Defense Health: Actions Needed to Help Ensure Combat Casualty Care Research Achieves Goals
Highlights
What GAO Found
The biomedical research organizations of the Department of Defense (DOD) use a coordinated approach to plan combat casualty care research and development, but not all of DOD's nonmedical research organizations share information early in the research process. GAO has previously reported that federal agencies can enhance and sustain collaboration of efforts by using key practices, such as agreeing on roles and responsibilities and establishing the means to operate across organizational boundaries. In 2010, DOD established a planning committee to coordinate the efforts of organizations conducting combat casualty care research. The committee developed a draft charter in 2010 identifying members respective roles and responsibilities. DOD issued the final charter in early January 2013, while GAO was conducting its review. DOD also facilitated operation across organizational boundaries by colocating most of the organizations conducting combat casualty care research. However, DOD organizations that typically do not conduct biomedical research, such as the Army Research Laboratory, are not involved in DOD's efforts to coordinate this research. When these organizations conduct research relevant to combat casualty care they do not always share information with appropriate officials early in the research process, as they are not aware of the need to coordinate early and may not fully understand medical research requirements. As a result, some researchers have had to repeat some work to adhere to these requirements. DOD has also taken steps to coordinate with other federal agencies that are involved in this research.
The Office of the Assistant Secretary of Defense for Health Affairs (Health Affairs) and the Army Medical Research and Materiel Command (MRMC) assess the progress of combat casualty care research and development projects, but they have not assessed the extent to which this research fills gaps in DOD's capability to provide this care or achieves other DOD goals. Federal internal control standards state that agencies should assess their performance to ensure they meet the agency's objectives. Health Affairs and Army MRMC--the two organizations that fund most combat casualty care research and development--monitor research projects to determine whether to continue funding, make necessary corrections, or terminate these projects. However, in 2008 DOD identified gaps in its capability to provide combat casualty care, and although Health Affairs and Army MRMC have completed 44 research projects since then designed to address these gaps, they have not assessed whether the results of this research fill the gaps identified in 2008. In addition, Health Affairs and Army MRMC established other goals for this research portfolio to improve combat casualty care. For example, in 2010, Health Affairs set goals to improve DOD's ability to control bleeding. However, neither organization has developed an assessment that comprehensively identifies each of the goals for the portfolio and includes information about the extent to which each goal has been met. Health Affairs and Army MRMC officials stated that they intend to complete a strategic roadmap for the portfolio, but GAO was unable to determine if the roadmap will include a plan for a comprehensive assessment of this portfolio. Without such a plan for a comprehensive assessment, these organizations cannot be sure the research they are conducting is producing results that most effectively improve combat casualty care to save lives on the battlefield.
Why GAO Did This Study
DOD estimates that about 24 percent of servicemembers who die in combat could have survived if improved and more timely medical care could be made available. Because multiple DOD organizations conduct research to develop medical products and processes to improve combat casualty care, it is critical that these organizations coordinate their work. It is also important that agencies monitor and assess their performance to help achieve organizational goals, which for DOD include addressing gaps in its capability to provide combat casualty care. The National Defense Authorization Act for Fiscal Year 2012 directed GAO to review DOD’s combat casualty care research and development programs. This report assesses whether DOD (1) uses a coordinated approach to plan this research; and (2) monitors and assesses this research to determine the extent to which it fills capability gaps and achieves other goals. GAO reviewed DOD’s policies and documentation; interviewed officials from DOD and other federal agencies; and analyzed metrics DOD used to gauge the progress of its research.
Recommendations
GAO recommends that DOD (1) communicate the importance of early coordination among DOD's nonmedical organizations and (2) develop and implement a plan to determine the extent to which research fills gaps and achieves other goals. DOD concurred with these recommendations.
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| Department of Defense | To ensure that nonmedical DOD research organizations coordinate with the Assistant Secretary of Defense for Health Affairs early in the research process to understand medical research requirements and avoid inefficiencies that may lead to duplicative work, the Secretary of Defense should direct the Under Secretary of Defense for Acquisition, Technology and Logistics to communicate to DOD's nonmedical research organizations the importance of coordination with the Joint Program Committee for Combat Casualty Care chair on combat casualty care issues, and require this coordination early in the research process when these organizations conduct research with implications for combat casualty care. |
Closed – Not Implemented
DOD took several actions in 2014 to communicate to DOD's nonmedical research organizations the importance of coordination. Specifically, DOD chartered the Armed Services Biomedical Research Evaluation and Management Community of Interest to include both medical and non-medical researchers and to improve coordination, collaboration, and cooperation. DOD also appointed senior leaders to work in both this community of interest and in other DOD research communities of interest, to improve coordination. Furthermore, DOD conducted joint research meetings to share research data across the medical and non-medical communities. However, DOD did not indicate a requirement for this coordination to occur early in the research process, as included in GAO's recommendation. While DOD did not fully implement this recommendation, circumstances have changed since 2014. Specifically, DOD has reorganized its medical and non-medical research organizations that were the focus of this recommendation, including the Under Secretary of Defense for Acquisition, Technology and Logistics. DOD has also created a new research directorate within the Defense Health Agency. According to DOD, this group--which did not exist at the time of our recommendation--will play a key role in future biomedical research.
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| Department of Defense | To improve DOD's ability to assess the overall performance of its combat casualty care research portfolio, the Secretary of Defense should direct the Under Secretary of Defense for Personnel and Readiness to direct the Assistant Secretary of Defense for Health Affairs to develop and implement a plan to assess the extent to which combat casualty care research and development fills gaps in DOD's capability to provide combat casualty care and achieves DOD's other goals for this portfolio of research. |
Closed – Implemented
DOD's Defense Health Agency developed and implemented a plan in 2014 to assess the extent to which combat casualty care research and development filled gaps in DOD's capability to provide combat casualty care, as GAO recommended. Specifically, a panel of 20 senior experts in combat casualty care assessed the progress from 2008 through 2013 in filling research and development gaps identified by DOD related to combat casualty care. This assessment indicated substantial progress in addressing the gaps, and also provides direction for future research priorities.
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