Importance Low surgical volume in the US Military Health System (MHS) has been identified as a challenge to military surgeon readiness. The Uniformed Services University of Health Sciences, in partnership with the American College of Surgeons, developed the Knowledge, Skills, and Abilities (KSA) Clinical Readiness Program that includes a tool for quantifying the clinical readiness value of surgeon workload, known as the KSA metric.

Objective To describe changes in US military general surgeon procedural volume and readiness using the KSA metric.

Design, Setting, and Participants This cohort study analyzed general surgery workload performed across the MHS, including military and civilian facilities, between fiscal year 2015 and 2019 and the calculated KSA metric value. The surgeon-level readiness among military general surgeons was calculated based on the KSA metric readiness threshold. Data were obtained from TRICARE, the US Department of Defense health insurance product.

Main Outcomes and Measures The main outcomes were general surgery procedural volumes and the KSA metric point value of those procedures across the MHS as well as the number of military general surgeons meeting the KSA metric readiness threshold. Aggregate facility and regional market-level claims data were used to calculate the procedural volumes and KSA metric readiness value of those procedures. Annual adjusted KSA metric points earned were used to determine the number of individual US military general surgeons meeting the readiness threshold.

Results The number of general surgery procedures generating KSAs in military hospitals decreased 25.6%, from 128 377 in 2015 to 95 461 in 2019, with a 19.1% decrease in the number of general surgeon KSA points (from 7 155 563 to 5 790 001). From 2015 to 2019, there was a 3.2% increase in both the number of procedures (from 419 980 to 433 495) and KSA points (from 21 071 033 to 21 748 984) in civilian care settings. The proportion of military general surgeons meeting the KSA metric readiness threshold decreased from 16.7% (n = 97) in 2015 to 10.1% (n = 68) in 2019.

Conclusions and Relevance This study noted that the number of KSA metric points and procedural volume in military hospitals has been decreasing since 2015, whereas both measures have increased in civilian facilities. The findings suggest that loss of surgical workload has resulted in further decreases in military surgeon readiness and may require substantial changes in patient care flow in the MHS to reverse the change.

重要性 美国军事卫生系统 (MHS) 的低手术量已被确定为对军事外科医生准备工作的挑战。健康科学统一服务大学与美国外科医生学院合作，开发了知识、技能和能力 (KSA) 临床准备计划，其中包括一个用于量化外科医生工作量的临床准备值的工具，称为 KSA 指标.

目的 使用 KSA 指标描述美国军事普通外科医生手术量和准备情况的变化。

设计、设置和参与者 该队列研究分析了 2015 至 2019 财年期间在 MHS （包括军事和民用设施）执行的普通外科工作量以及计算的 KSA 指标值。军事普通外科医生的外科医生级别准备情况是根据 KSA 指标准备情况阈值计算的。数据来自美国国防部健康保险产品TRICARE。

主要成果和措施 主要成果是普通外科手术量和这些程序在 MHS 中的 KSA 度量点值，以及满足 KSA 度量准备阈值的军事外科医生的数量。综合设施和区域市场层面的索赔数据用于计算这些程序的程序量和 KSA 指标就绪值。获得的年度调整后的 KSA 度量点用于确定满足准备阈值的美国军事普通外科医生的数量。

结果 军队医院产生 KSA 的普外科手术次数减少了 25.6%，从 2015 年的 128 377 次减少到 2019 年的 95 461 次，其中普通外科医生 KSA 点数减少了 19.1%（从 7 155 563 减少到 5 790 001） . 从 2015 年到 2019 年，民事护理机构的程序数量（从 419 980 到 433 495）和 KSA 积分（从 21 071 033 到 21 748 984）都增加了 3.2%。符合 KSA 指标准备阈值的军事普通外科医生比例从 2015 年的 16.7%（n = 97）下降到 2019 年的 10.1%（n = 68）。

结论和相关性 本研究指出，自 2015 年以来，军队医院的 KSA 指标点数和手术量一直在减少，而民用设施中的这两项指标都有所增加。研究结果表明，手术工作量的​​减少导致军事外科医生的准备情况进一步下降，并且可能需要对 MHS 中的患者护理流程进行重大改变以扭转这种变化。