2024-10-27-兰德-评估接受私营部门行为健康护理的服务人员的准备情况（英）_130页_982kb

Summary of ReadyMilitary Study on Readiness Assessment for Service Members Receiving Private-Sector Behavioral Health Care

Access to 5-Day Consideration

Members of the services are subject to mandatory periodic physical and mental evaluations to determine their fitness for continued service. Recent defense health assessments revealed overwhelming use of private-sector resources for mental health care. This report provides data on readiness assessment completion for service members charged to receive clinical care from non-Military Treatment Facility (MTF) providers.

Administrative Approach

We conducted an analysis of data collected from October 2017 through September 2022, including behavioral health (BH) care utilization records from both direct care (MTF-based) and private-sector sources, supplemented by 32 staff interviews (16 administrators, 16 providers) across 8 diverse MTFs.

Key Findings

1. Rising Demand: The proportion of outpatient BH visits shifted dramatically from 9% to 38% in private-sector care during the study period.

2. Staffing and Process Variation: Unstructured approaches dominate readiness assessment, with ad hoc methods for tracking service members, and insufficient documentation of readiness reviews in electronic health records.

3. Incomplete Documentation: Administrative data lack standardization for tracking readiness, often missing or under-documenting assessments. Administrative treatment data captured patterns but lacked clinical specifics needed to accurately derive resource consumption.

4. Coordination Deficits: Lack of secure, standardized information exchange between private-sector and MTF providers hinders command communication about duty limitations.

5. Policy Implementation: Despite recent policy guidance from Defense Health Agency (DHA), implementation remains inconsistent at many MTFs.

Recommendations

1. DHA Administrative Instruction Implementation: DHA should clarify minimum requirements for readiness tracking (frequency, information to collect) and develop guidance differentiating essential from modifiable readiness monitoring activities based on demand.

2. Enhanced Information-Sharing: Establish standardized reporting formats for documentation exchange between providers and commands for service members receiving BH care in private practice. Include administrative guidance on processes to ensure compliant information transfer.

3. Clear Policy Enforcement: Educate private-sector providers about military readiness standards and the terms of their contracts regarding duty limitation reporting. Create accountability measures ensuring timely documentation submission.

This assessment highlights the critical need to balance military healthcare delivery with readiness determination requirements for personnel utilizing non-MTF behavioral health services.