Improving U.S. Military Accession Medical Screening Systems

Résumé du livre

Responsibility for medically screening enlisted and officer applicants for the armed forces falls on two Department of Defense (DoD) organizations: the U.S. Military Entrance Processing Command (USMEPCOM), which screens mainly enlisted applicants at military entrance processing stations (MEPS) throughout the country; and the Department of Defense Medical Examination Review Board (DoDMERB), which contracts with civilian health care providers to screen officer applicants. Given the inconsistencies and inefficiencies of the two systems, the project team was tasked with exploring how best to reform the medical screening process. After conducting interviews, focus groups, and a workshop with key stakeholders; reviewing documentation on current policies and practices; and examining prior DoD efforts at improvement, the team developed three main courses of action (COAs) to reform the business models used for accession medical screening, considered the potential feasibility of implementing each COA, and identified the COA for a hybrid model of the two systems as presenting the least amount of risk while allowing for simultaneous testing of enlisted and officer applicants across the two systems. Because of the potential for major impacts of implementing the hybrid model COA, the team recommended that DoD conduct a pilot program involving a randomized control trial at four experimental sites in the United States. The program incorporates strategic elements of an accession medical screening system (regardless of business model) described by stakeholders, as well as findings from analyses of organizational and geographic-based features using a RAND-developed geographic information system tool.