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In recent years, the number of U.S. service members treated for psychological health conditions has increased substantially. In particular, at least two psychological health conditions -- posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) -- have become more common, with prevalence estimates up to 20 percent for PTSD and 37 percent for MDD. Delivering quality care to service members with these conditions is a high-priority goal for the military health system (MHS). Meeting this goal requires understanding the extent to which the care the MHS provides is consistent with evidence-based clinical practice guidelines and its own standards for quality. To better understand these issues, RAND Corporation researchers developed a framework to identify and classify a set of measures for monitoring the quality of care provided by the MHS for PTSD and MDD. The goal of this project was to identify, develop, and describe a set of candidate quality measures to assess care for PTSD and MDD. To accomplish this goal, the authors performed two tasks: (1) developed a conceptual framework for assessing the quality of care for psychological health conditions and (2) identified a candidate set of measures for monitoring, assessing, and improving the quality of care for PTSD and MDD. This document describes their research approach and the candidate measure sets for PTSD and MDD that they identified. The current task did not include implementation planning but provides the foundation for future RAND work to pilot a subset of these measures.

• Introduction : looking to the past for lessons ... to apply in the future
• Evolution of the European system of providing for casualties : Greece, Rome, the Middle Ages, and the Renaissance
• Evolution of the European system of providing for casualties in the Age of Enlightenment : France and Britain as the antecedents of the American system of care
• The American system of providing for the wounded evolves
• The Civil War
• From the Civil War to the World War
• The World War
• World War II
• Summary : What happened?---What have we learned?---How did we get here?

War has always been a dangerous business, bringing injury, wounds, and death, and -- until recently -- often disease. What has changed over time, most dramatically in the last 150 or so years, is the care these casualties receive and who provides it. Medical services have become highly organized and are state sponsored. Diseases are now prevented through vaccination and good sanitation. Sedation now ameliorates pain, and antibiotics combat infection. Wounds that once meant amputation or death no longer do so. Transfers from the field to more-capable hospitals are now as swift as aircraft can make them. The mental consequences of war are now seen as genuine illnesses and treated accordingly, rather than punished to the extreme. Likewise, treatment of those disabled by war and of veterans generally has changed markedly -- along with who supplies these and other benefits. This book looks at the history of how humanity has cared for its war casualties, from ancient times through the aftermath of World War II. For each historical period, the author examines the care the sick and wounded received in the field and in hospitals, the care given to the disabled veteran and his dependents, and who provided that care and how. He shows how the lessons of history have informed the American experience over time. Finally, the author sums up this history thematically, focusing on changes in the nature and treatment of injuries, organization of services on and off the battlefield, the role of the state in providing care, and the invisible wounds of war.

• Healthcare coverage
• Disability outcomes for reserve component members.

Because Reserve Component (RC) members have been increasingly used in an operational capacity, among the policy issues being addressed by the 11th Quadrennial Review of Military Compensation (QRMC) is compensation and benefits for the National Guard and Reserve. As part of the review, RAND was asked to analyze healthcare coverage and disability benefits for RC members, including participation in the TRICARE Reserve Select (TRS) program, the potential effects of national health reform on coverage rates, and disability evaluation outcomes for RC members. This report summarizes the results of RAND's analysis. The author finds that 30 percent of RC members lack health insurance to cover care for non-service-related conditions. The TRS program offers the option of purchasing health insurance through the military on terms that are superior to typical employer benefits. Although program participation has increased, it remains low and TRS does not appear to be effectively targeting those most likely to be uninsured. TRS premiums are also lower than the premiums for the new options that will be available under health reform and the same as the penalty for not being insured. So health reform is likely to increase TRS enrollment. Finally, previously deployed RC members are referred to the Disability Evaluation System at a much lower rate than Active Component (AC) members, even for deployment-related conditions, but those who are referred receive dispositions (and thus benefits) similar to those for AC members. These findings suggest that the Department of Defense may want to consider ways to better coordinate TRS with other insurance options that will be available to RC members and that the identification of RC members who experience health consequences from deployment leading to disability merits further investigation.

• Why stabilization and reconstruction?
• What do stabilization and reconstruction operations entail?
• Recent efforts to build capacity
• Conclusions and recommendations.

U.S. experiences in Iraq and Afghanistan have demonstrated that improving U.S. capacity for stabilization and reconstruction operations is critical to national security. To help craft a way ahead, the authors provide an overview of the requirements posed by stabilization and reconstruction operations and recommend ways to improve U.S. capacity to meet these needs.

• Introduction
• Methods and data
• Asthma populations and practices at the baseline
• The guideline implementation process
• Effects of guideline implementation
• Synthesis of findings from the demonstration
• Appendix A. Hypotheses for effects of improved asthma care practices
• Appendix B. Evaluation methodology
• Appendix C. Modules of the climate survey
• Appendix D. Physician questionnaire
• Appendix E. Analyses of asthma metrics.

In partnership with the Army Medical Department (AMEDD), RAND researchers worked to implement clinical practice guidelines in treatment of three common ailments (asthma, diabetes, and low back pain). This report is an evaluation of the asthma practice guideline demonstration. It documents the extent to which intended actions were implemented, assesses short-term effects on clinical practices, and measures the quality and limitations of available data for monitoring practice improvements and clinical outcomes. The authors found that, although the implementation scored some notable successes, resource limitations and organizational barriers curbed overall progress. They conclude that allowing for flexibility, monitoring the facilities consistently, and training providers thoroughly are the keys to implementing the practice guidelines throughout AMEDD. The also concluded that patient education was an area in need of improvement.

Documents the Army Medical Department's efforts to assess the medical risks associated with emerging Army operational concepts and its capacity to mitigate these risks. As the Army transforms itself for the future and develops new operational concepts and technologies, the Army Medical Department (AMEDD) is identifying operational medicine issues whose resolution will be critical to its ability to support the Army of the future. The purpose of this research was to develop a method to assess these issues and further investigate a subset of them.
(source: Nielsen Book Data)