the medical process at recruitment centers
DESCRIPTION
Medical conditions in adolescents – from epidemiological trends to a nationwide health project for disease risk reduction. Y. Chaiter 1 , Y. Machluf 1 , A. Pirogovsky 2 , A. Yona 1 , A. Navon 1 , O. Tal 2 , E. Ringler 1 , G. Abbebe-Campino 1 , Y. Erlich 1 , and N. Ash 2 - PowerPoint PPT PresentationTRANSCRIPT
MEDICAL CONDITIONS IN ADOLESCENTS – FROM EPIDEMIOLOGICAL TRENDS TO A
NATIONWIDE HEALTH PROJECT FOR DISEASE RISK REDUCTION
Y. Chaiter1, Y. Machluf 1, A. Pirogovsky2, A. Yona1, A. Navon1, O. Tal2, E. Ringler1, G. Abbebe-Campino1, Y. Erlich1,
and N. Ash2
1 Israel Defence Forces, Israel2 Ministry of Health, Israel
The medical process at recruitment centers
DocumentsPreliminary medical information (from family physician)
Basic measurementsAntropometric Visual analysisVital signs Urinalysis
Medical committeeSystematic anamnesis (history, habits,
psychology…)Complete physical examination
Further investigationPsychological
evaluationSpecialist
consultationLaboratory testsImaging + measuresDocumentation
Medical statusMedical profile ± Functional classification codes (FCCs)
Quality assurance and control system
GoalsTo assess components of the medical process and committees’ performances and to ensure a uniform and professional medical process at recruitment centres
Assessment1.Medical committee staff2.Administrative medical
personnel 3.Recruits4.Physical conditions &
medical equipment5.Computer-based
assessment
ToolsObservations, Sampling, Re-examination, Questionnaires, Medical files, Report & data analysis
Analysis1.Inadequacies in
anamnesis quality2.Insufficient physical
examination3.Errors in decision-
making4.Local administrative
procedures5.Inappropriate equipment
and use6.inconsistencies in
medical process7.Variability in prevalence
of medical conditions
Intervention program1.Lectures &
Instructions2.Simulation centre3.Manual 4.Renewal of medical
equipment5.Reports
Improvements1.Professional
performance2.Working environment3.Patients’ satisfaction4.Uniform working
platform
Opportunity for epidemiological research
New horizons
The medical processes for the adolescent population of Israel present a unique opportunity to assess the health status of the young Israeli population on a nationwide level and to identify risk factors that can affect present and future morbidity.
A pilot study
General characteristics~105,000 adolescents 61427 males and 43473 femalesAge of 16-19 years old, at time of medical examinationWere born between 1971-1992 (>1000 people / gender/
years)All have basic measurements data (height, weight…)All from 1 recruitment centreGoalsMedical conditions- trends over the yearsAssess risk factors
BMI
A significant increase in average BMI was observed
(more pronounced in male recruits)
BMI
A significant decrease in the prevalence of normal BMI was observed, in both male and
female recruits
BMI
A significant increase in the prevalence of overweight BMI was observed (more pronounced
in male recruits)
BMI
A significant increase in the prevalence of obesity BMI was observed, in both female and male
recruits
BMI
A significant increase in the prevalence of underweight BMI was observed, in female but not
in male recruits
A pilot study
Data stratification – identification of risk factors
Except gender, data was stratified by religion, country of origin, education, family-related parameters, medical measurements (blood pressure, pulse etc.) and inter-relations were assessed. This approach led to the identification of novel risk factors as well as supported known ones.
Periodic data mining
“Old data – new insights”
One way by which the control system operates is data mining and processing from the computerized medical database.
It is aimed at identifying discrepancies in medical profiling, along with follow-ups and analyses of medical profiles and FCCs assigned to recruits. Comparison of findings over the years may uncover interesting trends…
Solid tumors
An increase in the prevalence of solid tumors in both male and female recruits
Congenital heart disease
An increase in the prevalence of both valvular and non-valvular congenital heart disease, among male
recruits
A nationwide health project
NeedA need for a nationwide intervention program to reduce morbidity and future illness and even mortality.
BenefitsIdentification of important trends in risk factors by the
quality assurance and control system. An automated process of information sharing between
the military and civilian medical systems.Complete communication between various medical
systems.Future view: one medical file for the life time of a person.
A nationwide health project
IDF 1. Medical committee2. Quality assurance &
control system
Ministry of healthPsychiatric hospitalizations
Ministry of Social affairsMentally retarded
populations in special institutions
Past
Present & Future
HMOSFamily physicians in primary
clinics
Ministry of Social affairsExpansion: severely
disabled, pervasive developmental disorders, etc.
Israeli National Cancer Registry
National insuranceHandicaps
A nationwide health project
Pilot I:
A project of information sharing was started at northern Israel with family physicians at primary clinics (Clalit Health Services).Pilot phase (launched in 03/2010): 4 selected primary clinics, ~500 recruits (growing…).Pilot II:
A project of information sharing and was started on a nationwide level, with the Israeli National Cancer Registry, The Ministry of Social Affairs and National Insurance.Pilot phase, launched in 04/2010: 24449 male (0.233%) + 21892 (0.169%) female recruits (prevalence).
IDF – CHS Pilot
Higher rate of information gathering from clinics as compared to questionnaires
Total (n=105)
Clinic – B (n=70)
Clinic – A (n=35)
62.9% 58.6% 71.4% Information - Questionnaire 74.3% 71.4% 80.0% Information – Clinics
(computer)
IDF – CHS Pilot
A significant contribution to both recruits that did not return questionnaire or did return
questionnaire, indicating the importance of a complementary source of information
Total (n=105)
Clinic – B (n=70)
Clinic – A (n=35)
62.9% 58.6% 71.4% Information - Questionnaire
74.3% 71.4% 80.0% Information – Clinics (computer)
39.7% 38.0% 42.9% Novel medical findings*46.7% 30.0% 80.0% Rate among recruits that
did not return questionnaire35.1% 43.3% 22.5% Rate among recruits that
did return questionnaire
IDF – ICR Pilot
Bi-directional information sharing
Distribution of Malignancies Among Male and Female Recruits(which were born Sep-92 to Apr-93)
Summary
Quality assurance and control system
Epidemiological pilot study
A nationwide health project
Medical process at medical committees
Thank You!
Height
A slight but significant decrease in average height was observed in female but not in male
recruits
Weight
A significant increase in average weight was observed
(more pronounced in male recruits(