This description of data and databases covers a small sample of the data that the committee attempted to secure. In some cases, the committee was successful in obtaining data; in most cases, however, it was not. In its effort to conduct analyses that would provide information pertinent to its charge but not available in the literature, the committee had hoped to link data from these databases with the Defense Manpower Data Center (DMDC) data that it received on all those deployed. The committee provides here a brief explanation of some of those data and databases.
SELECTED DEPARTMENT OF DEFENSE DATA AND DATABASES
Defense Manpower Data Center
Since 1974, the DMDC has maintained an archive of Department of Defense (DOD) data, including all branches and components (active duty, reserve, and guard) of military personnel, manpower, training, and financial data. Data have been collected on over 42 million persons connected to DOD, and they have been followed through their military life (accession, service, separation, and retirement). The DMDC combines data from numerous programs (such as the Defense Enrollment Eligibility Reporting System [DEERS]) and personnel files (for active duty, reserve, guard, retired military personnel, contractors, and civilians) and data from many other sources (such as the Department of Veterans Affairs [VA], the Social Security Administration [SSA], and Medicare) to allow reporting of entitlements, benefits, and readiness; for personnel identification, validation, and authentication; and for decision-support purposes. (https://www.dmdc.osd.mil/appj/dwp/index.jsp)
Postdeployment Health Assessment and Postdeployment Health Reassessment
The Postdeployment Health Assessment (PDHA) is a self-conducted health screen for examining physical and mental health outcomes associated with deployment. It is meant to be completed in the theater of operation before redeployment, ideally within 5 days but not more than 30 days before departure from theater. The PDHA is also to be completed by all reserve-component personnel activated to active-duty status for more than 30 days in support of any contingency operation. (https://g1arng.army.pentagon.mil/programs/pdha/pages/default.aspx)
The Postdeployment Health Reassessment (PDHRA) is a self-conducted health screen for examining physical and mental health outcomes associated with deployment that is conducted 90–180 days after deployment and is required for all service members and reserve-component personnel who deployed outside the continental United States for 30 days or more. (https://g1arng.army.pentagon.mil/programs/pdha/pages/default.aspx)
Survey of Spouses
On May 10, 2010, DOD launched the Military Family Life Project, the first large-scale, longitudinal DOD-wide survey to assess quality-of-life issues that might affect military families during and after deployments. Invitations to participate in the online survey—starting May 10, 2010, and available for 3 months—were mailed to 100,000 military spouses and 40,000 married service members in all services selected at random. Spouses were encouraged to complete the survey online quickly, and those who did not respond were sent a paper copy of the survey. Spouses were to be contacted again for a follow-up survey in the following year. The survey is voluntary and confidential. (http://www.militaryhomefront.dod.mil/MOS/f?p=MHF:DETAIL1:0::::SID,COHE:22.214.171.124.0.0.0.0.0,256706)
The DMDC has conducted longitudinal surveys of active-duty and reserve military spouses to determine how DOD can support military families better and assess the attitudes and opinions of the military community pertaining to a wide array of personal issues. The Survey of Active Duty Spouses is administered to spouses of active Army, Navy, Marine Corps, and Air Force members who have served for at least 6 months and below flag rank. The 2006 survey was conducted from November 21, 2005, to June 1, 2006, and had a 32.7% response rate. The 2008 survey was conducted from March 14 to August 4, 2008, and had a 28% weighted response rate. Data pertaining to background information, permanent change-of-station moves, spouse deployment, deployment effects on children, use of Military OneSource, education and employment, financial and health well-being, and feeling about military life were collected. (DMDC. 2006 Survey of Active-Duty Spouses: Administration, Datasets, and Codebook. Report No. 2006-034. March 2007. Available at: http://www.dod.mil/pubs/foi/Personnel_and_Personnel_Readiness/Personnel/DMDC_2006-034.pdf)
(DMDC. 2006 Survey of Active Duty Spouses: Financial Well-Being and Spouse Employment Survey Note. Note No. 2008-005. http://www.military.com/spouse/fs/0,,fs_SpouseSurvey,00.html?ESRC=mscc.n)
(The survey is also conducted among spouses of reserve component personnel. http://www.allmilitary.com/board/viewtopic.php?id=24752; limitations of the survey may be found at http://afs.sagepub.com/content/early/2010/01/19/0095327X09358652.abstract)
TRICARE is the DOD’s collective health care program that provides health benefits for military personnel, military retirees, their dependents, and activated members of the guard and reserves. Services may be provided through managed care providers directly in DOD facilities, which include 44 inpatient hospitals and medical centers and 291 ambulatory care clinics in the United States, or through the purchased care system, which includes 379,233 network individual
providers (for primary care, behavioral health, and specialty care) and 3,146 TRICARE network acute care hospitals (Department of Defense, 2011; Merlis, 2012). There is also a fee-for-service option for care administered by civilian providers who are not part of the network (Deployment Health Clinical Center, 2012).
