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AF PDHRA

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AF PDHRA

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    2. 2 AF perspective on implementation and maturation process of PDHRAAF perspective on implementation and maturation process of PDHRA

    3. 3 What is PDHRA? Post-deployment Health Reassessment (DD Form 2900) OSD/Ha-mandated 10 March 2005 Standardized Assessment Instrument Completed 90-180 Days After A Return From Deployment Includes 16 Questions Both Physical And Behavioral Health Questions Healthcare Provider Evaluation (For Positives Only In The Air Force) Overly sensitive algorithm No data stating which is better Face to face for all vs. positives only Health Affairs is currently engaged in a study to determine which practice is more effective in identification of latent post-deployment health needsOverly sensitive algorithm No data stating which is better Face to face for all vs. positives only Health Affairs is currently engaged in a study to determine which practice is more effective in identification of latent post-deployment health needs

    4. 4 Why ? Reports Deployment-related Health Concerns That Emerge Over Time Enhances Force Health Protection And Readiness Program; Extends Deployment-related Healthcare Provides A Population Level Health Assessment For Early Identification And Intervention Demonstrates Caring Posture To Those Who Serve Through Targeted Outreach Procedures Removes Barriers To Care, De-stigmatize Care-seeking At All Levels

    5. 5 Timeline ? AFMS wide process stood up Apr 06 required line buy-in (education of program and f/u post deployment)AFMS wide process stood up Apr 06 required line buy-in (education of program and f/u post deployment)

    6. 6 Web-based Line driven Executed through PIMR platform in Primary Care (Fam Med, FSO) 2 Yellow diamonds are key steps in the process Web-based Line driven Executed through PIMR platform in Primary Care (Fam Med, FSO) 2 Yellow diamonds are key steps in the process

    7. 7 Additional Question Sets Alcohol Use Disorders Identification Test (AUDIT) 10-item Screening Questionnaire A Score Of 8 Or More Is Associated With Harmful Or Hazardous Drinking A Score Of 13 Or More In Women, And 15 Or More In Men, Is Likely To Indicate Alcohol Dependence Post Traumatic Stress Disorder (PTSD) Checklist-military Version (PCL-M) Standardized Self-report Rating Scale For PTSD Comprising 17 Items That Correspond To The Key Symptoms Of PTSD Modified Patient Health Questionnaire (PHQ-9) Brief 9-item Patient Self-report Depression Assessment With Question 9 About Suicidal Ideation Removed From The Web-application Decline = + response which needs to be addressedDecline = + response which needs to be addressed

    8. 8 PDHRA Completion Rate For Current ADAF As Of 26 Jan 07 Currently average 5500 2900’s completed per month Currently average 2000 p.4 completed per month Those PDHRAs that are in the 90 – 180 day window were subtracted from the numerator of those completed and from the denominator of total. Barriers: Contacting member Appt availabilityCurrently average 5500 2900’s completed per month Currently average 2000 p.4 completed per month Those PDHRAs that are in the 90 – 180 day window were subtracted from the numerator of those completed and from the denominator of total. Barriers: Contacting member Appt availability

    9. 9 Screener: Percent ADAF Positive Completed AD PDHRAs as of Jan 26th 2007 Total completes: 45,0004 – the decliners (2,512) and any duplicate SSNs (such that we took the most recent deployment for a member with > 1 deployment) = 42,492 Completed AD PDHRAs as of Jan 26th 2007 Total completes: 45,0004 – the decliners (2,512) and any duplicate SSNs (such that we took the most recent deployment for a member with > 1 deployment) = 42,492

    10. 10 Page 4 Compliance Metric: ADAF Requirement is that personnel with a positive PDHRA will be reviewed within the first 30 days of the positive. AFMS compliance with 30 day time range is 70.9%. We have room to grow here….access to care issues due to our shortage Requirement is that personnel with a positive PDHRA will be reviewed within the first 30 days of the positive. AFMS compliance with 30 day time range is 70.9%. We have room to grow here….access to care issues due to our shortage

    11. 11 Types of Positives: ADAF

    12. 12 Screener Symptom Type*: ADAF Of the POSITIVES this table depicts the distribution of concerns as determined by the provider Shows % using 18,043 positives as denominator Shows % using total population of 45,106 (all of those positive + all not positive) Of the POSITIVES this table depicts the distribution of concerns as determined by the provider Shows % using 18,043 positives as denominator Shows % using total population of 45,106 (all of those positive + all not positive)

    13. 13 Included in analysis if 4 conditions were met: Arrived in the theater = July 1st, 2004 Departed from theater = Mar 31st 2006 Were ADAF 6 months prior to deployment and 6 months after Had no other deployment 12 months prior and 6 months after 41,712 met the criteria All outpatient diagnoses are included (not just primary) Moving Toward A Diagnosis

    14. 14 Infectious and parasitic Neoplasms Endocrine, Nutritional, Metabolic, Immune Blood Mental Health* Nervous/Sense Circulatory Respiratory Digestive Genitourinary Pregnancy/Childbirth Skin/Subcutaneous Musculoskeletal/Connective Congenital Perinatal Ill-Defined Injury/Poisoning better mental health language groupingsbetter mental health language groupings

    15. 15 Overview of Results: ICD-9-CM Groupings Most Prevalent Post-Deployment Groupings Musculoskeletal / Connective Nervous / Sensory Respiratory Ill-Defined Injury / Poisoning Skin / Subcutaneous

    16. 16 Musculoskeletal / Connective

    17. 17 Nervous / Sensory

    18. 18 Respiratory

    19. 19 Ill-Defined

    20. 20 Injury / Poisoning

    21. 21 Skin / Subcutaneous

    22. 22 Infectious and parasitic Neoplasms Endocrine, Nutritional, Metabolic, Immune Blood Mental Health Nervous/Sense Circulatory Respiratory Digestive Genitourinary Pregnancy/Childbirth Skin/Subcutaneous Musculoskeletal/Connective Congenital Perinatal Ill-Defined Injury/Poisoning V1-9       Communicable V10-19   Personal/family history V20-29   Reproductive/development services V30-39   Liveborn infants V40-49   Condition influencing health V50-59   Procedure/aftercare services V60-69   Services Other circumstances V70-85   Exam-No diagnosis Insert list of groups

    23. 23 Overall Mental Health

    24. 24 Overview of Results: CBHIG Most Prevalent Post-Deployment Mental Groupings Tobacco Depression Anxiety Adjustment Alcohol Dx Deferred / NK

    25. 25 Tobacco

    26. 26 Depression

    27. 27 Anxiety

    28. 28 Adjustment

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