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Suggested Citation:"Appendix M: Site Visit Questions." Institute of Medicine. 1998. Adequacy of the VA Persian Gulf Registry and Uniform Case Assessment Protocol. Washington, DC: The National Academies Press. doi: 10.17226/6084.
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Page 163
Suggested Citation:"Appendix M: Site Visit Questions." Institute of Medicine. 1998. Adequacy of the VA Persian Gulf Registry and Uniform Case Assessment Protocol. Washington, DC: The National Academies Press. doi: 10.17226/6084.
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Page 164
Suggested Citation:"Appendix M: Site Visit Questions." Institute of Medicine. 1998. Adequacy of the VA Persian Gulf Registry and Uniform Case Assessment Protocol. Washington, DC: The National Academies Press. doi: 10.17226/6084.
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Page 165
Suggested Citation:"Appendix M: Site Visit Questions." Institute of Medicine. 1998. Adequacy of the VA Persian Gulf Registry and Uniform Case Assessment Protocol. Washington, DC: The National Academies Press. doi: 10.17226/6084.
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Page 166

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Appendix M Site Visit Questions These questions should be asked of three groups of providers: primary care physicians (or nurse practitioner?) who are not designated Persian Gulf providers, Persian Gulf physicians/team, and specialists (need to determine if there are specialists assigned to Persian Gulf just as there are primary care physicians). Introductory statement should be made to the effect that this is not intended to be a comprehensive survey. Rather, we are looking for ideas from front-line providers about how they view the system, how well it seems to function vis a vis the guidelines, and what they think could be done to improve the program. Providers 1. How are patients triaged, from your point of view? 2. What type of orientation did you receive regarding this program? 3. What is your understanding of Phase I versus Phase II, that is, how do patients get referred to Phase II? 4. How do you address specific problems? · chronic fatigue · headache 163

164 ADEQUACY OF THE VA PERSL4N GULF REGISTRY AND UCAP · diarrhea (for specialists, ask their area) 5. How do you define an undiagnosed condition? Would any diagnosis eliminate that patient from the category undiagnosed condition? 6. Who actually sees the patient (conducts the exam)? 7. What kind of feedback do you give the patient? . . . · alagnosls ~ PG War related · additional options 8. How do you refer a patient to a specialist in Phase I (the PG Registry exam)? How long does it take? Are there any barriers to this? How do you refer a patient for a Phase II exam? How long does that take? Are there any barriers to such a referral? 9. Who manages the patient medically once diagnosis is made? 10. What kind of follow-up do you receive after referral? after diagnosis? That is, do you receive feedback on what happened to the patient? 11. If the illness is deemed non-service related, is Here any contact between yol1 and the community physician caring for the patient? 12. Are there any differences between men and women in the diagnostic or referral process? 13. What do you think of the program? 14. What would you do to improve the program? Outreach 1. Is there a designated staff member or program charged with outreach to Persian Gulf veterans regarding services available to them? Who? 2. What is the message of the outreach? (description of program, number to call, who should apply, etc.)

APPENDIX M 165 3. What is the facility doing with regard to community outreach for Persian Gulf veterans? . - specific activities · scope of activities · any evaluation of the effectiveness of outreach Intake Is there a centralized intake point andlor procedure? 2. How are Persian Gulf veterans identified? 3. Once identified, how are Persian Gulf veterans informed about the program? · Is there a designated person at the facility to do this? · What is the veteran told about the program? 4. How are non-medical personnel being informedltrained regarding the Registry (written materials, workshops, etc)? 5. Who is being trained? (i.e., how is "non-medical personnel" defined?) Access 1. How are appointments scheduled for Phase I? 2. Are there different procedures for those with and without symptoms? 3. What is the veteran told about the actual process of the exam, consultations, etc.?

Next: Appendix N: Summary of Responses to Requests for Information »
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As mandated in Public Law 103-446, the Department of Veterns Affairs (VA) asked the Institute of Medicine (IOM) to review its Uniform Case Assessment Protocol (UCAP) for Persian Gulf veterans. The purpose of the program is to provide a systematic, comprehensive medical protocol for the diagnosis of health problems of Persian Gulf veterans. This report is the third in a series of studies by IOM reviewing the protocols used by the VA and the Department of Defense to diagnose the health complaints of Gulf veterans. The committee reviews and makes recommendations concerning the adequacy of the medical protocol and its implementation by the VA, as well as the VA's outreach and education efforts aimed at informing Persian Gulf veterans and their care providers of the purpose and availability of this program. In addition, the report contains as appendixes the findings and recommendations of the previous reports, as well as those of two related IOM reports on Health Consequences of Service During the Persian Gulf War.

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