recruit assessment program: A program to collect comprehensive baseline health data from U.S. Military personnel, The

Military Medicine, Jan 2002 by Hyams, Kenneth C

Pilot testing has begun on the Recruit Assessment Program (RAP). The RAP is a proposed Department of Defense (DoD) program for the routine collection of baseline demographic, medical, psychosocial, occupational, and health risk factor data from all U.S. military personnel at entry into the armed forces. The RAP currently uses an optically scannable paper questionnaire, which will provide data for the first building block of an electronic medical record within the DoD and the Department of Veterans Affairs. The RAP will serve several important functions, including automating enrollment into the military health care system, improving patient care and preventive medicine efforts, and providing critical data for investigations of health problems among military personnel and veterans. If the feasibility of the RAP is demonstrated and the program is fully implemented throughout the DoD, it could provide a substantial improvement in health care delivery. For the first time, DoD and Department of Veterans Affairs physicians, public health officers, and researchers will have access to comprehensive baseline health status data.

Introduction

During the last 10 years, several scientific review panels have recommended that the Department of Defense (DoD) maintain more complete and accessible medical records and collect greater health surveillance data.1-4 One specific recommendation has been for the DoD to document health status before hazardous deployments.5 However, surveillance efforts initiated after the decision to wage war or engage in peacekeeping activities are often impractical for two reasons: (1) medical assessment programs take time to implement, but future wars are likely to begin with little warning; and (2) it is difficult to obtain accurate medical and psychosocial data during busy preparations for major deployments.

The collection of comprehensive health data at the start of military service would obviate many of the problems associated with health appraisals initiated just before a hazardous deployment. Baseline health information could provide many important benefits, particularly if integrated with health data collected periodically as part of a longitudinal health record. Because of the potential usefulness of baseline health data, the feasibility of establishing a program to collect this information is being evaluated within the DoD.

Recruit Assessment Program

Pilot testing has begun on the Recruit Assessment Program (RAP). The RAP is a proposed DoD program for the routine collection of demographic, medical, psychosocial, occupational, and health risk factor data from all U.S. military personnel at the time of accession. As planned, this information will be the start of a longitudinal database that will be maintained as part of a computerized health record. Baseline RAP data will be accessible by DoD and Department of Veterans Affairs (VA) clinicians and preventive medicine personnel on a routine and confidential basis and by medical researchers through approved protocols.

The RAP could provide several important functions within the DoD and VA health care systems. Baseline data will have immediate application during initial military training. Medical and risk factor data would aid in identifying recruits who can benefit from health promotion programs, such as smoking cessation and education about alcohol use. Moreover, the electronic format of RAP data collection can be used to automate the enrollment of new recruits into administrative and health care databases such as the Composite Health Care System II.

The RAP also would be of assistance in routine health care by aiding in diagnosis and clinical preventive medicine. Access to information regarding previous health status is important for clinical purposes to document changes in a patient's condition. Furthermore, the availability of comprehensive health risk data will help clinicians identify factors that may benefit from preventive health interventions.

In addition to aiding clinical care, the use of a computerized baseline database will make medical record keeping more efficient because only changes in health status need to be documented during a clinical encounter. The RAP would be the first building block of the military and VA electronic medical record. Finally, baseline health data are needed by the DoD and VA to provide documentation of previous health status when determining service-connected disability.

The RAP would assist in monitoring trends in health behaviors and in the development of population-based preventive health measures. With computerized data, it will be possible to distinguish groups at high risk for various illnesses, such as cancer, diabetes, hypertension, and heart disease. For example, with a longitudinal health record, the VA and DoD could rapidly identify and contact women who would most benefit from mammography because of a family history of breast cancer.

The RAP would be especially valuable in the evaluation of military and veteran populations during and after hazardous overseas assignments by providing baseline medical and psychological information from before the deployment. Baseline health data will further ensure the optimal use of surveillance data collected during deployments.