1. Session 11a: Increasing MTF
Effectiveness & Efficiency through
Population Health and Medical
Management
CDR James Ellzy, MD, CMQ
Teaching Faculty, DeWitt Army Family Medicine Residency
& Immediate Past Director of MHS Clinical Quality
james.ellzy@amedd.army.mil
11-1
3. Functions of Medical Officers
Misconceptions as to the functions of the Medical
Department are not uncommon even in the Army.
Since, in the time of peace, the medical officer is best
known through his relation to the sick, his more
important duties may be overlooked. His prime
function is, in peace or war, not the cure, but the
prevention of disease… The care of the sick,
essential though it is from ethical and political
considerations, thus assumes relative insignificance
from the military standpoint.
Military Hygiene (1914) by Frank Keefer
11-3
4. Levels of Prevention / Intervention
True Prevention:
Primary
Remove risk
Early detection
Secondary
and Treatment
Reduce
Tertiary
complications
11-4
5. Disease Continuum
Onset of
pre- Diagnosis
clinical Onset of Seek &
disease Detectable symptoms care treatment Outcome
Disease
free
1o 2o 3o
11-5
6. Definition of Epidemiology
The study of the distribution and
determinants
of health related states or events
in specified populations and its
application to the control
of health problems
11-6
7. Clinical Medicine vs. Epidemiology
Clinical Medicine Epidemiology
Focus Individuals Populations
Diagnosis and
Main Goal Prevention and Control
Treatment
What are the leading
What is wrong with
causes of death or
this patient?
Questions disability in this
What treatment is
population? What can be
appropriate?
done to reduce them?
11-7
8. Uses of Epidemiology
• Identify the etiology or cause of disease and the
relevant risk factors
• Determine the extent of disease in the community
• Study the natural history and prognosis of
disease
• Evaluate preventive and therapeutic measures
and modes of health care delivery
• Provide foundation for public policy relating to
environmental and genetic issues, and other
considerations regarding disease prevention and
health promotion
11-8
12. Population Health Surveillance
Its purpose is to provide a factual
basis
•Appropriately set priorities
from which you can:
• Plan programs
• Take action to promote and protect
the population’s health
11-12
13. Why Use Surveillance Systems?
• Monitor trends of disease including the detection
of epidemics or outbreaks
• Assess your population’s health status
• Guide the planning, implementation, and
evaluation of programs to prevent and control
disease, injury, or adverse exposure
• Define your healthcare priorities
• Evaluate health policies
11-13
14. No Vaccine = ARD Epidemics
Vaccine year-round Vaccine given No Vaccine
only 1 Sep-31Mar
11-14
22. Electronic Surveillance System for the Early
Notification of Community-based Epidemics
(ESSENCE)
Standard
Ambulatory
Data Records
ADM data is
are archived
at MTFs M sent to
Tricare
Prescription data
for DOD
T beneficiaries is
captured by PDTS
and sent to Tricare
F
Tricare updates
ESSENCE
Version 1B repository every
8 hours
Version IV
Data analyzed by
syndrome and organized
into alerts by MTFs
Graphs of daily visit counts by syndrome
11-22
23. What Do You Want to Know About Your
Population’s Health Status???
• How sick or healthy is my population?
• What are the disease states that require the most services
and utilization?
• What are their clinical preventive service and disease
management needs?
• Who are my high utilizers that may need case
management?
• How can I estimate demand for future services?
• How can I most effectively use my providers to meet these
needs?
11-23
