1. 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 1 Israel Defence Forces, Israel 2 Ministry of Health, Israel

2. The medical process at recruitment centers Documents Preliminary medical information (from family physician) Basic measurements Antropometric Visual analysis Vital signs Urinalysis Medical committee Systematic anamnesis (history, habits, psychology…) Complete physical examination Further investigation Psychological evaluation Specialist consultation Laboratory tests Imaging + measures Documentation Medical status Medical profile ± Functional classification codes (FCCs)

3. Quality assurance and control system Goals To assess components of the medical process and committees’ performances and to ensure a uniform and professional medical process at recruitment centres Assessment 1.Medical committee staff 2.Administrative medical personnel 3.Recruits 4.Physical conditions & medical equipment 5.Computer-based assessment Tools Observations, Sampling, Re- examination, Questionnaires, Medical files, Report & data analysis Analysis 1.Inadequacies in anamnesis quality 2.Insufficient physical examination 3.Errors in decision-making 4.Local administrative procedures 5.Inappropriate equipment and use 6.inconsistencies in medical process 7.Variability in prevalence of medical conditions Intervention program 1.Lectures & Instructions 2.Simulation centre 3.Manual 4.Renewal of medical equipment 5.Reports Improvements 1.Professional performance 2.Working environment 3.Patients’ satisfaction 4.Uniform working platform

4. 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.

5. A pilot study General characteristics  ~105,000 adolescents  61427 males and 43473 females  Age of 16-19 years old, at time of medical examination  Were born between 1971-1992 (>1000 people / gender/ years)  All have basic measurements data (height, weight…)  All from 1 recruitment centre Goals  Medical conditions- trends over the years  Assess risk factors

6. BMI

7. BMI

8. BMI

9. BMI

10. BMI

11. 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.

12. 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…

13. Solid tumors

14. Congenital heart disease

15. A nationwide health project Need A need for a nationwide intervention program to reduce morbidity and future illness and even mortality. Benefits  Identification 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.

16. A nationwide health project IDF 1.Medical committee 2.Quality assurance & control system Ministry of health Psychiatric hospitalizations Ministry of Social affairs Mentally retarded populations in special institutions HMOS Family physicians in primary clinics Ministry of Social affairs Expansion: severely disabled, pervasive developmental disorders, etc. Israeli National Cancer Registry National insurance Handicaps

17. 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).

18. IDF – CHS Pilot 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)

19. IDF – CHS Pilot 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 questionnaire 35.1% 43.3%22.5% Rate among recruits that did return questionnaire

20. IDF – ICR Pilot Distribution of Malignancies Among Male and Female Recruits (which were born Sep-92 to Apr-93)

21. Summary Quality assurance and control system Epidemiological pilot study A nationwide health project Medical process at medical committees

23. Height

24. Weight