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CHAMP uses more predictive analytics to improve beneficiary healthcare

Image of A game of tug-of-war. Soldiers assigned to 1st Battalion, 28th Infantry Regiment, 3rd Infantry Division, from Fort Benning, Georgia, compete in a tug-of-war event during Marne Week on Fort Stewart, Georgia, May 17, 2021. Marne week events, such as sporting competitions, are designed to connect and celebrate the proud lineage of the Dogface Solder and the "Rock of the Marne." (Photo by: Army Sgt. Reva Catholic, 3rd Infantry Division)

[July is the month to highlight military health innovations, and Total Force Fitness (TFF) plays a strong role in military inventiveness. This article is the second in a series about the culture of military inventiveness and how it is driving the Defense Health Agency in its role as a High Reliability Organization.]

The holy grail of Total Force Fitness (TFF) is the ability to find predictive analytics about service members.

These analytics must be focused on the service member throughout the course of their careers from induction onward based on the TFF eight domains of fitness, which connect to optimize health, performance, and readiness holistically.

"Being able to have a great dataset, which we have, and being able to look longitudinally from service members' entrance into the military onto their careers, this helps us to find signals up front" about their fitness in the eight domains, said Patricia Deuster, executive director, Consortium for Health and Military Performance, (CHAMP), Defense Center of Excellence for Human Performance Optimization Translation, Bethesda, Maryland.

"Predictive data analytics are being conducted in the realm of musculoskeletal care, and we would like that in mental health," said Deuster, who holds a doctorate in nutrition science and physiology and is a master of public health with a specialty in public health and epidemiology.

"Medical data are not good enough; we need all pieces of data collected in one place from all the services," she said. Currently, data are collected individually by the services, and their measurements vary.

"We are looking at each person as a whole," she said. "We look at them from their totality."

"CHAMP has already been contacted by Walter Reed National Military Medicine Center" to gather a dataset for chronic kidney disease (CKD); such an analysis would "inform upstream health signals that could mitigate downstream effects," she said. CKD can be present in people long before there are symptoms or a crisis.

Sickle cell trait is another dataset that would be useful, she added. The Army has announced that it will now screen for sickle cell trait in inductees, as do the other services.

Said Deuster: "The possibilities are limitless."

Enhancing just one domain, or even two or three, like physical fitness, preventive care and nutrition, misses the connections that collectively lead to wellness. All the domains play a role in optimal health and performance.

CHAMP plans to present some promising results to Military Health System personnel and "show what can be done" with such a dataset, she said.

An impactful CHAMP program forthcoming is a web-based application to improve the "military nutrition environment." The military Nutrition Environmental Assessment Tool, or m-NEAT, will be deployed within the next several months, Deuster said.

CHAMP will beta test m-NEAT, which aims to evaluate access to high-quality, nutritious foods, health messaging, policies, and economics parameters of the nutrition environment on military installations, she explained. The goal is to improve the availability of healthy food choices across the enterprise, which "the nutrition community has been working on for a long time," Deuster said.

Another area of innovation that would be helpful is training of embedded Human Performance Teams (HPTs). For example, -social workers, physical fitness specialists, clinical psychologists, mental performance specialists, chaplains and dietitians all work together, Deuster said. "We need optimize their abilities to most effectively work as a team to sustain warfighter performance," she suggested.

"We need to have a good training program to work effectively as members of a team and not independently. If we want to improve cognitive function, we need the HPT working together from the Total Force Fitness perspective," she said.

Picture of seminar notes The 50th Space Wing Chaplain’s office provides seminar notes during a single parent retreat at Great Wolf Lodge in Colorado Springs, Colorado, Sept. 6, 2018. The Chaplain’s Office provided seminars to give families the opportunity to strengthen their relationships. (Photo by: Senior Airman Arielle Vasquez, 50th Space Wing)

In other words, "what are best practices for teamwork and how are they evaluated?" Deuster said. "It's not just a matter of putting resources in [the team] but providing the resources needed by the unit to optimize their effectiveness," she said.

Another example of health innovation within TFF, Deuster said, is the work of Navy Cmdr. (Ch.) David Alexander, at the Uniformed Services University of the Health Sciences in Bethesda, Maryland.

"He's working with other chaplains to bring spiritual fitness in a proactive, rather than reactive, fashion to optimize human performance. It's a change in culture" for the chaplains in their outreach, Deuster said, adding the project wants chaplains to have service members "improve their ability to discuss difficult topics, such as stigma and relationships."

Alexander's team has developed and published the Special Operations Command (SOCOM) Spiritual Fitness Scale, which features 17 questions designed to measure commitment to three distinct spiritual traits: connection with a Higher Power, pursuit of purpose and meaning, and sacrificial service to others. A specific 'screening' question allows non-theists to exempt themselves from questions containing specific language about God or a Higher Power, while still taking questions that will generate results for the other two spiritual traits.

The CHAMP/SOCOM Spiritual Fitness Scale (the SFS) is a "multi-dimensional, reliable and validated quantitative metric," Alexander said.

"The SFS can generate individual spiritual profiles that easily bridge to individual chaplain coaching," he said, adding that group baseline profiles also can be created.

Doing so helps chaplains to "aggregate the data and save it for later data-driven decision-making," Alexander said.

Chaplains also can isolate the SFS subscales for use in quantitative and mixed-methods assessment strategies tailored for their programs and services.

Lastly, Alexander explained, "chaplains can use the SFS for program planning by aligning existing services with the three attributes, conducting pre-assessment activities, proposing disciplined and tailored programs informed by pre-assessment, and continuously assessing those eventual programs for impact on spiritual growth."

The survey is designed to be compatible with the framework for SF as described in the 2011 Chairman of the Joint Chiefs of Staff Instruction.

The instruction defines SF as "the ability to adhere to beliefs, principles, or values needed to persevere and prevail in accomplishing missions." SF "should neither preclude no presume any particular theistic orientation," based on the Instruction, Alexander stated in an article in the Nov. 23, 2020 "Journal of Pastoral Care & Counseling."

The idea is to take the SOCOM survey outward into other areas of the military by the end of the current fiscal year, Alexander said. His team is developing a public-facing web page on the Health Performance Resources by CHAMP part of the CHAMP website.

The page will take chaplains through the scales of the metric, how to understand it, score it, and apply it to assessments, Alexander explained. The page will also include a book as a resource.

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