation Workload - statistics & numerical data |
| Title | Analysis of Surgical Volume in Military Medical Treatment Facilities and Clinical Combat Readiness of US Military Surgeons |
| URI | https://www.ncbi.nlm.nih.gov/pubmed/34705038 https://www.proquest.com/docview/2586992558 |
| Volume | 157 |
| WOSCitedRecordID | wos000724220200003&url=https%3A%2F%2Fcvtisr.summon.serialssolutions.com%2F%23%21%2Fsearch%3Fho%3Df%26include.ft.matches%3Dt%26l%3Dnull%26q%3D |
| hasFullText | |
| inHoldings | 1 |
| isFullTextHit | |
| isPrint | |
| link | http://cvtisr.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwpV07T8MwELaAMrDwEK_ykpFYA3XiJPaEEKJiaVWpLepW2YmNKqGkNC0S_HruHIcuDEgsWaI4lu98_uw7fx8hN4aFxiD5oAY8GnCFSUIhkyBRUcekWnY0105sIu33xWQiB_7ArfJllU1MdIE6LzM8I78LY5FICQBY3M_fA1SNwuyql9DYJK0IoAx6dToRP2csiIa4ExMLWSICwO6hvzfTEA9Vq8UrbBJDdhs3OnO_oky32nT3_tvPfbLrcSZ9qB3jgGyY4pB8NRQktLR0CJ1CC9EXF6DorKA9R9m9-KQ-fUNHTRk67aoMX8K-mqoip55O9I1CPNFqSetafIia2PJ4uG4J_2LAs4_IuPs0enwOvPhCoDiXyyBLtQZoxXJhE80jFXFrI8ljMK0FSCWtsgzZA1OlEmYUV1Gei9ykmRBKGCvCY7JVlIU5JTSMbJ7irXvJNOA1vPgXs0xlEhZQnnPVJtfNUE7BuTFjoQpTrqrpejDb5KS2x3Res3BMI546LpuzP3x9TnaYRIUdLLO9IC0LU9tcku3sYzmrFlfOa-DZH_S-AZ96zjs |
| linkProvider | ProQuest |
| openUrl | ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Analysis+of+Surgical+Volume+in+Military+Medical+Treatment+Facilities+and+Clinical+Combat+Readiness+of+US+Military+Surgeons&rft.jtitle=JAMA+surgery&rft.au=Dalton%2C+Michael+K&rft.au=Remick%2C+Kyle+N&rft.au=Mathias%2C+Michael&rft.au=Trinh%2C+Quoc-Dien&rft.date=2022-01-01&rft.issn=2168-6262&rft.eissn=2168-6262&rft.volume=157&rft.issue=1&rft.spage=43&rft_id=info:doi/10.1001%2Fjamasurg.2021.5331&rft.externalDBID=NO_FULL_TEXT |
| thumbnail_l | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/lc.gif&issn=2168-6262&client=summon |
| thumbnail_m | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/mc.gif&issn=2168-6262&client=summon |
| thumbnail_s | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/sc.gif&issn=2168-6262&client=summon |