The Defense Department has decided to have its own health analysts study Air Force hospital data after a private consultant found suggestions of poor care during childbirth in Air Force hospitals.
Staff members of the Defense Department's Health Affairs Office are writing a report that they say will refute criticisms of care made in the findings of Health Data Institute, a firm that has conducted studies for Blue Cross/Blue Shield, General Motors, Chrysler, Wang and other major corporations.
Health Data had designed the $170,000 study as a three-phase assessment program. After the initial phase, however, representatives of the Defense Department's Health Affairs Office decided to do the remaining two phases, as well as go over the initial Health Data findings.
"We had exhausted our funds," said Dr. Jarrett Clinton, deputy assistant secretary for professional affairs and quality assurance.
Glen Wegner, senior vice president of the four-year-old data firm, acknowledged the Defense Department has challenged Health Data's figures. "If the military thinks that is a solution to a quality-of-care problem, it is not our business," Wegner said.
Filed in December, the Health Data study said women at several Air Force hospitals, including Malcolm Grow Hospital at Andrews Air Force Base in Suitland, suffered severe tears and cuts during childbirth at a rate of 40 to 49 per 1,000 women, twice that shown for civilian hospitals surveyed by the National Center for Health Statistics.
Other childbirth complications such as postpartum hemorrhage and retained placentas also occurred at a rate higher than national standards, the study indicated.
Health Data analysts also looked at data regarding other medical procedures, including length of stay. They concluded those overall figures were consistent with civilian care or that specific patterns of possible poor care were limited to isolated hospitals.
The Defense Department's report will clear hospitals at the five Air Force bases -- Lackland in San Antonio, Mather in Sacramento, Calif.; Eglin in Fort Walton Beach, Fla., and Keesler in Biloxi, Miss., as well as Andrews, officials from the health affairs office said.
Defense Department analysts are reviewing the same medical records used by Health Data -- 243,000 Air Force admission records recorded in 1982. But they are not factoring into their results as many cases as Health Data did.
Health Data analysts recorded postsurgical complications exactly as the doctors cited them on patients' charts. Defense analysts, who are reviewing records and interviewing doctors, are recording only cases in which the physician specified criterion -- such as severity of tear -- to substantiate a complication.
"They made a big deal out of that," Wegner said about the more stringent requirements set up under the Defense review. "What we've said is: Hey, you don't get that from a doctor. He doesn't list a textbook definition of every complication he records."
Clinton said yesterday that the Defense Department found health care questions raised by Health Data stemmed from inconsistencies in record keeping, as well as the differing definitions of postsurgical complications.
Clinton said Andrews Air Force Base was informed earlier this year that 96 percent of the patients that Health Data reported as suffering severe cuts and 65 percent of the patients reported as having postpartum hemorrhages did not have documentation to satisfy Defense analysts.
Military medical care -- and concerns over the quality of that care -- have been the focus of extensive internal audits by each branch of the armed services and a separate study by the inspector general. The audits, ordered two years ago after the federal government lost a $2.1 million malpractice suit stemming from an operation by an Air Force surgeon, revealed gaps in health care standards that have led to a number of plans for reforms.
The Health Data report was the only audit contracted to a private firm.