The objective of this research is to review the degree of United States Army compliance in the implementation of evidence-based design practices within the Military Health System construction cycle. This research looks at the impact of the 2007 Assistant Secretary of Defense for Health Affairs memorandum directing the use of evidence-based design within the Military Healthcare System construction process. The memorandum impacted the military medical construction process that includes over 6.2 billion dollars in government programmed military medical construction covering 9.2 million beneficiaries. An analysis of federal construction documents, interviews, and an online survey was conducted with 85 government and civilian healthcare facility planners to measure general evidence-based design knowledge, direct knowledge of medical construction policy requirements, and the level to which the Military Health System Evidence-based Design Principles matrix has been implemented within four selected military medical construction projects. Results of the review of construction publications show minimal evidence of evidence-based design incorporation with key federal regulatory documents. The results of an online survey conducted during the research had a 65.8% response rate (39 government personnel, 17 civilian personnel). The survey showed that basic knowledge of evidence-based design was present, but revealed severe deficiencies in specific knowledge and application of construction policies. Review of selected medical facilities demonstrated non-standardized incorporation of evidence-based design features. This research concludes that evidence-based design has achieved minimal integration into the Military Health System general knowledge base and project execution. Achieving compliance with the 2007 directive memorandum requires that significant efforts be made in personnel training and reconciliation with federal military medical construction documents.

Operation Enduring Freedom (OEF) (Afghanistan) and Operation Iraqi Freedom (OIF) represent one of the longest wartime deployments in the history of the American military. To date, 1.6 million American military members have deployed. Of these, an estimated 300,000 have returned with a mental health condition, such as depression or PTSD. The Department of Defense has established a robust screening program to identify and track deployment-related physical and psychiatric illnesses. The Post-Deployment Health Reassessment (PDHRA) is a primary tool to identify physical and psychiatric risk following a deployment. The PDHRA is a web-based survey, which is administered between 90-180 days after a deployment. This study seeks to evaluate the psychometric properties and clinical utility of the Post-Deployment Health Reassessment (PDHRA) for accurately identifying truama and depression among Airmen following a deployment. Descriptive statistics, confirmatory factor analysis and structural equation modeling were used to address separate research aims. Study aims assessed the impact of deployment on military members and the clinical utility and psychometric properties of the Post-Deployment Health Reassessment. Findings suggest that the Post-Deployment Health Reassessment is a useful triage tool to identify trauma and depression among Airmen following deployment. The study makes recommendations for improving the clinical utility and psychometric properties of the Post-Deployment Health Reassessment (PDHRA). / text