Hepner Kimberly A, Sloss Elizabeth M, Roth Carol P, Krull Heather, Paddock Susan M, Moen Shaela, Timmer Martha J, Pincus Harold Alan
Rand Health Q. 2016 Jun 20;6(1):14.
The U.S. Department of Defense (DoD) strives to maintain a physically and psychologically healthy, mission-ready force, and the care provided by the Military Health System (MHS) is critical to meeting this goal. Given the rates of posttraumatic stress disorder (PTSD) and depression among U.S. service members, attention has been directed to ensuring the quality and availability of programs and services targeting these and other psychological health (PH) conditions. Understanding the current quality of care for PTSD and depression is an important step toward improving care across the MHS. To help determine whether service members with PTSD or depression are receiving evidence-based care and whether there are disparities in care quality by branch of service, geographic region, and service member characteristics (e.g., gender, age, pay grade, race/ethnicity, deployment history), DoD's Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE) asked the RAND Corporation to conduct a review of the administrative data of service members diagnosed with PTSD or depression and to recommend areas on which the MHS could focus its efforts to continuously improve the quality of care provided to all service members. This study characterizes care for service members seen by MHS for diagnoses of PTSD and/or depression and finds that while the MHS performs well in ensuring outpatient follow-up following psychiatric hospitalization, providing sufficient psychotherapy and medication management needs to be improved. Further, quality of care for PTSD and depression varied by service branch, TRICARE region, and service member characteristics, suggesting the need to ensure that all service members receive high-quality care.
美国国防部（DoD）致力于维持一支身心健康、随时能执行任务的部队，而军事卫生系统（MHS）提供的护理对于实现这一目标至关重要。鉴于美国军人中创伤后应激障碍（PTSD）和抑郁症的发病率，人们已将注意力转向确保针对这些及其他心理健康（PH）状况的项目和服务的质量与可及性。了解当前对PTSD和抑郁症的护理质量是改善整个军事卫生系统护理的重要一步。为了帮助确定患有PTSD或抑郁症的军人是否接受了循证护理，以及在护理质量方面是否存在军种、地理区域和军人特征（如性别、年龄、薪级、种族/族裔、部署经历）方面的差异，国防部心理健康与创伤性脑损伤卓越中心（DCoE）要求兰德公司对被诊断患有PTSD或抑郁症的军人的行政数据进行审查，并就军事卫生系统可以集中精力持续改善向所有军人提供的护理质量的领域提出建议。本研究描述了军事卫生系统为被诊断患有PTSD和/或抑郁症的军人提供的护理情况，发现虽然军事卫生系统在确保精神病住院后的门诊随访方面表现良好，但提供足够的心理治疗和药物管理仍需改进。此外，PTSD和抑郁症的护理质量因军种、TRICARE地区和军人特征而异，这表明需要确保所有军人都能获得高质量的护理。
