DOD Health Care
Occurrence Screen Program Undergoing Changes, but Weaknesses Still Exist Gao ID: HRD-89-36 January 5, 1989In 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.
RecommendationsOur recommendations from this work are listed below with a Contact for more information. Status will change from "In process" to "Open," "Closed - implemented," or "Closed - not implemented" based on our follow up work.
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