J. Dewey Lutes Peer Research Award
The Army-Baylor University Graduate Program in Health & Business Administration has informally established the J. Dewey Lutes Peer Research Award, recognizing excellence in student research. The award was established in 1987 and named after J. Dewey Lutes, FACHA, the primary founder and the first Director-General of the ACHA (now ACHE) from 1933 to 1937.
Substance Use Disorder (SUD) Residential Treatment Program (RTP) Business Case Analysis (BCA)
Brooke Army Medical Center (BAMC) in San Antonio, Texas, is the largest and highest volume healthcare facility within the Defense Health Agency (DHA). BAMC provides the entire continuum of addiction care, from inpatient and residential treatment options to intensive outpatient programs, and multi-disciplinary outpatient treatments. Active-duty service member utilization of residential treatment programs for substance use disorders in purchased care (care provided outside the military health system) increased by 44% in four years. The average cost of mental health bed days increased by 25% during the same period. By examining a proposal to reassign underutilized Soldier Recovery Unit (SRU) space to better meet patient needs, this Business Case Analysis (BCA) provides BAMC’s Behavioral Health leaders with the likely costs and benefits associated with implementing an expanded Residential Treatment Program (RTP). The proposal advocates for an expanded RTP, allowing care to take place outside the main hospital, changing the treatment intensity to target a larger patient population, and changing the staffing requirements. Comparing the proposed expanded RTP with the status quo, this project shows that changing the RTP to treat a larger pool of lower acuity patients will reduce staff costs while increasing patient throughput for the program. Because purchased care recapture is vital to the expanded RTP, resulting in a positive return on investment in DHA-wide referral management, changes should be implemented before moving forward with this project. This project has implications for the DHA Behavior Health service line to improve the continuity of addiction care for active-duty service members.
Lead Measures for Zero Preventable Harm
While much study has been conducted on harm prevention, their scopes are precisely narrowed to specific procedures, practices, and staff types. This project attempts to develop a comprehensive lead measure that serves as a Key Performance Indicator towards zero preventable harm. A comprehensive lead measure allows Landstuhl Regional Medical Center (LRMC) departments and leaders to react and adjust before a harm event occurs. The basis for this study was to utilized machine learning algorithms to identify predictive variables related to preventable harm events. Cultural and burnout proxy variables were regressed against monthly harm events aggregated by department, using lasso and ridge predictive models. ß values ranged from near zero to slightly over .5. Provider skill types one and four utilization had the highest coefficients at -.506 and .503, respectively. The next most significant factor was Support Hrs. Ratio at .224. The fourth most impactful variable, Previous Month’s Support Hrs. Ratio was the only lag variable with a ß >.10, at .151. The strong negative ß value for Skill Type One Provider’s Available FTEs (AFTE) would suggest a strong link between their level of burnout and the occurrence of a harm event. With a negative correlation, the model suggests that the more availability a provider has (less over-worked), the less likely a harm event is to occur. Conversely, available Skill Type Four hours have a near equal but opposite effect. The less they are in clinic the more likely a harm event is to occur. These data indicate that the more active the support staff is, the less likely a harm event is to occur. Limited data availability creates significant limitations to the effectiveness of this study. The variables contained in the studied data biases heavily toward burnout factors as indicators. Other, unobserved factors, likely play a role and influence the outcome variable. For example, this study does not explain how provider and staff safety education may also influence harm events. While this study provides valuable insights for shaping staffing models, it is not complete enough to establish a reliable lead measure to predict future harm events. This study provides a foundation for future causal studies related to harm prediction and prevention. The scope of data should be expanded to encompass other areas of observation that could influence the likelihood of a harm event
Emergency Department (ED) Utilization
Periods of freezing temperatures in San Antonio provide a unique ED utilization dataset due to their irregularity. There was a markedly steep drop in utilization during all freeze periods between 2017 and 2022, but the admission rates were consistent. This indicated a correlation between freezing temperatures and lower ED utilization, but more importantly, it identified the ‘true need’ of patients as those who traversed precarious weather conditions were sicker and bore a more severe acuity rating. I first found correlation between ED utilization and temperature, then I compared non-freeze weeks diagnoses with freeze weeks diagnoses and found that the following conditions were absent from freeze week diagnoses: cough, cellulitis, dental caries, constipation, diarrhea, and leaving AMA. Additionally, I found that the vast majority of lower acuity patients presented between 0900 and 1700. The results of this quantitative analysis revealed an STVHCS need for a ‘fast-lane’ ED process for lower acuity patients to improve patient satisfaction and ED flow. STVHCS plans to open an urgent care inside the ED within the next year
Previous Awardees for the J. Dewey Lutes Peer Research Award
Title: The Effects of Patient-Centered Medical Home Implementation on Cervical Cancer Screening Compliance Rates at the Screaming Eagle Medical Home
Authors: LTJG Eric Harasimowitz, Dr. Michael Hawkins, CPT Jeremy Trescott
Title: Impact of Embedded Behavioral Health Teams on Soldier Behavioral Health Inpatient Admissions
Authors: Ms. Jessica Jones, Mr. Mike Henry
Title: An Investigation of Pulse Oximetry Methods in a Vasoconstricted Environment
Authors: 1Lt Joshua Dean, Ms. Barbara Marquette, CPT David Glad, MAJ Ron Gesaman