Improving Trauma and Critical Care Proficiency and Readiness for Air Force Personnel in Critical Medical Specialties: A Pacific Air Forces Perspective.

Most U.S. Air Force medical personnel spend their time at military treatment facilities (MTFs) caring for patients whose ailments are far less complex or urgent than the severe trauma-related injuries they would see in war. This mismatch between peacetime and wartime medical care necessitates a deliberate effort on the part of the Air Force Medical Service (AFMS) as a whole and the Pacific Air Forces (PACAF) to ensure that personnel in critical medical specialties receive the training and hands-on clinical experience they need to save lives in a high-casualty environment. The goal of this research project was to investigate approaches for increasing readiness and proficiency. To develop a portfolio of readiness building activities, the authors analyzed manpower and personnel data, reviewed Comprehensive Medical Readiness Program (CMRP) checklists and relevant literature, engaged in discussions with the stakeholder community, and developed models of the assignment system and of skill acquisition and decay. They present their findings and recommendations for the future and have developed a prototype framework to demonstrate a possible method for deciding which readiness building activities and assignment policies to employ.

Strategies to Improve the Impact of Artificial Intelligence on Health Equity: Scoping Review.

BACKGROUND: Emerging artificial intelligence (AI) applications have the potential to improve health, but they may also perpetuate or exacerbate inequities. OBJECTIVE: This review aims to provide a comprehensive overview of the health equity issues related to the use of AI applications and identify strategies proposed to address them. METHODS: We searched PubMed, Web of Science, the IEEE (Institute of Electrical and Electronics Engineers) Xplore Digital Library, ProQuest U.S. Newsstream, Academic Search Complete, the Food and Drug Administration (FDA) website, and ClinicalTrials.gov to identify academic and gray literature related to AI and health equity that were published between 2014 and 2021 and additional literature related to AI and health equity during the COVID-19 pandemic from 2020 and 2021. Literature was eligible for inclusion in our review if it identified at least one equity issue and a corresponding strategy to address it. To organize and synthesize equity issues, we adopted a 4-step AI application framework: Background Context, Data Characteristics, Model Design, and Deployment. We then created a many-to-many mapping of the links between issues and strategies. RESULTS: In 660 documents, we identified 18 equity issues and 15 strategies to address them. Equity issues related to Data Characteristics and Model Design were the most common. The most common strategies recommended to improve equity were improving the quantity and quality of data, evaluating the disparities introduced by an application, increasing model reporting and transparency, involving the broader community in AI application development, and improving governance. CONCLUSIONS: Stakeholders should review our many-to-many mapping of equity issues and strategies when planning, developing, and implementing AI applications in health care so that they can make appropriate plans to ensure equity for populations affected by their products. AI application developers should consider adopting equity-focused checklists, and regulators such as the FDA should consider requiring them. Given that our review was limited to documents published online, developers may have unpublished knowledge of additional issues and strategies that we were unable to identify.

Health Services and Primary Care Research Study: Comprehensive Report.

This study presents the results of a congressionally mandated, independent assessment of federally funded health services research (HSR) and primary care research (PCR) spanning the U.S. Department of Health and Human Services (HHS) and U.S. Department of Veterans Affairs (VA) from FYs 2012 to 2018. Through technical expert panels, stakeholder interviews, and a systematic environmental scan of research grants and contracts funded by HHS and the VA, the authors characterize the distinct contributions of agencies in these departments to the federal HSR and PCR enterprise. The authors also identify opportunities to improve detection and coordination of overlap in agency research portfolios, the impacts of HSR and PCR and how they cumulate across research portfolios, and gaps in research funding, methods, and dissemination. The authors offer recommendations to maximize the outcomes and value of future investments in federal HSR and PCR to better guide and serve the needs of a complex and rapidly changing U.S. health care system.

Translational Impacts of World Trade Center Health Program Research: A Mixed Methods Study.

