DOD Health Care:

Better Use of Malpractice Data Could Help Improve Quality of Care

HRD-87-30: Published: Jun 4, 1987. Publicly Released: Jun 4, 1987.

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Pursuant to a congressional request, GAO reviewed how the Department of Defense (DOD) utilizes medical malpractice information to improve the quality of medical care and reduce the risk of malpractice.

GAO found that: (1) although DOD collected some data on malpractice claims, the data did not include information on potential claims or specific providers responsible for inadequate care necessary to identify patterns of recurring medical problems; (2) DOD did not systematically provide malpractice information or educational case studies to the services for quality assurance or risk management purposes; (3) service regulations varied concerning the definition of a potential claim; (4) DOD did not investigate all potential malpractice claims; and (5) DOD needed a centralized system to collect and analyze known medical care problems and focus attention on corrective and preventive actions.

Recommendations for Executive Action

  1. Status: Closed - Implemented

    Comments: DOD Directive 6025.17 includes a definition of potential claims and requires central reporting to the service level, but not to DOD except on an aggregated basis. No specifics are given concerning what data about potential claims should be reported and reviewed.

    Recommendation: The Secretary of Defense should direct the service secretaries to issue regulations adopting the revised definition of potential claims and requirements for inclusion in the centralized malpractice information system.

    Agency Affected: Department of Defense

  2. Status: Closed - Not Implemented

    Comments: DOD Directive 6025.17 states that military departments are to ensure evaluation of claims regardless of whether the patient is active duty or civilian status. However, the evaluation is at the hospital level only. DOD believes that a claims service investigation is only necessary if litigation is possible. Active duty members cannot file suit.

    Recommendation: The Secretary of Defense should direct the service secretaries to issue regulations requiring that malpractice incidents involving active duty service members are investigated through the claims system in the same manner as incidents involving nonactive duty beneficiaries.

    Agency Affected: Department of Defense

  3. Status: Closed - Implemented

    Comments: Definition of potential claims is included in DOD Medical Quality Assurance Directive 6025.13. This directive also requires potential claims be included in hospital databases for analysis and that data be reported to the service level for review and inclusion in the annual QA report to DOD. DOD actions do not call for central DOD-level tracking of potential claims.

    Recommendation: The Secretary of Defense should direct the Assistant Secretary for Health Affairs, in conjunction with the service secretaries, to establish a consistent definition of potential claims and consistent requirements for forwarding potential claims investigations to a central agency for inclusion in a centralized malpractice information system.

    Agency Affected: Department of Defense

  4. Status: Closed - Implemented

    Comments: DOD intends to participate in the system. The Department of Health and Human Services has not yet implemented P.L. 99-660. DOD stated that the system became operational in April 1990 and that it will be fully participating by January 1991. DOD implemented participation in the data bank on September 9, 1990 in accordance with DOD Directive 6025.14.

    Recommendation: The Secretary of Defense should direct the Assistant Secretary for Health Affairs to participate fully in the provider tracking system required by Public Law (P.L.) 99-660.

    Agency Affected: Department of Defense

  5. Status: Closed - Implemented

    Comments: DOD has an instruction requiring identification of responsible providers when claims are filed. DOD Directive 6025.13 requires reporting the name of any provider a claims investigation finds negligent. However, DOD directives are silent on reporting providers if a claim is not filed.

    Recommendation: To better ensure that complete information about provider responsibility is included in the system, the Secretary of Defense should direct the service secretaries to ensure that investigations of malpractice incidents clearly identify providers found responsible for malpractice or substandard care.

    Agency Affected: Department of Defense

  6. Status: Closed - Implemented

    Comments: DOD Directive 6025.13 established the database for a central DOD system, with data GAO recommended, for malpractice claims. DOD actions fall short of the GAO recommendations concerning potential claims, however. While requiring a service-level review of potential claims data, a significant step, the DOD directive does not specify what data are to be reported or allow DOD-wide training.

    Recommendation: The Secretary of Defense should direct the Assistant Secretary of Health Affairs, in conjunction with the service secretaries, to develop a DOD-wide system for collecting medical information from investigations of malpractice incidents, both potential and actual claims. The system should provide for: (1) tracking and analysis of data on malpractice incidents to identify patterns of problems, including identifying providers responsible for malpractice or substandard care; (2) further investigation to determine whether poor medical care is given; (3) follow-up to ensure that corrective and preventive action is taken; and (4) dissemination of statistical and educational information to the three service medical commands and medical facilities.

    Agency Affected: Department of Defense

  7. Status: Closed - Not Implemented

    Comments: DOD officials stated that a claims service investigation is required only when litigation is possible. They did not define potential claim in these terms, but instead as any adverse event.

    Recommendation: The Secretary of Defense should direct the service secretaries to fully implement regulations requiring hospital reporting and claims service investigations of potential claims, once the definition of a potential claim is clarified.

    Agency Affected: Department of Defense

 

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