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.
CPT Felicia Williams
Consult and Appointment Management Office (CAMO) Time Motion Study
The San Antonio Market (SAM) located in San Antonio, Texas, is comprised of 12 military treatment facilities (MTFs), 12,000 employees, and 255,000 beneficiaries. Additionally, the SAM includes the Department of Defense’s (DoD’s) most productive inpatient facility, only Level I Trauma Center and the DoD’s largest outpatient facility. In January 2022, the SAM Consult and Appointment Management Office (CAMO), also known as the SAM appointment call center, transitioned to the use of a new medical informatics system, MHS Genesis, to schedule medical appointments for patients. Immediately after the transition, call center hold times increased substantially. The CAMO was no longer able to meet the government service level requirement that 90% of all monthly inbound calls be answered within 90 seconds. Holds times increased from an average of 18 seconds to an average of 15 minutes and 43 seconds. I conducted a time motion study to determine the number of call agents needed to meet the government service level requirement. The study consisted of quantitative data including my observation of a random sample of 70 calls and 6 call agents to measure call lengths and steps in the MHS Genesis workflow. Additional data incorporated was the quantitative analysis of call agents employed and present, employee turnover and absenteeism, and qualitative data such as call agent interviews and patient experience. Applicable quantitative data was inputted into the national call center staffing Erlang Calculator and resulted in a $2.1M contract modification request to ensure sufficient staffing for the CAMO. This project is applicable to other Federal Health Systems as all MTFs are transitioning to the use of MHS Genesis.
LTC Michael Lynch
Civilian Technician Training at the Medical Education and Training Campus
Timely surgical intervention is critical in ensuring rapid return to duty times for service members. Maintaining the appropriate space, personnel, and equipment for adequate surgical capability allows timely access to surgical intervention for service members, dependents, and other beneficiaries. Brooke Army Medical Center (BAMC) in San Antonio, Texas, is the largest and highest volume healthcare facility within the Defense Health Agency (DHA). However, BAMC currently operates only 20 of 35 available operating room suites, due not to a lack of surgeons or equipment but a lack of qualified surgical technicians. Currently the fill rate for authorized surgical technician positions at BAMC is 77%, negatively impacting surgical case volume and resulting in greater wait times for surgery. This proposal advocates for utilizing the Medical Education and Training Campus (METC) to train limited numbers of civilian surgical technicians for BAMC. Training space, faculty, and equipment are available to support, as the historical fill rates in the AIT program are less than 70%. Both BAMC and METC are under the DHA umbrella, allowing this proposal to be approved ‘in house’ and in an expeditious manner. Training of civilian technicians in METC courses would provide DHA facilities with personnel trained to the expected standard. Requiring a two-year commitment in exchange for the training will provide longer term stability for technicians at BAMC. The two-year commitment is not unusual in the healthcare marketplace as HCA Healthcare offers similar training opportunities with this required service obligation. This project has implications for all DHA and VA facilities and can be tailored to specific personnel needs, as METC offers training courses covering all medical technician specialties.
MAJ Bill Kirby
Gastrointestinal Clinic Process Mapping and Improvement Case Study
Not available for public release.
MAJ Clark Cave
Automated Clear and Legible Report (CLR) Chasing ‘El Macho’
The project addresses the persistent challenge of low CLR retrieval rates within the Defense Health Agency (DHA), impacting millions of Tricare beneficiaries. CLRs encompass consultation reports, operative notes, and discharge summaries, which network providers must return to military providers for continuity of care. Before the development of El Macho, no clear solution existed to manage, measure, or resolve low CLR rates aside from hiring more staff. In 10 months, this research team conceptualized, designed, developed, and managed the deployment of an innovative software application to automate CLR chasing, significantly improving CLR retrieval rates. The average monthly CLR retrieval increased from 1,206 to 9,947 at the time of this publication, representing a rolling 12 retrieval ratio improvement from approximately 33% to 77%. The project's success hinged on the ability to influence hundreds of network practices in the San Antonio Market (SAM) to return thousands of CLRs to the SAM Consult and Appointment Management Office (CAMO). Furthermore, implementing El Macho eliminated the previously manual task of CLR chasing. Under the previous system, the chasing process took approximately 3-5 minutes to chase one CLR. Using El Macho, the chasing process is completely automated and executed in a manner of seconds. To accomplish these objectives, the research team successfully influenced leadership at multiple levels, allowing for the allocation of a dedicated lead software developer to the initiative. The research team also persuaded CAMO to adopt an innovative approach to CLR chasing as part of a lean leader certification, utilizing the A3 process as a framework. Additionally, the research team built a SQL-integrated, user-friendly dashboard to present complex metrics in a simple, sustainable, and understandable manner. Notably, the project leveraged available tools such as SQL jobs, Microsoft PowerShell, Visual Studio, and a text editor to build a robust software solution. The project exceeded expectations by conservatively saving over 2,000 hours of avoidable work. Within four months, the application achieved a remarkable improvement of over 300% in monthly CLR retrieval rates. The outcomes of this pioneering endeavor have significant implications for enhancing the quality and cost of care for thousands of individuals in the San Antonio Market, with potential benefits extending to millions upon adoption by the Defense Health Agency (DHA).
MAJ Kristy Martinez
Door to Needle – Reduce Emergent Brain Attack Time from Door to TNK
Not available for public release.
MAJ Lennin Castellon
Improving Utilization of Eye Screening Machine for Diabetic Retinopathy Analysis
According to the Centers for Disease Control and Prevention (CDC, 2023), approximately 50% of the US population is either diabetic or pre-diabetic. UT Health San Antonio services a substantial diabetic patient population. If diabetes is left untreated it can result in multiple serious complications including blindness. Studies, like Maberly (2003), have shown that diabetic retinopathy can result in annual loss of vision from 4% to 12.5%. This project focused on increasing access to care for eye exams for the UT Health patient population. Utilizing a lean methodology, a review of the current process was conducted to identify ways to improve utilization of a TOPCON TRC-NW400 eye screening machine. The recommended changes focused on three areas of improvement: 1) workflow, 2) management and policy updates, and 3) information technology updates. The results included increasing access to care by up to 2 months for some patients and an increased utilization rate of the eye exam machine by over 70%. In addition, further research was recommended to improve billing and collection operations.
Previous Awardees for the J. Dewey Lutes Peer Research Award
2022: CPT Chris Bennet
Title: Emergency Department (ED) Utilization
2013: LTJG Eric Harasimowitz
Title: The Effects of Patient-Centered Medical Home Implementation on Cervical Cancer Screening Compliance Rates at the Screaming Eagle Medical Home
2012: Ms. Jessica Jones
Title: Impact of Embedded Behavioral Health Teams on Soldier Behavioral Health Inpatient Admissions
2009: 1LT Joshua Dean
Title: An Investigation of Pulse Oximetry Methods in a Vasoconstricted Environment