To enroll in a TRICARE plan, service members, their families, and retirees must first establish eligibility through DEERS. Active-duty and retired service members, including National Guard and reserve members activated for at least 30 days, are automatically registered in DEERS, but individual service members are responsible for registering their family members, updating their status, and ensuring that their information is current and correct (TRICARE Management Activity, 2009). Active duty service members, including members of the reserve components activated for at least 30 days, automatically enroll in TRICARE Prime1 at no cost.
DEERS contains data on all service members and family members who are eligible for TRICARE coverage. Family members must be entered by the service member, and people are responsible for updating their information in the database. (http://tricare.mil/mybenefit/home/overview/Eligibility/DEERS)
The Military Health System Data Repository (MDR), maintained by the Defense Health Service, is the centralized repository for DOD health-system data to capture, integrate, validate, and distribute health data in DOD health care networks. (http://health.mil/Libraries/OCIO_Documents/MDR_Fact_Sheet.pdf)
Included in the MDR are the Standard Inpatient Data Record (SIDR) and the Standard Ambulatory Data Record (SADR), which are generated by the Composite Health Care System (CHCS). CHCS contains data on direct care in each DOD medical treatment facility (MTF). For example, patient registration, appointments and scheduling, patient administration, nursing, pharmacy, laboratory, radiology, and dietetics information and services are recorded. CHCS aids in patient administration, billing and accounting, and workload assignment tasks and allows medical-records tracking and quality assurance. (DHIMS. CHCS factsheet. http://dhims.health.mil/docs/factsheets/factsheet-CHCS.pdf)
The SIDR contains information pertaining to inpatient services for military health system beneficiaries in each MTF and contains details on patient stay, diagnoses, procedures, bed days, treatment facility, and personal data.
(DHSS. Interface Control Document Describing the Standard Inpatient Data Record [SIDR] Data Exchange to MDR Mod 2. ICD-1300-3110-06. Sept 16, 2010) The SADR includes direct care outpatient-service data on each MTF or clinic. Patient information, provider, diagnoses, treatments, and insurance information are included.
(DHSS. Interface Control Document Describing the PID Enhanced SADR Data Exchange from ADM Mod 3. ICD-1300-3310-04. May 29, 2008).
