DOD Health Care: GAO's Reviews of Quality Assurance Programs

GAO discussed the results of its monitoring of Department of Defense (DOD) efforts to assess and improve the quality of care that DOD military hospitals provide. GAO found that: (1) a centralized medical malpractice information system would help DOD identify recurring problems and focus attention on needed corrective and preventive actions; (2) although DOD agreed that a centralized system would be useful, its approach may not adequately isolate the identification and reporting of actual or potential malpractice claims against its providers and it may require a long-term implementation strategy; (3) although DOD and the services have strengthened their procedures for recruiting qualified physicians, awarding clinical privileges, and verifying the education, training, and licensure status of military physicians, the military hospitals need to improve their implementation of those requirements; (4) DOD is revising its Occurrence Screening Program, which identifies and follows up on events that are not a natural consequence of a patient's disease or treatment, to focus more on hospital-level uses and to allow hospitals more flexibility in program design and implementation; and (5) in September 1986, DOD issued an emergency services directive, which set forth minimum requirements for staffing, training of emergency-room personnel, use of treatment protocols reflecting national standards, and physician reviews of treatment by nonphysician health care providers.