NASA Scientific and Technical Aerospace Reports

In behavioral health (BH), considerable resources are allocated to the basic, standard processes of conducting initial
evaluations. Patients present to BH clinics much like they do to an emergency room or sick call; problems range from minor
to severe, urgent to routine, administrative to medical needs. Triaging patients is required to determine an appropriate
immediate disposition. The critical yield of the evaluation is actuarial data used to predict risk. Historically, this has not been
optimized for either resource allocation or quality of care, resulting in delays in service, additional cost to provide care, and
inconsistent scientific application of BH. This project originally proposed to apply decision algorithms to an automated intake
system to directly address quality, cost and access limitations. The key tasks were: 1. Defining an explicit knowledge base used
to make triage and assessment decisions. 2. Providing a detailed analysis of current best practices and evidence-based
decision- making criteria. 3. Creating symbolic logic using the identified criteria. 4. Designing output that is useful to
providers. 5. Systematically evaluating the decisions and logic against clinician judgment. 6. Integrating the outcome of the
project with larger initiatives (BHAVRS, DCSP, CHCSII).
DTIC
Expert Systems; Health
20040050811 Uniformed Services Univ. of the Health Sciences, Bethesda, MD
Adherence to Hypertension Management Recommendations for Patient Follow-Up Care and Lifestyle Modifications
Made by Military Healthcare Providers
Collins, Timothy J.; May 2000; 82 pp.; In English
Report No.(s): AD-A421146; No Copyright; Avail: CASI; A05, Hardcopy
The purpose of this study was to describe military healthcare providers adherence to nationally recognized hypertensive
patient guidelines concerning lifestyle modifications and follow-up instructions after an initial diagnosis of hypertension. The
importance of monitoring high blood pressure (follow-up) and maintaining blood pressure control was examined. Research
has shown that while hypertension follow-up is being performed, physicians are not following established guidelines
aggressively enough in identifying situations in which more robust management may be appreciated. Neuman’s Systems
Model was used as the conceptual framework to guide this study. Data was collected utilizing a checklist developed by the
researcher according to national treatment recommendations. Using a descriptive quantitative design, eight research questions
were investigated during a retrospective chart review on a convenience sample of 35 medical records at an Air Force medical
treatment facility located in the northeast USA. Military Healthcare Providers fared well (94%) in maintaining oversight of
their hypertensive patients by providing excellent follow-up management. However, lifestyle modification prescriptions to
their patients, were less favorable. There was a low compliance with weight loss instruction (36%), the limitation of alcohol
use (57%), and need to increase physical activity (38%), reduce sodium intake (6%), and maintain adequate potassium (3%),
calcium (9%), and magnesium (0%). Patients in this study were also not provided with adequate information about decreasing
dietary fat (17%). However, Military Healthcare Providers were exceptional in both identifying and counseling cigarette
smokers (100%). This thesis revealed a better compliance to JNC VI (1997) guidelines by Advanced Nurse Practitioners than
physicians did in all areas of instructions.
DTIC
Hypertension; Medical Services; Patients
20040050813 Uniformed Services Univ. of the Health Sciences, Bethesda, MD
A Comparison of Diabetes Management in a Federal Prison with the National Standards of Care Published by the ADA
in 1998
Giroux, Virginia A.; May 2000; 59 pp.; In English
Report No.(s): AD-A421148; No Copyright; Avail: CASI; A04, Hardcopy
Diabetes Mellitus (DM) affects 16 million Americans, or 6.2% of the population, and costs the U.S. $120 billion annually.
Specifically, within the Federal Bureau of Prisons (FBOP), DM affects 5.7% of the total inmate population. It is associated
with significant morbidity and mortality. It is the leading cause of blindness, non-traumatic lower extremity amputations, and
end-stage renal disease. Results of the Diabetes Control and Complications Trial have shown that intensive treatment can
significantly reduce the debilitating and costly long-term complications associated with the disease. Managing a chronic illness
such as DM can best be accomplished by following nationally recognized standards of care such as those published by the
American Diabetes Association (ADA). The purpose of this study was to describe the medical management for inmates
diagnosed with DM within the FBOP, and compare this to the national standards of care published by the ADA in 1998. To
measure adherence to the ADA standards, this descriptive quantitative study utilized the Diabetes Quality Assurance (DQA)
Checklist to perform a chart review in a federal prison outpatient clinic. The DQA Checklist major categories include referrals,
blood glucose evaluation, diet and exercise, foot care, cardiovascular risk factors, and laboratory tests. Cardiovascular risk
126