All ETDs from UAB

Advisory Committee Chair

Patricia A Patrician

Advisory Committee Members

Lori A Loan

Pauline A Swiger

Larry R Hearld

Peng Li

Patricia A Patrician

Document Type

Dissertation

Date of Award

2021

Degree Name by School

Doctor of Philosophy (PhD) School of Nursing

Abstract

Readiness, the Armed Forces’ ability to carry out a range of military operations, is one of the U.S. Army’s highest strategic priorities. The medical readiness of soldiers is a critical component of overall operational readiness. The greatest threat to medical readiness is acute musculoskeletal injuries (MSIs). Medical providers place soldiers on medical limitations referred to as a “temporary profile” to facilitate treatment and recovery of acute MSIs. Poorly managed temporary profiles negatively impact soldiers’ work attendance and performance, leading to the loss or limitation of over 25 million training/duty days annually. Changes within the primary care setting, including implementing the Army Medical Home, have contributed to improvements in temporary profile management over the last decade. The Army Medical Home encompasses care delivery platforms, such as the Patient-Centered Medical Home (PCMH) and Soldier-Centered Medical Home (SCMH). The PCMHs and SCMHs consist of structural attributes and care processes, including access to care, primary care manager continuity, and patient-centered communication, which play an essential role in supporting timely MSI recovery and temporary profile management. The PCMH and SCMH structures differ in ways that may affect care processes and outcomes. Unfortunately, little is known about how these differences affect soldier health outcomes. The purpose of this dissertation was threefold. First, we conducted an integrative literature review synthesizing evidence on the relationships between medical home implementation, care processes, and outcomes. Second, we examined the differences in PCMH and SCMH structures and care processes. Lastly, we examined the relationships between PCMH and SCMH structural characteristics, care processes, and temporary profile days among active-duty soldiers. The resulting body of work supports the value of the medical home model in timely MSI recovery and temporary profile management. This research demonstrated that differences in medical home structural attributes were associated with access to care and continuity. Our findings suggest that PCMH and SCMH structural attributes and care processes influence temporary profile days among active-duty soldiers. Knowledge gained from this study is essential to further explore barriers to perceived access among soldiers, improve communication quality between soldiers and providers, and expand continuity domains within the medical home.

Included in

Nursing Commons

Share

COinS