Quality control and quality assurance of medical committee performance in the Israel Defense Forces.
OBJECTIVE
The paper aims to focus on a unique quality control system that was set up ten years ago to evaluate Medical Classification Committee decision-making processes at the Israel Defense Forces (IDF) conscription center.


METHODS
Two main approaches were deployed by the control system to assess medical classification committees' performance. The first was direct assessment of the medical committees' clinical work and decision-making processes. The second applied data mining procedures to the computerized medical databases. The functional classification codes (FCCs)--codes for the most common medical disorders assigned to male recruits from the central computerized central IDF database, the sub-districts comprising the recruitment centers, and the chairmen assigning the FCCs to recruits--were all analyzed.


RESULTS
A total of 26 FCCs, each indicating a common medical problem and its severity, constituted approximately 90 percent of all FCCs assigned at recruitment centers between 2001 and 2006. Major contributors to medical profiling outcomes were underweight, asthma, chronic headache, mental illness, symptomatic scoliosis, hypnosis, chronic back pain, knee joint disorders, allergic rhinitis and sinusitis. Evaluating the computerized medical database revealed significant differences in: medical profile prevalence; recruitment center FCCs; different sub-districts in a given recruitment center; and profiling by medical committee chairmen.


CONCLUSIONS
Findings indicate disparities between recruitment centers and their chairmen in the medical profiling process owing to variations in recruitment center working methods and medical history taking, physical examinations, interpreting medical information and individual differences in the chairmen's decision-making process. Other reasons include technician and laboratory staff inaccuracies. These significant discrepancies highlighted the need for an intervention program. To minimize variations and create a uniform work platform, an orderly instruction system and training programs for the committee chairmen, technicians and laboratory staff were established. These actions resulted in improved performance in 2007 as confirmed by a decreased variability in the assignment of medical FCCs.


CONCLUSIONS
The paper highlights methods that can be used to assess disability screening, sports medicine committees and primary care setting procedures.
Chaiter
Yoram
Y
Israel Defense Forces, Medical Corps, Quality Control Committee, Haifa. chaiter@bezeqint.net
Machluf
Yossy
Y
Pirogovsky
Avinoam
A
Palma
Elio
E
Yona
Avi
A
Shohat
Tamar
T
Yitzak
Amir
A
Tal
Orna
O
Ash
Nachman
N
D003657:Decision Making; D019937:Diagnostic Techniques and Procedures; D004185:Disability Evaluation; D006801:Humans; D007557:Israel; D008889:Military Personnel; D010808:Physical Examination; D011785:Quality Assurance, Health Care / Q000458:organization & administration*; D011786:Quality Control