Health care systems are complex, high-risk environments. Medical knowledge is expanding significantly and producing data about health care delivery. Health systems research enhances our understanding of system-level improvements and seeks to identify factors influencing care delivery. 

R&E Military Health System Research supports the Military Health System, one of America's largest and most complex health care systems, which serves approximately 9.5 million beneficiaries. MHSR uses data to tease out patient-, system-, regional- and facility-level variables that can influence the delivery of care, beneficiary health, and readiness of the Force. These efforts lead to military health care that is safe, effective, accessible and patient-centered.

MHSR is key to ensuring the evolution of the Military Health System into a high-reliability organization that acquires and uses new knowledge and insights to modify behaviors. As a strategic project in the DHA FY22-26 Campaign Plan, MHSR is a vital tool for generating actionable insights about health delivery in terms of economics/costs, quality, variation, outcomes, health system reform, and the impact to health readiness.

Annual MHSR Grant Program

The MHSR program supports research projects to innovate and improve military health care through annual grant awards. Funding for MHSR grants is made available through the Defense Health Program. For each funding round, MHSR publishes a Notice of Funding Opportunity on grants.gov seeking rigorous intramural and extramural health systems research based on MHSR and clinical research priorities. The process for soliciting and reviewing proposals and awarding grants is updated each year.

The MHSRP Notice of Funding Opportunity is released in Quarter 2 (January to March). Researchers interested in applying can find eligibility criteria and submission requirements by visiting grants.gov and searching by Opportunity Number.

MHSR Grant Process

*LOI: Letter of Intent

MHSR Priority Topic Areas and Clinical Priority Areas

Proposed research must address at least one MHSR priority topic area and one MHSR clinical priority area. Letters of Intent applicants that do not meet this requirement will not be asked to submit a full proposal.

MHSR Priority Topic Areas:

Economics and Cost – Research on the factors that shape the MHS cost, drive demand and utilization, and influence cost in either TRICARE direct or Click to closePurchased CareThe TRICARE Health Program is often referred to as purchased care. It is the services we “purchase” through the managed care support contracts.purchased care systems; issues related to efficiency, effectiveness, value and behavior in the production, and utilization health care in terms of costs, charges, and expenditures; the impact of technologies on care delivery and cost; and the impact of workforce, recruitment, and retention of medical personnel. Research that delineates value-based care within the MHS in both purchased and Click to closeDirect CareDirect care refers to military hospitals and clinics, also known as “military treatment facilities” and “MTFs.”direct care; pre- and post- studies to evaluate the impact of the structure of the TRICARE contract on patient care.

Quality – Research which examines the degree to which health services for individuals and populations are safe, effective, patient-centered, timely, efficient, and equitable with the outcome of increasing the likelihood of improved health. Research should measure the impact of standardizing clinical practice through clinical practice guidelines, evidence-based practices, and process interventions on the health of the population/sub-population.

Outcomes – Health outcome research identifies and measures the factors which impact a population of patients and examines the system level factors which influence achievement of the Quadruple Aim “better health.” Comparison to private sector efforts or between direct and purchased care should be considered. Health outcomes research incorporates more than clinical outcomes, it must include consideration of the financial impact, health, quality of life, and measurement of indicators that predict factors important to patients and patient experience at the enterprise, geographic market level, or sub-population levels.

Variation – Studies that examine the factors that influence unwarranted variation or differences in quality, utilization, cost, or outcomes within the MHS and the implications to the enterprise as a system of system of care.

Health Readiness – Burden of disease and associated health and risk factors within the MHS populations that affect active-duty service members’ ability to deploy. Implications of disease burden as an indicator of medical readiness, potential impact to staffing, network utilization, and cost for direct care and/or private care.

Health System – Research related to the impact of the significant changes in policy, structure, or funding of healthcare system; impact of policy and system change to healthcare cost, quality, utilization, health outcomes, manpower/staffing, or health care readiness; comparisons between direct and private care, or care within the private sector should be considered; measurement of the impact of policy changes to the TRICARE benefit structure on utilization and cost to the system.

FY2025 MHSR Clinical Priority Areas (new areas are determined each grant cycle):

• Cardiovascular Health
• Women Health
• Primary Care
• Specialty Care
• Surgical Services
• Telehealth
• Sensory Health
• Nutritional Care
• Dental Care

All research should consider including in their analysis an examination the system variables listed below: 

• Disparities in care in terms of age, race, gender, rank, service 
• Manpower and staffing models should include physicians, nurses, allied health professionals and administrative support 
• Impact of major transformational change resulting from Genesis 
• Difference between care delivered in the direct versus private care system 

MHSR Published Research: Health Care Utilization and Variation in the MHS

Regional Variation in Low Back Pain Treatments within the Military Health System

Lurie JD, Leggett CG, Skinner J, Carragee E, Austin AM, Luan WP. A Regional Analysis of Low Back Pain Treatments in the Military Health System. Spine (Phila Pa 1976). 2024;49(4):278-284. doi:10.1097/BRS.0000000000004639

The study analyzes how different regions within the MHS manage and treat low back pain, highlighting the variations in care practices and treatment approaches. The findings aim to identify inconsistencies in treatment to inform policy and improve the standardization of care across the military health care network.

Comparative Analysis of Public vs. Private Care in the Military Health System for Low Back Pain Patients

Leggett CG, Schmidt RO, Skinner J, Lurie JD, Luan WP. Public versus Private Care in the Military Health System: Evidence from Low Back Pain Patients. 2024. Military Medicine.

The study compares outcomes and treatment approaches for low back pain patients in public and private care settings within the MHS. The research aims to assess differences in the quality of care, cost, and patient outcomes to inform decision-making and policy improvements in military health care delivery.

Regional Perinatal Risk Factors and NICU Capacity for MHS-Insured Newborns

Goodman DC, Romano CJ, Hall C, et al. The association of regional perinatal risk factors and neonatal intensive care capacity for Military Health System-insured newborns. J Perinatol. 2023;43(6):787-795. doi:10.1038/s41372-023-01633-4.

The study examines the relationship between perinatal risk factors in different regions and the availability of neonatal intensive care units (NICUs) within the MHS. The research aims to understand how regional variation in risk factors influence NICU capacity and inform strategies for improving neonatal care for military families.

Fiscal Year 2024 MHSR Research Awardees

Fiscal Year 2023 MHSR Research Awardees

Fiscal Year 2022 MHSR Research Awardees

Helpful Resources

For Health Services Research Funding and Resources

• Agency for Healthcare Research and Quality Data
• National Institutes of Health Funding
• National Institutes of Health Data
• National Health and Nutrition Examination Survey Data
• Military Health System Data

For the Military Health System

• MHS website
• TRICARE Eligibility
• Annual Evaluation of the TRICARE Program

For Researchers Concerning Data and Data Sharing

• Submission of a Data Sharing Agreement
• DHA Privacy and Civil Liberties Office
• DHA Office of Research Protections