1 TRICARE Prime is a managed care option offering.
Assistant Deputy Under Secretary for Health Monthly Enrollment File
The Veterans Health Administration (VHA) Assistant Deputy Under Secretary for Health (ADUSH) Monthly Enrollment File (the Enrollment File) is a compilation of national statistics on VHA expenditures, enrollment, and patients. It is also used to develop statistical models for forecasting enrollment and expenditures and for policy analyses. Numerous files provide data for the VHA ADUSH Monthly Enrollment File. (http://www.virec.research.va.gov/RUGs/RUG-ADUSH-EF-FY99-06-ER.pdf)
Patient Treatment File and Outpatient Care File
The Patient Treatment File (PTF) is an automated system for recording and tracking inpatient care received in VA and non-VA medical facilities (at VA’s expense). The PTF provides an abstract of inpatient activity (hospital care), diagnoses, procedures, and surgeries performed from the time of admission to the time of discharge from inpatient care. (https://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1650)
The Outpatient Care File is a file of outpatient visits and ambulatory care. Clinical encounters are characterized by a “stop code,” a three-digit code that corresponds to a location where care was provided. (http://www.herc.research.va.gov/files/RPRT_8.pdf)
Decision Support System
The Decision Support System (DSS) generates estimates of the cost of inpatient hospital stays and outpatient health care encounters. The DSS consists of a set of programs that use relational databases to provide cost and other information. VA notes that the DSS allows measurement of quality of care, clinical outcomes, and financial impact and assists in reporting, analysis, budgeting, and modeling of care and costs. DSS data are available in the form of National Data Extracts, SAS datasets of selected DSS fields by fiscal year, and DSS production databases, and contains facility-level cost and clinical data. (http://www.herc.research.va.gov/data/dss.asp)
Medical SAS Datasets
The Medical SAS Datasets contain inpatient and outpatient information. Medical SAS Datasets contain national, patient-level, and administrative data on VHA care extracted from the National Patient Care Database (NPCD, a relational database) by fiscal year. Inpatient data are from the PTFs. (http://www.virec.research.va.gov/MedSAS/Overview.htm)
National Patient Care Database
The NPCD is a relational database, updated daily, of VHA clinical information. It contains patient information, service information (including date and time, provider, and location), diagnoses and procedures, patient’s primary care provider, and some patient-status
information, such as exposure to Agent Orange. (http://www.virec.research.va.gov/NPCD/Overview.htm)
The committee had hoped to access numerous additional databases, including the Pharmacy Benefits Management Database (a national database of information on all prescriptions dispensed in the VHA System beginning with fiscal year 1999) and the VHA Vital Status File (which contains information for determining the vital status of veterans who enrolled in or received care from the VHA or received benefits from the Veterans Benefits Administration).
VETERANS BENEFITS ADMINISTRATION DATA SOURCES
Compensation and Pension Disability Information
The National Center for Veterans Analysis and Statistics collects, validates, and analyzes data pertaining to veterans and VA benefits and programs. Data collected, analyzed, and reported include demographic and socioeconomic data, use of and expenditures for VA programs (health care, home loans, education benefits, and compensation and pension), and data from the National Survey of Veterans (including data on education, employment, home loans, insurance, and demographics). (http://www.va.gov/vetdata/index.asp)
Veterans Service Network
The VETSNET (new version of the Compensation and Pension [C&P] file) Veterans Service Network Corporate Mini Master File consists of selected fields from the Veterans Benefits Administration (VBA) Corporate Database. Updated monthly, the VETSNET Corporate Mini Master File contains a selected subset of VBA fields of information on compensation and benefits to veterans or their beneficiaries. Current and terminated benefits are included. This data file is to replace the C&P Mini File (a data extract of the legacy Benefits Delivery Network containing data only on current benefits). (http://www.virec.research.va.gov/VETSNET/Overview.htm)
Beneficiary Identification Records Locator System
The VBA database containing VA beneficiaries since 1973 is known as the Beneficiary Identification Records Locator System (BIRLS). BIRLS contains records of beneficiaries, including survivors of veterans who applied for death benefits. (https://www.va.gov/vetdata/Glossary.asp)
The BIRLS Death File is an extract of the BIRLS database that contains death information (but not cause of death) on deceased veterans; it is updated monthly. Death information is gathered from VHA hospitals, the VA National Cemetery Administration, and family members’ applications to VBA for death benefits. (http://www.virec.research.va.gov/BIRLS/Overview.htm)
The committee had hoped to link data from the datasets below to the DMDC data to gain a full appreciation of the deployed population and so that it could examine employment and earnings, cause of death, criminal statistics, and whether veterans deployed to Operation Enduring Freedom or Operation Iraqi Freedom or their family members had applied for Medicaid:
• SSA files.
• National Death Index.
• National Crime Information Center files maintained by the Federal Bureau of Investigation.
• Centers for Medicare & Medicaid Services.
Department of Defense. 2011. Evaluation of the TRICARE program. Washington, DC: Department of Defense.
Deployment Health Clinical Center. 2012. DOD and VA Federal Healthcare Services. http://www.pdhealth.mil/hss/healthcare_services.asp#mhs (accessed September 25, 2012).
Merlis, M. 2012. The future of health care for military personnel and veterans. Washington, DC: Academy Health.
TRICARE Management Activity. 2009. Evaluation of the TRICARE program, FY 2009 report to Congress. Washington, DC: Department of Defense.