273153 Warrior transition units at 5: Are they the optimal model of care for wounded, ill and injured soldiers?

Monday, October 29, 2012 : 8:30 AM - 8:50 AM

Stephen K. Trynosky, JD, MPH , U.S. Army Reserve, Washington, DC
After the 2007 scandal surrounding patient living conditions at the former Walter Reed Army Medical Center, the Army hastily stood up warrior transition units (WTUs) to care for its wounded, ill, and injured. This sweeping response to a localized incident effectively established shadow, non-medical chains of command within most Army medical facilities by removing the daily administrative management of wounded, ill and injured soldiers from Army Medical Department (AMEDD) personnel. Over the last five years, this sprawling network has grown to include 29 WTUs on military installations and an additional 9 community-based WTUs primarily serving National Guard and Army Reserve personnel. Overall, WTUs now oversee the administrative support and case management of approximately 9,500 soldiers. Numerous media accounts and Inspector General reports suggest that the WTU model has not delivered its promised outcomes for patient case management and the coordination of care. Some observers suggest that the WTU “triad of care” (primary care manager, nurse case manager, and squad leader) creates an inherent tension in the clinical environment. The squad leaders and commanders of soldiers assigned to WTUs are non-medical personnel and despite their motivation and dedication to duty, many do not have the skill sets, attitudes or backgrounds to navigate the care environment of complex patient cases. The current budgetary environment may provide an opportunity to take a fresh look at the WTU concept and its performance. An objective analysis of costs, personnel requirements and patient outcomes might suggest that current WTU command and administrative functions could be best performed by AMEDD personnel as they were prior to 2007.

Learning Areas:
Public health or related organizational policy, standards, or other guidelines

Learning Objectives:
Explain the current model for patient case management in warrior transition units and how it differs from the previous structure. Describe the theory behind the WTU “triad of care” and the stated benefits of its structure. Discuss recent critiques of the WTU model and its role within the larger medical care continuum. List the factors that possibly contributed to the 2007 incident involving substandard patient housing at the former Walter Reed Army Medical Center.

Keywords: War, Veterans' Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have over 13 years of service as Medical Service Corps Officer in the US Army and the US Army Reserve. I gave presentations on issues related to military healthcare at previous APHA annual meetings. This presentation is a continuation of that research. The views expressed in this presentation do not necessarily reflect those of the US Army Medical Department, the US Army Reserve, or the Department of Defense.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.