The World Trade Center (WTC) Health Program (hereafter Program) provides medical monitoring and treatment for its Members: the responders and survivors who were at the WTC and related sites or located within the New York City disaster area during and after the terrorist attacks of September 11, 2001. Scientific research supported by the Program provides an evidence base for the health monitoring and clinical care of Members. In this article, the authors describe the findings and recommendations of a four-year study of the Program's research portfolio and its translational impact. They present results from a mixed methods assessment that integrates (1) a scoping review of nearly 1,000 peer-reviewed publications and thousands of pages of grey literature that reference research related to the health effects of 9/11, (2) stakeholder perspectives gathered through focus groups and interviews, and (3) a review of Program documentation. The study is intended to guide planning by Program leadership as it aims to maximize the impacts of Program research and achieve its goal of translating research into care for those affected by the attacks on 9/11.

Artificial intelligence applications used in the clinical response to COVID-19: A scoping review.

Research into using artificial intelligence (AI) in health care is growing and several observers predicted that AI would play a key role in the clinical response to the COVID-19. Many AI models have been proposed though previous reviews have identified only a few applications used in clinical practice. In this study, we aim to (1) identify and characterize AI applications used in the clinical response to COVID-19; (2) examine the timing, location, and extent of their use; (3) examine how they relate to pre-pandemic applications and the U.S. regulatory approval process; and (4) characterize the evidence that is available to support their use. We searched academic and grey literature sources to identify 66 AI applications that performed a wide range of diagnostic, prognostic, and triage functions in the clinical response to COVID-19. Many were deployed early in the pandemic and most were used in the U.S., other high-income countries, or China. While some applications were used to care for hundreds of thousands of patients, others were used to an unknown or limited extent. We found studies supporting the use of 39 applications, though few of these were independent evaluations and we found no clinical trials evaluating any application's impact on patient health. Due to limited evidence, it is impossible to determine the extent to which the clinical use of AI in the pandemic response has benefited patients overall. Further research is needed, particularly independent evaluations on AI application performance and health impacts in real-world care settings.

Impact of World Trade Center-Related Health Research: An Application of the NIEHS Translational Framework.

The World Trade Center Health Program (WTCHP) has a research mission to identify physical and mental health conditions that may be related to the 9/11 terrorist attacks as well as effective diagnostic procedures and treatments for WTC-related health conditions. The ability of the WTCHP to serve its members and realize positive impacts on all of its stakeholders depends on effective translation of research findings. As part of an ongoing assessment of the translational impact of World Trade Center (WTC)-related research, we applied the National Institute of Environmental Health Sciences (NIEHS) translational framework to two case studies: WTC-related research on post-traumatic stress disorder (PTSD) and cancer. We conducted a review of 9/11 health-related research in the peer-reviewed literature through October 2017, grey literature, and WTCHP program documentation. We mapped peer-reviewed studies in the literature to the NIEHS framework and used WTCHP program documentation and grey literature to find evidence of translation of research into clinical practice and policy. Using the NIEHS framework, we identified numerous translational milestones and bridges, as well as areas of opportunity, within each case study. This application demonstrates the utility of the NIEHS framework for documenting progress toward public health impact and for setting future research goals.

Resources and Capabilities of the Department of Veterans Affairs to Provide Timely and Accessible Care to Veterans.

The Veterans Access, Choice, and Accountability Act of 2014 addressed the need for access to timely, high-quality health care for veterans. Section 201 of the legislation called for an independent assessment of various aspects of veterans' health care. The RAND Corporation was tasked with an assessment of the Department of Veterans Affairs (VA) current and projected health care capabilities and resources. An examination of data from a variety of sources, along with a survey of VA medical facility leaders, revealed the breadth and depth of VA resources and capabilities: fiscal resources, workforce and human resources, physical infrastructure, interorganizational relationships, and information resources. The assessment identified barriers to the effective use of these resources and capabilities. Analysis of data on access to VA care and the quality of that care showed that almost all veterans live within 40 miles of a VA health facility, but fewer have access to VA specialty care. Veterans usually receive care within 14 days of their desired appointment date, but wait times vary considerably across VA facilities. VA has long played a national leadership role in measuring the quality of health care. The assessment showed that VA health care quality was as good or better on most measures compared with other health systems, but quality performance lagged at some VA facilities. VA will require more resources and capabilities to meet a projected increase in veterans' demand for VA care over the next five years. Options for increasing capacity include accelerated hiring, full nurse practice authority, and expanded use of telehealth.