Research for Medical Administration

The Assistant Chief for Health Care Operations (BUMED 03) asked CNA to develop a method that Navy medicine can use to determine whether it is meeting Tricare access standards, especially for scheduling appointments. The report found that the Composite Health Care System (CHCS) currently gives local military medicine providers the ability to track patient access to care, but that many providers are grappling with the same concerns and issues. To reduce redundancy, the report recommends that Navy medicine adopt standard guidelines for appointing and tracking access based on the experience of the facilities pioneering Tricare. It specifically recommends that Navy medicine develop system-wide appointing guidelines that increase the use of central appointing, standardize appointment types, make specialty referrals electronic, and develop specialty referral guidelines.

The U.S. Navy Surgeon General tasked the Center for Naval Analyses to evaluate the TRICARE demonstration project. This demonstration is an attempt to coordinate health care for the medical-eligible military population of 300,000 in the Tidewater area of Virginia. When TRICARE matures, it will integrate a series of military treatment facilities, a preferred provider network, and a health maintenance organization, under joint service management. The evaluation consists of a comparison of several measures of effectiveness, before and after TRICARE implementation. We will be comparing Tidewater with two other regions: southern California, which is under CRI (a managed care program), and North Carolina, which is under standard CHAMPUS. The evaluation will take about three years to complete. In the meantime, we have collected baseline data for Tidewater and the comparison sites. The purpose of this paper is to present the findings of the baseline analysis of access to, and satisfaction with, health care during the pre-implementation period. This is not an evaluation of TRICARE. The results will be helpful in interpreting subsequent changes in the components of the program after TRICARE implementation.

To evaluate the TRICARE demonstration project in the Tidewater area of Virginia, we need to collect health care information about military beneficiaries that is not available from administrative records. We chose to acquire information on access, satisfaction, and health status from a mail survey. We conducted a baseline mail survey in the fall of 1992, before the start of TRICARE. We plan to conduct a follow-up survey in the winter of 1995. Our response rate for the baseline survey was lower than expected, with 38 percent of the adult beneficiaries responding. With high levels of nonresponse, one can never be sure that there isn't some degree of bias in the survey responses. Therefore, we feel strongly about trying to improve the response rate for the follow-up survey. We reworked our survey implementation plan and tested it on a small sample of Navy beneficiaries. We find that modifying the survey implementation process has a dramatic effect on the response rate. This paper discusses the modifications we made and how they specifically affect the response rate.

The Center for Naval Analyses (CNA) has performed formal studies of Navy medicine for over two decades. These studies have covered a wide range of topics and used many different research methods. Because these studies have been performed for many different Navy commands, they would be difficult to find without a centralized listing. This information memorandum is a bibliography with abstracts of all formal research conducted by CNA concerning Navy medicine. The studies are organized as follows: compensation, recruiting, entry standards, and attrition; cost and medical organization studies; data quality analyses; decision analysis; Operation Desert Storm/Desert Shield; peacetime medical requirements; TRICARE evaluation and support; and wartime medical requirements.