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Using Geographic Variations to Improve Quality and Reduce Costs in the Military Health System

Funding Agency: Department of Defense
Funding Period: January 2020 - October 2023
PI: David Goodman, MD, MS

Background

Depending on the year, 100,000-120,000 newborns are born annually to military medical beneficiaries. While there are known shortcomings in perinatal health and health care that vary by hospital in civilian populations, there is virtually no information regarding variation of newborn care and outcomes in military populations. Within this project, we will exploit health system variation to describe and investigate newborn health care variation and identify modifiable factors that would accelerate improvement.

Motivation and Aims

The overarching hypothesis of this study is that military medical and surgical care and resource inputs vary across regions and providers and that this variation primarily reflects differences in health system performance in quality and efficiency. The overall objectives are to measure the variation, investigate the causes and consequences of the variation and its determinants, interpret the relevance of the findings for organizational policy development and clinical improvement, and to disseminate the findings to military health stakeholders and the health care research community. We will achieve this objective through the following specific aims:

  1. Characterize variation in TRICARE newborn crude and adjusted utilization, outcomes, and resource inputs across cohorts of high, medium, and low newborn health risk.
  2. Test the association of variation in newborn health risk with regional NICU capacity and utilization.
  3. Examine hypothesized place-level correlates of utilization, resource inputs, and mortality variations such as purchased care market concentration, the distribution of NICU beds, and pediatric specialist concentration.
  4. Test the association of inpatient and post-discharge outcomes with patterns of neonatal care and identify high-efficiency (in the sense of best outcomes, lowest cost) medical centers to encourage the diffusion of best practice across the MHS.