Exposure reporting disparity in Gulf War Registry-related clinical assessments

Objectives: The Gulf War Registry monitors related health conditions of veterans returning from the Persian Gulf Region. Enrollment consists of two phases: Phase I-veterans meet with their local VA Environmental Health Coordinator and complete the self-reported Gulf War Phase I Worksheet (VA Form 10-9009A). Phase II involves a physical exam, medical history review, and laboratory test analysis conducted by a licensed physician. The providers' documentations are frequently referred for exposure assessment and benefit claim. We conducted an initial comparison assessment to ascertain any potential disparity in exposure reporting between the applicants in Phase I and the providers in Phase II.

Methods: With institutional human subject committee approval, a list of veterans with a Gulf War Registry electronic medical note from the VA San Diego Healthcare System (2013-2015) was obtained. Comparing Phase I with Phase II reports allows three distinct reporting group combinations for each of the 21 exposure categories. Group I: both the patients and the healthcare personnel provided the same report for the respective exposure. Group II: healthcare personnel but not the patients reported the exposure. Group III: only the patients but not the healthcare personnel reported the exposure.

Results: A total of 178 (of 367) subjects had both the medical note from the healthcare provider and a physical copy of their Phase I Worksheet available, and therefore were eligible to be included in the overall one-way and subsequent pair-wise chi-square analyses. The results indicate that Group I reporting pattern had a significantly (p < 0.01) lower prevalence in nine exposure categories compared to Group III.

Conclusion: The findings suggest that the medical documentation from the healthcare providers does not consistently and accurately reflect the patients' report in near 50% (9/21) of assessed exposure categories. Potential remedies addressing this exposure reporting disparity, such as a standardized template or electronic upload, are further discussed.