Abstract
In October 1988, the Department of Veterans Affairs (VA) established an occurrence screening program in its large, heterogeneous health care system. The program--comprising four stages: initial screening and clinical, peer, and service chief reviews--was designed to be sufficiently uniform for the collection of comparable data throughout the VA system, yet allow for local autonomy at 172 different facilities. Highly objective screening criteria were chosen so that identification of cases for review could be performed by automated procedures.
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