Institute of Medicine issues report card on DoD’s Comprehensive Clinical Evaluation Program


WASHINGTON, DC - May 8, 1997 (GulfLINK) - The Institute of Medicine (IOM) recently issued their report on the Department of Defense’s (DoD) Comprehensive Clinical Evaluation Program (CCEP) and its efforts to address the clinical needs of Gulf War veterans.

As part of an overall system of procedural monitoring, the DoD asked the Institute of Medicine in 1994 to evaluate the adequacy of this CCEP. This is the second time that the CCEP has been examined. The second examination resulted in this report of April 1997, which will be followed by a final report anticipated sometime in October 1997. After this study and monitoring results, the IOM’s report from its most recent examination concludes that the CCEP has resulted in a comprehensive effort to deal with the thousands of active duty Gulf War veterans and their clinical needs.

The IOM committee concluded, "The CCEP provides an appropriate screening approach to the diagnosis of a wide spectrum of neurological diseases and conditions." Further, the IOM committee said, "Given the possibility of low-level nerve agent exposure, that certain refinements in the CCEP will enhance its overall value." Although it said these refinements need not be applied retrospectively, the committee hopes implementation will be rapid so that as many new enrollees as possible will benefit from the improved system.

Some of the refinements recommended include improving documentation of the screening used during Phase I for post traumatic stress disorder-affected and depressed patients; improved documentation of neurological screen during both Phases I and II of the CCEP; and ensuring that Phase I primary physicians have easy access to referral neurologists and psychiatrists.

Further, the IOM recommended that more complete histories be taken, to include personal and family histories; that the CCEP should standardize its forms and its reporting procedures throughout its sites, in addition to standardizing a predeployment physical examination for all Services; that physicians should provide written evidence to each patient that all organ systems were evaluated; and finally that DoD should offer group education and counseling to soldiers and their families concerned about toxic agent exposure.

Additionally, the CCEP has been labeled by the IOM as a program whose results could and should be used to educate both Persian Gulf veterans and the physicians who care for them.

The IOM also cautioned that the CCEP cannot serve as a research tool or replace a proper program for investigating the long-term health effects of low-level exposure to nerve agents. Very little research has been done to date in this arena.

In a letter to Kenneth I. Shine, MD, president of the Institute of Medicine, Acting Assistant Secretary of Defense for Health Affairs Edward D. Martin, MD, praised the efforts of the IOM committee for its extensive review of the CCEP. Dr. Martin said this report was "especially important to our Gulf War veterans and should help to reassure those veterans who participated in the CCEP evaluation in the past."

Dr. Martin also praised the IOM report for its "thoughtful comments and constructive guidance," which "provided excellent ideas, which will greatly enhance our continuous refinement of military medical surveillance and assist us in further refining the CCEP and formulating appropriate research questions for serious consideration." As part of this response, Dr. Martin said he would incorporate all of the IOM’s recommendations into the CCEP.

The CCEP was developed in June 1994 to provide a systematic clinical evaluation program for the diagnosis and treatment of active duty military personnel. Since that time, the CCEP has examined over 24,400 veterans. There are also 4180 veterans are still involved in some phase of this process.

In 1970 the National Academy of Sciences chartered the Institute of Medicine to enlist distinguished members of appropriate professions in the examination of policy matters pertaining to the health of the public. As such, the IOM acts under its own initiative in identifying issues of medical care, research, and education, plus the Academy’s own 1863 congressional charter responsibility.

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