Photo By Ronald Bell | U.S. Army Reserve Lt. Col. Donald Keen, Emergency Physician from the 909th Forward...... read more read more
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The Defense Health Agency’s award-winning safety, high-quality care, and external transparency in all processes and improvements lead to “ready, reliable care” that meets or exceeds the nationally defined standard of care.
Continual fine-tuning and the use of both internal and external reviews mean military families and veterans will have as successful an outcome as in the best civilian hospitals and clinics, according to Dr. Paul Cordts, the DHA’s chief medical officer and the DHA deputy assistant director of medical affairs. “All of our beneficiaries deserve nothing less than excellence, anytime, anywhere—always.”
“We're proud of the quality of care we deliver. We work side by side as a military organization with the people we care for,” said Cordts. “We have a unique mission in military medicine, and we do everything in our power to engage, educate, and equip our team with the tools they need to deliver on that mission.”
Comparisons to Industry Benchmarks
Through public access to records, military beneficiaries can see how the DHA hospitals and clinics compare to civilian health care. “We post our performance for all the world to see,” Cordts said.
“It’s important that we compare ourselves to civilian benchmarks for a very large set of preventive and primary care measures,” Cordts added. “And it’s important that we compare ourselves to civilian hospitals and health care systems” directly, he added.
Military beneficiaries can make these apples-to-apples comparisons via information posted by:
• The Joint Commission, which conducts independent health care accreditation inspections of participating U.S. hospitals and clinics every three years
• The Leapfrog Group, a national watchdog organization, known as the toughest standard-setters for health care safety and quality in its Hospital Safety Grade Program
• The Centers for Medicare & Medicaid Services’ Care Compare initiative
These three groups allow military beneficiaries to “make informed choices about where they receive their health care,” Cordts said.
Of note, the Leapfrog Hospital Safety Grade is a letter-grade program that focuses exclusively on a hospital’s patient safety measures through more than 30 national performance indicators. Twice each year, it evaluates hospital safety measures such as errors, injuries, and infections.
On Nov. 15, 2024, Leapfrog announced their fall 2024 ratings, and 15 military hospitals received the “A” grade. Of participating hospitals nationwide, 32% got the highest grade. Of the eligible military hospitals that took part, 75% earned the “A” grade.
“Achieving these grades is no small feat,” said Dr. Cordts in the DHA’s Leapfrog announcement. “The commitment of our teams to ensure the safety of every patient in our care shows that military treatment facilities are among the best in the country when it comes to protecting patients and ensuring high standards.”
The Military Health System operates a Quality, Patient Safety and Access web page. This open electronic archive provides searchers with the ability to review their chosen military hospital or clinic across the Joint Commission, Leapfrog, and Care Compare with clear data showing how military facilities score on industry standard measures for patient safety, health care outcomes, quality of care, patient satisfaction, and access to care.
For example, you can specify a military hospital or clinic by name and review data on patient access to care and patient satisfaction reviews, quality of care, and patient safety information. You can also view overall ratings, which summarize up to 57 core quality measures, and download data sheets. A feature of the transparency tool is the ability to compare up to three facilities in a geographic area at once.
Cordts highlighted three other external national quality registries that rate the MHS: the National Surgical Quality Improvement Program, National Perinatal Information Center, and the Health Employer Data Information System. Delivering babies is the top line of care in the MHS. DHA medical facilities and TRICARE’s private sector combined deliver approximately 100,000 babies each year, ensuring a wealth of experience in prenatal care, labor, delivery, and postpartum care—all covered fully by TRICARE.
As another measure of transparency, each year the DHA publicly releases a comprehensive report detailing how well the system is meeting the standards set for quality, safety, and patient satisfaction.
Titled “Annual Evaluation of the TRICARE Program,” at over 200 pages, it provides in-depth data that reflect the current state of the MHS with in-depth reviews and analysis covering quality of care, patient trends, hospital and clinic ratings, and patient safety statistics. It also provides population statistics, TRICARE plan enrollment data, and a financial breakdown of the Department of Defense’s medical programs. The report, required by law, is distributed to Congress and other stakeholders and is publicly available on the official website of the MHS.
Standardizing Care
Standardizing care across the MHS “makes the care higher quality and safer over time,” Cordts said.
He pointed to two ways the MHS standardizes care: the MHS GENESIS electronic health record system and the 24 evidence-based clinical practice guidelines developed jointly between the DOD and Department of Veterans Affairs.
Cordts said the DHA will “hardwire” the clinical practice guidelines into MHS GENESIS to track adherence to best practices in areas such as limb loss and amputation, mild kidney disease, pregnancy, mild traumatic brain injury (concussion), and mental health. Electronic and portable medical records from MHS GENESIS follow military members and beneficiaries from cradle to grave, ensuring patient safety and quality of care across their time in the MHS.
