2.) GENERAL RECOMMENDATIONS FOR THE IMPLEMENTATION OF THE CCEP:

2.1.) Referrals of Patients from Phase I to Phase II of the CCEP:

2.1.1.) Structure and revise the CCEP protocol and logistics to allow the majority of patients to receive a final diagnosis by Phase I:

Currently, the majority of patients do not receive a final diagnosis until Phase II, yet some of these patients have straightforward medical problems. The Committee recommends that final diagnoses could be reached in Phase I if more diagnostic resources are made available. This major change would require the availability of substantial numbers of internists or family practitioners at MTFs to perform comprehensive evaluations. It would also require better, more consistent explanations to MTF physicians about the purposes and procedures of the CCEP. It would require regional medical center physicians to provide adequate quality assurance of MTF work-ups and timely feedback to MTF providers.

On January 17, 1995, the DoD adopted these suggestions by setting goals that about 80% of patients would receive a definitive diagnosis at an MTF level. For some patients, this change has required specialty consultations at the MTF, as well as advice from an RMC physician. These changes necessitated an enhanced quality control role by the RMC physician and prompt, appropriate feedback to the MTF physician.

2.1.2.) Curtail diagnostic work-ups in patients not seriously disabled with minor complaints:

Initially, patients who do not accept their initial diagnosis could request a continued evaluation all the way through Phase II. The Committee recommends that diagnostic work-ups in patients not seriously disabled but with minor complaints should be curtailed. Alternatively, if a physician has made a definitive diagnosis and appropriate treatment has been given, the evaluation would be concluded.

On January 17, 1995, the DoD implemented the suggestions that referral to Phase II be made on the basis of the clinical judgment of the primary care physician, and patients were no longer permitted to self refer to an RMC.



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