Estimating the Clinical Care Performed During the Periodic Health Assessment

The Periodic Health Assessment (PHA) is a critical annual screening program for active duty military personnel. It aims to identify any health conditions that could impact a service member's (SM) ability to perform their duties and maintain overall wellness. The current PHA process involves a self-assessment by the SM, a medical record review by a clinician, and a person-to-person encounter that includes a mental health assessment (MHA). However, concerns have been raised that a significant portion of PHAs may be primarily administrative, failing to identify new health issues. This study investigates the prevalence of potentially "low-risk" PHAs within the Naval Medical Forces Atlantic (NMFL) area of responsibility (AOR) to inform potential workflow improvements.

Data from calendar year 2022 on PHAs completed at various NMFL facilities was collected from the MHS MART (M2) and analyzed. The study defined "low-risk" PHAs as those where no further actions, such as referrals to specialists, lab tests, or radiology orders, were initiated within 5 days of the encounter. Data on provider workload and the specialties performing the most PHAs were also collected. Local IRB determination found that this analysis was exempted from IRB review.

The analysis revealed that over 84,000 PHAs were conducted in 2022 by a total of 857 providers across the NMFL AOR. On average, only 13.3% of these PHAs resulted in some form of follow-up action, suggesting that a substantial proportion, potentially exceeding 86.7%, could be categorized as "low-risk." Lab tests were the most common follow-up, followed by referrals to other specialists and radiology orders. The data also showed that nurse practitioners, physician assistants, independent duty corpsmen, general medical officers, and family medicine physicians performed the majority of PHAs. Notably, a larger share of the workload fell on advanced practice providers compared to other specialties.

These findings suggest that the current PHA process generates a significant administrative burden for health care providers. The study estimates that over a third of a million provider-hours annually are spent on potentially low-risk PHAs that offer minimal medical benefit to the service member. This workload reduction could free-up valuable clinician time for addressing the needs of SMs with more complex health concerns, improving both force medical readiness and the clinical readiness of our medical force.