Prevention and screening Cancer screening Cervical Cancer Screening ACOG and USPSTF agree on interval and age 2129 Cytology Q3 yrs 3065 Cytology Q3yrs OR Cytology HPV contesting Q5yrs HEMS ID: 779315
Download The PPT/PDF document "HEMS 2013 Healthcare effectiveness manag..." is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
HEMS 2013
Healthcare effectiveness management set
Slide2Prevention and screening
Slide3Cancer 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
Slide4Cervical cancer screening guidelines: at a glance
Slide5Cancer 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
Slide6National guideline clearinghouse
http://www.guideline.gov/syntheses/synthesis.aspx?id=39251
Slide7National guideline clearinghouse
http://www.guideline.gov/syntheses/synthesis.aspx?id=39251
Slide8Cancer 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
Slide9ACG Colon cancer screening update 2009
Slide10The
USPSTF recommends screening all adults for obesity. Clinicians should offer or refer patients with a body mass index (BMI) of 30 kg/m
2
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
Slide11NEW 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
Slide12Chronic condition management
Before we were just documenting whether tests were ordered now we are actually looking at interventions!
Slide13Diabetes comprehensive measures
Slide14Diabetes 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
Slide15Pediatric measures
Slide16Obesity – 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
Slide17obesity/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
Slide18Pediatric 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
Slide19USPSTF: 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
Slide20Pediatric immunizations
Slide21Summary/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 21
st
century (no matter what field you end up in!)
Questions ???