DoD Military Health System Beneficiary Survey Program General Health

1. DoD Military Health System Beneficiary Survey ProgramGeneral Health/OB-GYN Briefing for DACOWITS � MAY 25, 2004 Ms. Patricia Collins, TMA, Office of the Chief Medical Officer Lt Col Mike Hartzell, USAF, OASD(HA)/TMA Health Program Analysis & Evaluation Directorate CAPT Katherine Surman, NC,USN, OASD(HA) Clinical Program and Policy

3. Health Care Survey of DoD Beneficiaries Mail/Web survey measuring beneficiary satisfaction with all healthcare delivery for previous 12 months. Administered annually since 1995. Size = 50,000 questionnaires quarterly. Uses: inform Health Affairs (HA) and TRICARE (TMA) leadership. Identify areas for improvement; benchmark against civilian facilities.

4. Outpatient Customer Satisfaction Survey Measure patient satisfaction with specific outpatient Military Treatment Facility (MTF) encounter. Administered quarterly; ongoing since 1998. Size = 19,000 + 4,500 telephone + 4,500 web surveys. Uses: inform HA/TMA leadership; identify areas for improvement; benchmark.

5. Inpatient Customer Satisfaction Survey Measures satisfaction with inpatient care at MTFs and purchased care. Conducted annually since 1998. Size = 30,000 MTF/15,000 purchased care. Uses: inform HA/TMA leadership; identify areas for improvement; benchmark; focus on medical/surgical/OB care. DoD is a benchmark in medical / surgical care.

6. 2003 HCSDB Results:Access / Wait Times Health plan ratings for all TRICARE enrollment groups have increased from levels in 2001. Active duty have the lowest health plan and getting healthcare access ratings. MTF users are no more likely than users of civilian or VA facilities to report long waits in doctors� offices, but are more likely to report long waits for appointments and that their doctors� visits are too short.

7. 2003 HCSDB Results:Continuity/Care/Service Most active duty Prime enrollees do not have a personal doctor or nurse, nor do one-third of non-active duty enrollees. Breast and cervical cancer screening rates of both active duty women and dependents of active duty exceed Healthy People 2010 goals, but rates of first trimester pregnancy care fall short of the national benchmark. Since 1999, the proportion of TRICARE users who report that claims handling is correct and timely has gone up every year.

19. OB/GYN Care Facts Childbirth is the primary reason for hospitalization in the United States and in the Military Health System (MHS). It accounts for 40% of the health care in the MHS. Obstetrical care is often the first experience a family member has with the military health care. Impressions of these encounters can affect health care decisions following childbirth. National Defense Authorization Act for 2002 created the opportunity for TRICARE Standard patients to obtain obstetric without a non-availability statement from a military hospital. This was effective December 28, 2003.

20. Standards for OB/GYN Care Prior studies have shown that OB/GYN customer service has lagged behind the civilian sector. The Family Centered Care Policy which was enacted in January, 2004 is focused on improving early intervention and continuity of obstetrical care by offering comprehensive coordinated service. Little data at present due to recent start. Ancedotal evidence is available regarding MTFs that have started and/or enhanced their programs.

21. Partial List of New Standards Continuity of Care with the same provider/small group no fewer than 75% of routine visits. Follow-on appointments available prior to leaving clinic. DoD/VA Clinical Practice Guidelines for uncomplicated pregnancies. Steamlined DEERS Registration for the newborn. 24/7 Lactation Support.

22. Civilian Comparison Data National Perinatal Information Center (NPIC) contract for 2002 data. Compared 22 MTFs with OB services to comparable civilian facilities regarding case mix and outcomes. Study to be repeated in 2004. Preliminary results show that these MTFs are very similar in types of OB patients seen and the outcome of care.

23. Civilian-Military Studies Medical Team Training: Combined study of 15 military and civilian hospital Labor and Delivery Units to study how teamwork among staff may reduces errors and affect outcomes. Based on model utilized at Beth Israel Deaconess Medical Center (Boston, MA). Results pending summer, 2004. Concepts can be used in other hospital settings, e.g. Operating Suites, Intensive Care, etc.

24. Summary Be the provider of choice for our military families. Recognize where we must do better. Examine not only our perinatal care, but other types of care for quality processes, effectiveness and results. Continue with surveys, research and trying new things! Share successful approaches to care such as group prenatal support visits, �Daddy Bootcamp� and recapturing neonate intensive care patients.