To inform improvements to the quality of care delivered by the military health system for posttraumatic stress disorder and major depressive disorder, researchers developed a framework and identified, developed, and described a candidate set of measures for monitoring, assessing, and improving the quality of care. This document describes their research approach and the measure sets that they identified.

Understanding the current quality of care for posttraumatic stress disorder (PTSD) and depression delivered to service members is an important step toward improving care across the Military Health System (MHS). T.his report describes the characteristics of active-component service members who received care for PTSD or depression through the MHS and assesses the quality of care received using quality measures derived from administrative data

This monograph serves as a technical source for National Institute for Occupational Safety and Health (NIOSH) incident commander guidelines for emergency response immediately following large structural collapse events. It gives guidelines for personal protective equipment (PPE), focusing on required modifications to responders' typical PPE ensembles because of the duration of response and the need to prevent exposures to likely hazards from pathogens, airborne dusts, and gaseous hazardous materials.

The authors found that for the average adult beneficiary, costs to the government were 9 percent higher with CRI. Compared to the non-CRI program, costs were 57 percent higher for Prime enrollees, whereas they were the same for non-enrollees. Prime enrollees' use of outpatient care accounted for almost all of the utilization increase in CRI. Active-duty spouses who enrolled did not change their military treatment facility (MTF) use, but they were more likely to augment their (MTF) care with civilian care. Retired enrollees were more likely to use both MTF care and civilian care. CHAMPUS inpatient utilization was lower in CRI, as is often the case in managed-care programs, whereas use of MTF inpatient services did not change significantly. These findings suggest that CRI was able to increase access, especially to civilian care, with an accompanying increase in costs. The evidence points to high utilization among Prime enrollees, especially for retired beneficiaries.

Résultats basés sur des données récoltées aux USA entre 1974 et 1982. Le travail analyse la manière dont le partage des coûts, imposés par les assurances, agit sur la consommation des services de santé. La qualité des soins, l'état de santé des patients et leur satisfaction sont également évalués.

"Among the possible effects of stratospheric ozone depletion, perhaps the most important consequences are the health implications for human beings. Because a reduction in stratospheric ozone would increase the amount of ultraviolet radiation reaching the earth's surface, human diseases that might be influenced by increased exposure to ultraviolet radiation (UV) are important to consider. In this Note, the authors discuss the characteristics of several types of skin cancer and other diseases believed to be related to sunlight. Their primary goal is to educate the reader regarding the natural history and consequences of UV-related diseases, by translating into layman's language information available in the scientific literature. The information in this document lays the groundwork for further research on the economic costs of these diseases in estimating the impact of stratospheric ozone depletion."--Rand abstracts.

Recently, the Department of Defense replaced fee-for-service insurance plan for military health care beneficiaries with an HMO/PPO hybrid. Using survey and claims data, the authors compare changes in costs over two years at sites that implemented this initiative (CRI) with changes at matched control sites. The results indicate that CRI substantially raised per beneficiary government costs for providing benefits (as compared to predicted costs in the absence of CRI). The authors attribute this difference to the higher overhead of managed care and the imcreased expenditures by HMO participants.

The Veterans Access, Choice, and Accountability Act of 2014 addressed the need for access to timely, high-quality health care for veterans. Section 201 of the legislation called for an independent assessment of various aspects of veterans’ health care. The RAND Corporation was tasked with an assessment of the Department of Veterans Affairs (VA’s) current and projected health care capabilities and resources. An examination of data from a variety of sources, along with a survey of VA medical facility leaders, revealed the breadth and depth of VA resources and capabilities: fiscal resources, workforce and human resources, physical infrastructure, interorganizational relationships, and information resources. The assessment identified barriers to the effective use of these resources and capabilities. Analysis of data on access to VA care and the quality of that care showed that almost all veterans live within 40 miles of a VA health facility, but fewer have access to VA specialty care. Veterans usually receive care within 14 days of their desired appointment date, but wait times vary considerably across VA facilities. VA has long played a national leadership role in measuring the quality of health care. The assessment showed that VA health care quality was as good or better on most measures compared with other health systems, but quality performance lagged at some VA facilities. VA will require more resources and capabilities to meet a projected increase in veterans’ demand for VA care over the next five years. Options for increasing capacity include accelerated hiring, full nurse practice authority, and expanded use of telehealth.

This book is an assessment of the effects on human health of reclaimed water. The assessment focuses on adverse outcomes among liveborn infants, including low birth weight, preterm birth, infant mortality, and birth defects, from 1982 to 1993. Outcome rates in the Montebello Forebay area, which has received some reclaimed water in its water supply since 1962, are compared with a control area that received no reclaimed water. Using a cohort study design, this epidemiologic assessment analyzes outcome data on individuals classified by a ZIP code-level percentage of reclaimed water. The results of the study do not provide evidence of an association between reclaimed water and adverse birth outcomes.