Adequacy of the VA Persian Gulf Registry and Uniform Case Assessment Protocol (1998) / Chapter Skim
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Appendix C: Evaluation of the U.S. Department of Defense Persian Gulf Comprehensive Clinical Evaluation Program: Overall Assessment and Recommendations
Appendix C: Evaluation of the U.S. Department of Defense Persian Gulf Comprehensive Clinical Evaluation Program: Overall Assessment and Recommendations
Pages 79-96
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From page 79... ...
Department of Defense Persian Gulf Comprehensive Clinical Evaluation, Washington, D C.: National Academy Press, 1996.
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From page 80... ...
It would require regional medical center physicians to provide adequate quality assurance of MTF work-ups and timely feedback to MTF . prove Hers.
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From page 81... ...
The decision to refer to Phase II should be leased on the clinical ~ud~nent of Me primary Are physics=, which, in tum, would be dependent on the Claris of the patient's diagnoses and the feasibility of the proposed treatment program at the MTF level. The DoD should continue its goal of enhanced accessibility of RMC physicians to allow regular consultations with MTF primary care physicians on patients with more complex diagnoses.
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From page 82... ...
The committee concludes that this is a more likely interpretation than the interpretation that a high proportion of the CCEP patients are suffering from a unique, previously unknown "mystery disease." 3.1.1.3.) Provide more detailed information on specific diagnoses in future reports: By providing more detailed information on specific diagnoses in its future reports, the DoD might help correct the impressions among the general public that exist about the high degree of prevalence of a "mystery disease" or a new, unique "Persian Gulf Syndrome." 3.1.1.4.)
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From page 83... ...
There is a lack of clinical evidence of a unique Persian Gulf Syndrome: The committee agrees with DoD that there is currently no clinical evidence in the (:CEP of a previously unknown, serious illness among Persian Gulf veterans. If there were a new or unique illness or syndrome among Persian Gulf veterans that could cause serious impairment in a high proportion of veterans at risk, it would probably be detectable ~ the population of 10,Q20 CCEP patients.
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From page 84... ...
The CCEP findings could be used to generate epidemiological questions on other types of diseases that are much more Sequent in the CCEP population, such as musculoskeletal diseases.
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From page 85... ...
Psychiatric Conditions: 85 3.2.1.1.) Make patients aware of psychiatric conditions and their prevalence and morbidity: Patients need to understand Cat psychiatric conditions and disorders are real diseases that cause real symptoms and that diagnoses are made with objective criteria and are not merely "labels" applied because physical abno~malit~s were not Fields The CCEP patients, as well as their primal care physicians, also need to understand the prevalence of and the concomitant morbidity that result Dom psychiatric disorders in We general population (major depression, for example)
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From page 86... ...
3.2.1.9.) Add explicit written instruction on medical recordkeeping and coding: More explicit written instructions could be added to Me CCEP guidelines to help prevent the most frequent problems found in Me medical record-keeping and coding.
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From page 87... ...
Provide more details of diagnostic categorization of musculoskeletal conditions: The draft and final DoD reports on 10,020 CCEP patients do not provide adequate details for the IOM committee to make a thorough evaluation of the diagnostic categorization of musculoskeletal conditions. More explanation about Me diagnostic aspects of these musculoskeletal conditions would be useful, for example, information on singlejoint involvement versus multijoint conditions or articular versus non-articular conditions.
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From page 88... ...
Estimating prevalence of chronic fatigue syndrome, fibromyalgia, and multiple chemical sensitivity is difficult: The IOM committee's review of the CCEP protocol suggests that data on chronic fatigue syndrome (CFS) , fibromyalgia (FM)
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From page 89... ...
This would provide feedback on their diagnostic decision-making. Information on the frequencies of particular symptoms and their specific diagnoses made in the CCEP population could be useful, for instance, in developing a differential diagnosis for individual patients.
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From page 90... ...
Use CCEP examination results to improve standardization practices: The DoD now has results on the examinations of more than 10,000 CCEP patients, which could be used to improve the standardized questionnaires, lab tests, and specialty consultations.
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From page 91... ...
In addition, the final disposition of these cases could be evaluated, including the potential relationship between particular diseases and Persian Gulf service. The DoD could use the results of these disability determinations to predict which diseases are likely to be associated with the most impairment among CCEP patients in Me future.
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From page 92... ...
Medical staff at the SCC will need to lmow whether a particular therapeutic plan is feasible at the patient's nearest MTF and whether long-term follow-up care can be performed. The primary care physician at the MTF needs to encourage continuous patient compliance with the carefully designed, individualized therapeutic regimens.
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From page 93... ...
Several issues will need to be evaluated in light of the successes arid barriers that the program has experienced, including ~gib~ty criteria for patienm-, roles of the SCC in a diagnostic reevaluation of patients; successful continuity of care of patients, with shared responsibility by the SCC and MTFs; and the unique need for the SCC, beyond the usual standard of a tertiary care medical center.
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From page 94... ...
The types of symptoms and diseases in CCEP participants in these special groups and UICs could be analyzed and contrasted win the symptoms and diagnoses of CCEP participants in over units. COMMIII~E ON ,1~ DOD PERSIAN GULF SYNDROME COMPREHENSIVE CLINICAL EVALUATION PROGRAM Gerard Burrow, Chair, Dean, Yale University School of Medicine, New Haven, Connecticut Dan Blazer, Dean of Medical Education and Professor of Psychiatry, Duke University Medical Center, Durham, North Carolina Target Bleecker, Director, Center for Occupational and Environmental Neurology, Baltimore, Maryland Member, Institute of Medicine.
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From page 95... ...
Brix, Study Director Deborah Katz, Research Assistant Amy Noel O'Hara, Project Assistant Donna D Thompson, Division Assistant Mona Brinegar, Financial Associate
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