When Things Go Wrong: Telling the Family, Telling the Public
Despite all safety measures, sometimes things go wrong in any hospital or clinic, anywhere in the world, civilian and military. Although rare, these adverse events need to be examined thoroughly from both the patient and provider sides. DHA defines an adverse event as death, permanent harm, or severe temporary harm.
Across the enterprise, the MHS Health Care Resolutions Program specialists and providers seek to talk to the patient and their family within 30 minutes of an adverse event either in person on site or virtually. The program goal is to explain the facts of the case and what happened immediately and face-to-face, if possible.
Because DHA believes in the “principles of high reliability and is a continuously learning health care system, our hospitals report patient safety events whenever there is an unanticipated outcome so that we can learn from these events and prevent them from happening in the future,” Cordts emphasized.
Publicly reporting patient adverse events means the DHA has “comprehensive clinical quality improvement standards coupled with robust patient safety and accountability programs that promote a culture of safe, high-quality patient care,” he said.
When an adverse event happens to a patient, DHA will “look deeply at the system that supports our clinical teams,” and report errors through the patient safety reporting system, said Cordts.
Sometimes, DHA will do a “very deep analysis, called a comprehensive systemic analysis, or root-cause analysis, and in those deeper investigations [that look at causation and contributing factors] come up with a corrective action plan that our hospitals are required to execute on,” he explained. Additionally, “we then try to learn as many lessons as we can to deploy across the entire enterprise.”
Health Care Risk Management and the Provider
The credentialing and privileging process for MHS hospital and clinic staff is the “foundational” review that looks at education, training, and experience to ensure staff are “qualified and competent,” Cordts said. Candidates for privileging must have active, unrestricted licenses from the state or states they work in.
Once privileged, providers undergo a peer review by their professional colleagues on a regular basis to assess their quality of care and provide feedback.
Following an event that may or may not negatively affect the health and safety of a patient or active duty service member, DHA takes specific, structured steps.
The first step determines whether the incident met the standard of care, which means “was the care reasonable and appropriate or was it not,” said Cordts, who’s a vascular surgeon by training. Those standards are laid out in the DHA’s 7-volume Procedures Manual 6025.13 on clinical quality management. The manual lays out dozens of specific procedures and processes that must be taken to ensure quality management throughout the DHA.
The aftermath of an adverse event requires some immediate actions if it’s found the provider’s ability to practice safe care is in question, Cordts said.
The “privileging authority”—usually the director of the hospital or clinic—can immediately suspend the provider’s privileges, which pulls the provider from patient care, often the same day.
At the same time, the needs of the provider are addressed because “we are also very concerned about the well-being of the provider when there is an adverse event,” Cordts noted.
Other options for action include the focused professional practice evaluation that “allows the privileging authority additional time to evaluate the provider’s performance in more depth,” Cordts explained. The privileging authority would consider standard of care cases in any subsequent new or re-privileging decisions being made on that individual provider, he said.
If there’s a liability or malpractice claim paid out, or an active duty death benefit or an active duty disability benefit paid, those cases are transferred to DHA headquarters. Following a multi-step review process, the DHA director will make the final decision on standard of care.
DHA has thousands of privileged providers, Cordts said. Maintaining privileges requires an individual to prove a specific set of skills and types of care learned through education, experience, and training—their credentials. Not everyone credentialed or privileged is a doctor—they could also be nurses, pharmacists, or midwives, for example.
Adverse events and adverse privileging actions may enter another headquarters review process which, in some cases, leads to further reporting. This process applies to both civilian and military providers and includes:
• The National Practitioner Data Bank, which has permanent records of actions taken by authorized organizations regarding health care practitioners, entities, providers, and suppliers that do not meet professional standards and is part of the Department of Health and Human Services
• State licensing boards, which can discipline providers for not meeting the standard of care in their state and make provider information public at their discretion
“My family and I receive care in the Military Health System, as do many of the folks who work in our defense health system worldwide,” Cordts said. “When our patients come in to see us, they can be very confident that they will receive safe, high-quality care—and they will.”
DHA oversees every military hospital and clinic worldwide. As of fiscal year 2023, it administered care in 45 hospitals/inpatient facilities (31 in the U.S.); 566 military ambulatory care and occupational health facilities (466 in the U.S.), 117 dental clinics (94 in the U.S.), and contingent forward-deployed sites worldwide to bring high-quality health care to 9.5 million beneficiaries worldwide.
| Date Taken: | 01.17.2025 |
| Date Posted: | 01.17.2025 09:02 |
| Story ID: | 489249 |
| Location: | US |
| Web Views: | 114 |
| Downloads: | 1 |
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