DOD Health Care:

Occurrence Screen Program Undergoing Changes, but Weaknesses Still Exist

HRD-89-36: Published: Jan 5, 1989. Publicly Released: Jan 5, 1989.

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In response to a congressional request, GAO reviewed the Department of Defense's (DOD) Occurrence Screen Program, which is intended to identify military hospital's adverse patient-care outcomes.

GAO found that: (1) hospital reviewers missed one or more adverse occurrences in 65 percent of the records it reviewed; (2) medical reviewers did not always record every adverse occurrence in each file, since DOD did not provide sufficient guidance on multiple occurrences; (3) some reviewers did not have sufficient medical expertise or training to identify all occurrences; and (4) attending physicians in the Army and the Air Force screened their own patient records. In addition, GAO found that: (1) DOD hospitals did not fully utilize the original program because they believed that the screens were too prescriptive, and because DOD management information systems did not provide sufficient data to make occurrence screen programs useful; (2) although DOD expeded the number of screening criteria and other quality assurance indicators to make the programs more useful, the revised system allowed optional use of many additional screens; (3) use of a specified minimum set of screening criteria and services' data collection above the individual level would provide a degree of uniformity in the data collected and facilitate multihospital trending and analysis; and (4) although the Air Force and Navy require hospitals to report data to higher commands, the Army only requires hospitals to submit screens that have a positive effect on patient care quality.

Recommendations for Executive Action

  1. Status: Closed - Implemented

    Comments: Since occurrence screen data has not been useful in the past, DOD stated it will collect data when it has determined what will be most useful to higher authority. Ideas about data analysis above the hospital level are emerging, but will take time to refine. Case closed by the Office of the Inspector General (OIG).

    Recommendation: To help ensure effective implementation of occurrence screen programs in military hospitals, the Secretary of Defense should direct the service secretaries, in conjunction with the Assistant Secretary of Defense for Health Affairs, to collect and analyze occurrence screen data above the hospital level and provide comparative and related analysis to the individual hospital commanders for management purposes.

    Agency Affected: Department of Defense

  2. Status: Closed - Implemented

    Comments: DOD stated that all applicable occurrences should be identified and this concept has been addressed in the redesign of its quality assurance computer software. Although the DOD goal is to have all initial screening done by nonphysician personnel, budget constraints will most likely prevent this until the mid- to late 1990s. Case closed by OIG.

    Recommendation: To improve the reliability of the initial occurrence screening process, the Secretary of Defense should direct the service secretaries, in conjunction with the Assistant Secretary of Defense for Health Affairs, to: (1) instruct screeners to identify all applicable occurrences during the initial screening process; and (2) discontinue using physicians to screen their own patient records and use properly trained nonphysician personnel to perform this function.

    Agency Affected: Department of Defense

 

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