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6 Conclusion Change is inevitable, and as such, it is important to plan for that change on the basis of new information and techniques that have emerged from past experiences and scientific investigation. The committee believes that the changes recommended in this report build on the strengths and lessons learned through research, the implementation of the Registry and the UCAP, and advances made in the field of clinical practice evaluation. It is with the intent to assist VA with better serving Persian Gulf veterans that these recommendations are offered. The committee believes that the recommendations to adopt the described diagnostic pathway, to eliminate the distinction between Phase I and Phase II, to add to the collection of exposure information, and to develop appropriate clinical practice guidelines and pathways with feedback mechanisms on their usefulness will facilitate better and more timely provision of diagnostic services to Persian Gulf veterans. The concomitant changes in data collection and reporting and the collection of information on patient satisfaction will elicit information that can be used to assist in focusing efforts aimed at continuously improving the system. It is important to note that the system remains a diagnostic program, not a research study, and it is therefore not reasonable to expect the Registry and UCAP to identify a new syndrome or syndromes. The current excellent approaches to outreach and provider education will be supplemented by the committees' recommendations for the exploration of additional avenues and the involvement of additional practitioners. Although it will take thoughtful effort and time to plan for and implement these recommendations, the committee urges VA to make the implementation of these recommendations a priority. 51

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