Army Health Care: Progress Made in Staffing and Monitoring Units that Provide Outpatient Case Management, but Additional Steps Needed
Highlights
In February 2007, a series of Washington Post articles disclosed problems at Walter Reed Army Medical Center, particularly with the management of servicemembers receiving outpatient care. In response, the Army established Warrior Transition Units (WTU) for servicemembers requiring complex case management. Each servicemember in a WTU is assigned to a Triad of Care--a primary care manager, a nurse case manager, and a squad leader--who provide case management services to ensure continuity of care. The Army established staff-to-servicemember ratios for each Triad of Care position. This report examines (1) the Army's ongoing efforts to staff WTU Triad of Care positions and (2) how the Army monitors the recovery process of WTU servicemembers. GAO reviewed WTU policies, analyzed Army staffing and monitoring data, interviewed Army officials, and visited five selected WTUs.
Recommendations
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| Department of Defense | To help ensure that the WTU at Walter Reed Army Medical Center is providing an appropriate level of care to servicemembers and help the Army make future staffing decisions for the WTUs that will be caring for this population once Walter Reed closes, the Secretary of Defense should direct the Secretary of the Army to examine Walter Reed's WTU staffing model, including its Triad of Care staff-to-servicemember ratios, in light of the complexity of the health care needs of servicemembers placed in this WTU. |
DOD stated that a separate, individualized study of the Warrior Transition Units (WTU)staffing levels at Walter Reed Army Medical Center is not warranted because it believes that current, ongoing monitoring efforts are sufficient to identify any staffing issues.
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| Department of Defense | To help ensure that the Comprehensive Transition Plans are implemented consistently across WTUs and that the Army has performance data for monitoring the implementation of the transition plans, the Secretary of Defense should direct the Secretary of the Army to expedite efforts to finalize and implement its policy for guiding the development of the Comprehensive Transition Plans. |
DOD indicated in its agency comments that the policy for guiding the development of Comprehensive Transition Plans was signed on March 10, 2009.
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| Department of Defense | To determine whether the results of the Warrior Transition Unit Program Satisfaction Survey can be used to assess the effectiveness of the WTUs, the Secretary of Defense should direct the Secretary of the Army to take steps to determine whether the results are representative of all servicemembers in WTUs, such as by conducting nonresponse analyses, and should take additional steps if necessary to obtain results that are representative. |
The Army did conduct a non-response analysis of its Warrior Transition Unit Survey in 2010. However, due to our concerns about the methodology Army officials used, we are closing this recommendation as "not implemented." First, the Army did not include a date, so we are unsure as to which survey this analysis applies. Secondly,the Army limited its analysis to the demographic characteristics of the non-responders and did not contact them or otherwise attempt to obtain their views on the survey questions, which would have allowed them to determine whether the responses to the survey questions were in fact representative. The Army does not plan to conduct a follow-on analysis.
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