Medical Management Guide, 2009, Version 3.0 - Tricare

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Page 114Disease Management Version 3.0Medical Management GuideThe AMEDD enlisted the assistance of the RANDCorporation in developing the best method forimplementing VA/DoD CPGs (Nichols, 2001). Thatcollaboration resulted in an implementation guidepublished in 2001, titled Putting Practice Guidelinesto Work in the Department of Defense MedicalSystem: A Guide for Action ( CD-ROM ResourceDM-3). This document is also available at the ArmyQMO website: https://www.qmo.amedd.army.mil(see also Appendix D, Resources).and use. A template of attributes is completed foreach guideline included in the NGC; and the NCGverifies the currency of all guidelines representedin the database. The NGC website allows users toview more than 2,000 guidelines by clinical specialty,disease/condition, target population, treatment/intervention, or issuing organization. The websitealso features comprehensive structured summaries,full-text guidelines, guideline syntheses, guidelinecomparisons, and PDA downloads.From its work with RAND, the AMEDD developedthe current plan for implementing CPGs withinprimary care. That plan, the VA/DoD Manual forFacility Clinical Practice Guideline Champions (referto CD-ROM Resource DM-4) includes thefollowing steps:1. Know the Guideline (CPG)2. Assess Current MTF Practice Patterns3. Compare Practice Patterns with CPGRecommendations4. Identify "Gaps" in MTF Practice Patterns5. Develop an "Action Plan" to Close the Gaps6. Implement the Plan7. Develop a System to Monitor Practice ChangeNational Guideline Clearinghouse – http://www.guideline.gov/The National Guideline Clearinghouse (NGC) isa joint effort among the AHRQ, the AmericanMedical Association (AMA), and AHIP. The NGCis a comprehensive database of evidence-basedCPGs and related documents. The NGC websiteprovides an easily accessible mechanism forobtaining objective, detailed information on CPGsand furthering their dissemination, implementation,U. S. Preventive Services Task Force – http://odphp.osophs.dhhs.gov/pubs/guidecps/uspstf.htmThe U. S. Preventive Services Task Force (USPSTF)is an independent panel of primary care andprevention experts who systematically reviewcurrent evidence for effectiveness and developrecommendations for clinical preventive services.USPSTF recommendations, while not technicallyCPGs, are firmly based in evidence and deservemention because of their common use andacceptance. USPSTF recommendations and theirevidence reviews are routinely used by the TMAas the basis for determining TRICARE benefits.The USPSTF aims to:• Create age-, gender-, and risk-basedrecommendations regarding services that shouldbe a routine part of primary care.• Evaluate the benefits of individual services.• Identify a research agenda for clinical preventivecare.The USPSTF has provided recommendations forpreventive interventions related to screening,
Medical Management GuideVersion 3.0Disease ManagementPage 115counseling, immunizations, and chemoprophylactictreatments for more than 80 conditions anddisorders, including in the following areas:1. Cancer (oncology)2. Cardiovascular3. Infectious disease4. Injury and violence5. Mental health and substance abuse6. Metabolics, nutrition, and endocrinology7. Musculoskeletal8. Obstetrics and gynecology9. Pediatrics10. Vision and hearingClinical protocols and pathways are tools thatdelineate the optimal sequencing and timing ofinterventions by providers for a particular diagnosisor procedure. They are designed to minimize delaysand resource utilization and maximize the qualityof care. (Refer also to Appendix C, Definitions.)They often have a role in the clinical setting, inboth the inpatient and outpatient arenas. Althoughthey may be evidence-based, these protocols aredistinguishable from CPGs in that they do not havethe full complement of support resources. They areadjunct tools that may be leveraged by healthcareteams to streamline patient care processes.3. Collaborative Practice ModelsThe MHS has a wide variety of practice modelsin place. The most effective are those that fostercollaboration and communication among healthcareteam members, including providers, support/ancillarystaff, and Command leadership, as well as patientsand their families. Examples of ancillary staff whomay be involved in patient care include pharmacists,nutritionists, physical therapists; and dental, healthpromotion, health benefits, and laboratory staff.Deployment health services, health promotion, andmedical counterparts in the field should also beconsidered as potential partners. Other military andcivilian resources include organizations such as familysupport services, local health departments, and localfitness centers. To maximize the use of resourcesand increase efficiencies, it may be advantageous tocollaborate with MCSCs, the Multi-Service MarketOffice (MSMO), and the TRICARE Regional Office(TRO) (see Appendix D, Resources).The United States are divided intothree TRICARE regions. Each ofthe regions has a regional civiliancare partner, the Managed Care SupportContractor (MCSC), who helps administerthe TRICARE benefit plan. The MCSC workswith the TRICARE Regional Offices(TROs) to manage the benefit at the locallevel and receives overall guidance fromTRICARE Management Activity (TMA)headquarters.A Multi-Service Market Office (MSMO) isa TRICARE area with more than one Servicewith a Military Treatment Facility (MTF). Adesignated MTF Commander is appointedto serve as Senior Market Manager foreach MSMO. This role is responsible fordeveloping a single, consolidated, integratedbusiness plan for the Direct Care System(DCS) and Purchased Care System (PCS) forall services located within the MSMO. Thereare currently 12 MSMOs.
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