HEMS 2013HEALTHCARE EFFECTIVENESS MANAGEMENT SET

PREVENTION AND SCREENING

CANCER SCREENING

Cervical Cancer Screening ACOG and USPSTF agree on interval and age

21-29: Cytology Q3 yrs.

30-65: Cytology Q3yrs OR Cytology +HPV contesting Q5yrs

HEMS 21-29: Cytology Q2yrs

30-64: Cytology Q3yrs if history of 3 consecutive negative paps

Breast Cancer Screening

Colon Cancer Screening

CERVICAL CANCER SCREENING GUIDELINES: AT A GLANCE

CANCER SCREENING

Cervical Cancer Screening

Breast Cancer Screening ACOG (B level recommendation)

Women >40 yo should be offered yearly mammography

USPSTF (B level recommendation) Biennial mammography screening for Women 50-74 yo

HEMS Yearly mammography ordered/completed in Women 40-74 yo

Colon Cancer Screening

NATIONAL GUIDELINE CLEARINGHOUSE

HTTP://WWW.GUIDELINE.GOV/SYNTHESES/SYNTHESIS.ASPX?ID=39251

NATIONAL GUIDELINE CLEARINGHOUSE

HTTP://WWW.GUIDELINE.GOV/SYNTHESES/SYNTHESIS.ASPX?ID=39251

CANCER SCREENING Cervical Cancer Screening

Breast Cancer Screening

Colon Cancer Screening ACG

Colonoscopy Q10yrs >50 yo preferred cancer prevention test

Acceptable alternatives: Flex sig Q5-10yrs, CT colonography Q5yrs, Fecal Immunochemical occult test annually

USPSTF Screen using fecal occult blood testing, sigmoidoscopy or colonoscopy in 50-75 yo

(Grade A)

Recommend against screening >85 yo (Grade D)

Jury still out on 75-84 yo (Grade C)

HEMS Fecal occult annually or flex sig Q5yrs or colonoscopy Q10yrs

ACG COLON CANCER SCREENING UPDATE 2009

The USPSTF recommends screening all adults for obesity. Clinicians should offer or refer patients with a body mass index (BMI) of 30 kg/m2 or higher to intensive, multicomponent behavioral interventions. Grade: B Recommendation.

June 2012

Document BMI in visit diagnosis and problem list when discussed and put in your A/P Weight management group classes

Refer/Appt to Health Education: indicate weight group class in drop down box

Nutritionist

Refer/Appt to Nutrition

NEW MEASURES: BMI

NEW MEASURES: SMOKING

Document Tobacco abuse and or Smoking cessation/counseling when discussed in visit diagnosis and problem list

Smoking cessation aids: Smoking cessation classes

Refer/Appt to Health Education: indicate smoking cessation in drop down box

Wellbutrin (Buproprion SR): 150mg QAM x 3 days then increase to 150mg BID

Chantix (Varenicline)

FCC restricted: failed Buproprion or nicotine replacement; referred to smoking cessation class; documented eval for mental health and SI; 30 days supply with 2 refills; limited to 24 weeks of tx

The USPSTF recommends that clinicians ask all adults about tobacco use and provide tobacco cessation interventions for those who use tobacco products.  Grade: A recommendation.

April 2009

CHRONIC CONDITION MANAGEMENT

Before we were just documenting whether tests were ordered now we are actually looking at interventions!

DIABETES COMPREHENSIVE MEASURES

DIABETES COMPREHENSIVE MEASURES

Things to remember:

Diabetic foot exam yearly Should include sensation, pulses, and appearance

Can use .nexfeet for easy negative foot exam or .pexfoot for positive foot exam documentation

Can refer to podiatry if needed

Retinal exam yearly Retinal exam can be done by retinal scan (camera) or dilated retinal eye exam by

optometry/ophthalmology

Refer retinal scan

Refer/Appt to CHP Optometry/Ophthalmology

PEDIATRIC MEASURES

OBESITY – PEDI/ADOLESCENT BMI

BMI should be documented in vitals and nursing note (READ NURSING NOTE)

During well checks document pediatric BMI in visit diagnosis and in problem list

Discuss issue with patient and family

Document counseling on diet and exercise and plan for follow up in A/P

Every child with BMI >= 85% with one fasting lipid before 10 yo

Same resources for nutrition exist for children

Refer weight management clinic at Pasadena PAHC for pediatric weight management specialty clinic

OBESITY/CHOLESTEROL SCREENING IN PEDI/ADOLESCENTS

The USPSTF recommends that clinicians screen children aged 6 years and older for obesity and offer them or refer them to comprehensive, intensive behavioral interventions to promote improvement in weight status. Grade: B recommendation.

Updated in January 2010

The USPSTF concludes that the evidence is insufficient to recommend for or against routine screening for lipid disorders in infants, children, adolescents, or young adults (up to age 20). Grade: I Statement.

July 2007

NIH/NHLBI: Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents Endorsed by AAP

Universal Screening lipid at age 9-11 yo and again at age 17-21 yo

November 2011

PEDIATRIC HYPERTENSION – PEDI/ADOLESCENT BP

Blood pressure should be documented in vitals and nursing notes on all pts >=3yo

If BP > 90%ile for age/height/sex then it should be repeated manually by nursing and documented in their note

READ NURSING NOTE

As the medical provider, you must address this issue in your note! At EVERY visit!

Yes we can/do treat pediatrics patients with essential and secondary hypertension If needed referrals to renal and cardiology are available

USPSTF: SCREENING HTN IN PEDI/ADOLESCENTS

USPSTF: Update in Progress (2013) Draft recommendation statement (Feb 2013)

Currently open for public comment

The U.S. Preventive Services Task Force (USPSTF) concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for hypertension in asymptomatic children and adolescents to prevent subsequent cardiovascular disease in childhood or adulthood. Grade I Statement

PEDIATRIC IMMUNIZATIONS

SUMMARY/QUESTIONS

Lots of differing opinions

Try to comply with system wide recommendations BUT primary goal is to prevent/detect disease, reduce morbidity and mortality for our patients all while maintaining or improving their quality of life

Quality measures will be apart of medical care in the 21st century (no matter what field you end up in!)

Questions ???