Assessing Fitness for Military Enlistment Physical, Medical, and Mental Health Standards (2006) / Chapter Skim
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3 Framework for Evaluation Medical and Physical Standards
3 Framework for Evaluation Medical and Physical Standards
Pages 47-65
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From page 47... ...
Some of the material in this chapter is technical and is intended primarily for policy analysts and others who formulate and evaluate enlistment standards. The function of this chapter is to describe the methodological approach and data needed to evaluate medical and physical enlistment standards in terms of such outcomes as injury, lost time, and attrition.
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From page 48... ...
Rather, nongraduates (and lower aptitude recruits) can reduce military effectiveness in various ways, such as having high attrition rates or poor performance with respect to certain military duties.
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From page 49... ...
The evaluation of education standards, for example, uses the outcome of first-term attrition. The justification is that enlistees who leave before the end of their first term increase training costs, since more recruits must be trained to fill unit manpower requirements.
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From page 50... ...
Recruits with certain physical conditions, such as obesity or a very low level of physical fitness, may not be able to complete basic training or may not be able to adapt to difficult combat environments. Attrition might therefore be a reasonable outcome for evaluating specific standards for these conditions.
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From page 51... ...
In the case of high sensitivity and specificity measures, which are desirable for most screening tests, the regression coefficient would be quite high; for example, the regression coefficient would be .8 if both sensitivity and specificity were .9. In the case of military enlistment standards, validity has a somewhat different meaning and therefore validity studies have taken a somewhat different approach.
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From page 52... ...
Continuing with the examples of education and aptitude standards, the validity of education standards has been established by correlating education levels with first-term attrition rates, as in Table 3-2. The validation of aptitude standards with on-the-job performance outcomes required a massive original data collection effort that took place over a period of nearly 10 years (National Research Council, 1991)
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From page 53... ...
The full model is a computer-based optimization model that evaluates enlistment standards along two dimensions: high school graduation status and aptitudes. We present a much simplified version of this model and illustrate it with high school graduation status, a characteristic not unlike such medical conditions as asthma or drug use.
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From page 54... ...
However, the additional cost of recruiting high school graduates is greater than that of nongraduates, at the mix typically recruited. The optimization model implicitly makes trade-offs between the higher staff years and lower training costs of the high school graduate recruits and the lower recruiting cost, but also lower staff years and greater attrition, of nongraduate recruits.
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From page 55... ...
graduates. The increase in recruiting costs more 2In fact, 90 percent is the current DoD standard for the percentage of high school diploma graduates recruited.
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From page 56... ...
The right balance, then, and the optimal weight standard is one that minimizes cost by balancing the higher recruiting costs associated with a more stringent standard with the savings in attrition costs. Of course, there will not be an optimization model for all physical and medical standards.
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From page 57... ...
with dR/dN > 0 and dR/d POP < 0. The enlistment standard, in this analysis, is used to screen out populations that have higher expected attrition rates in the first year of service than the general population.
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From page 58... ...
Then, let the proportion of the recruits with the characteristic, before the standard is in place, be equal to p1 The average attrition rate . before introducing the enlistment standard, is a1 = (1- p1)
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From page 59... ...
DATA RELEVANT TO EVALUATING MEDICAL AND PHYSICAL STANDARDS DoD maintains many databases necessary, if not critical, for evaluating medical and physical standards. One of the factors that complicates carrying out studies of this type is that some of these databases, particularly health databases, are held by separate agencies, making cross-reference and linkage difficult and problematic.
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From page 60... ...
For example, the MEPCOM Integrated Resource System (MIRS) is the source for building the initial personnel records maintained by the Defense Manpower Data Center, some of whose record data are provided to the Total Army Injury and Health Outcomes Database.
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From page 61... ...
Recommendation 3-2: We recommend that DoD undertake a project to develop the data and technology necessary for a cost-performance trade-off model that could be applied to setting and evaluating medi cal and physical standards. Recommendation 3-3: We recommend that DoD commission a re view of the medical databases necessary for evaluating and assessing medical and physical enlistment standards and create a mechanism for integrating or linking the medical databases with existing person nel databases at the Defense Manpower Data Center, subject to all legal requirements.
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From page 62... ...
DMSS also has a component called the Reportable Medical Events System, which publishes monthly reports on communicable diseases in the military of public health significance, in parallel with the civilian reporting system of the Centers for Disease Control and Prevention. DMSS does not link directly to personnel databases; however, it receives data from the Defense Manpower Data Center and other sources, including demographics and occupational data, to permit population-based routine medical surveillance and to answer basic surveillance questions, such as rates by gender, rates for specific deployments, rates by age, and reportable diseases.
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From page 63... ...
Examples are the longitudinal health databases on all aviators in the Air Force. Research Databases Total Army Injury and Health Outcome Database The Total Army Injury and Health Outcome Database (TAIHOD)
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From page 64... ...
This database does not include health information acquired by recruiters of individual Service recruiting commands from individual applicants. Defense Manpower Data Center Databases The Defense Manpower Data Center (DMDC)
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From page 65... ...
FRAMEWORK FOR EVALUATING MEDICAL AND PHYSICAL STANDARDS 65 Similarly, databases such as the Active Duty Military Enlisted Cohort File, the Active Duty Military Personnel Transaction File, and the MEPCOM Examination and Accession File, are often used for research, studies, and analyses. Validity of Administrative Databases The issue of the validity of these administrative databases has been addressed in research publications by users of these databases.
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