Using USPSTF Recommendations in VHA Clinical Practice
description
Transcript of Using USPSTF Recommendations in VHA Clinical Practice
![Page 1: Using USPSTF Recommendations in VHA Clinical Practice](https://reader035.fdocuments.net/reader035/viewer/2022062322/56814eb4550346895dbc5b74/html5/thumbnails/1.jpg)
VA National Center for Health Promotion and Disease Prevention
Using USPSTF Recommendations
in VHA Clinical Practice
Linda Kinsinger, MD, MPHChief Consultant for Preventive Medicine
Office of Patient Care Services
![Page 2: Using USPSTF Recommendations in VHA Clinical Practice](https://reader035.fdocuments.net/reader035/viewer/2022062322/56814eb4550346895dbc5b74/html5/thumbnails/2.jpg)
Veterans Health Administration
• US’s largest integrated health care system– Facilities in all 50 states– 153 medical centers, 745 out-patient clinics
• 5.5 million active patients• Unique population
– Older (half over age 65)– Poorer (~70% with annual incomes <$26,000)– Sicker (more physical and mental health diagnoses)– Mostly men (5% women now but % increasing)
![Page 3: Using USPSTF Recommendations in VHA Clinical Practice](https://reader035.fdocuments.net/reader035/viewer/2022062322/56814eb4550346895dbc5b74/html5/thumbnails/3.jpg)
System Features that Support Delivery of Preventive Services
• Computerized patient record system
• Clinical practice guidelines– Cover ~ 20 clinical topics– Address both prevention and treatment
• Clinical reminders
• Performance measures
![Page 4: Using USPSTF Recommendations in VHA Clinical Practice](https://reader035.fdocuments.net/reader035/viewer/2022062322/56814eb4550346895dbc5b74/html5/thumbnails/4.jpg)
Performance Measures
• Process measures, based on evidence-based guidelines
• Prevention-related measures based on USPSTF recommendations:– Cancer screening
• Breast • Cervical • Colorectal
– Tobacco use screening and counseling
– Alcohol use screening and counseling
![Page 5: Using USPSTF Recommendations in VHA Clinical Practice](https://reader035.fdocuments.net/reader035/viewer/2022062322/56814eb4550346895dbc5b74/html5/thumbnails/5.jpg)
Prevention-Related Performance Measures
• Other prevention-related measures:– Cardiovascular
• Hypertension control, LDL in ischemic heart disease – Diabetes
• Hypertension control• Foot sensory exam• HbA1c control• LDL control• Retinal exam
– Infectious Diseases• Influenza immunization• Pneumococcal immunization
![Page 6: Using USPSTF Recommendations in VHA Clinical Practice](https://reader035.fdocuments.net/reader035/viewer/2022062322/56814eb4550346895dbc5b74/html5/thumbnails/6.jpg)
Delivery of Clinical Preventive Services
2000 2004
Test VA Non-VA VA Non-VA
CRC screening 65 51 79 57
Breast cancer screening 74 80 92 77
Cervical cancer screening
98 90 99 90
Cholesterol screening 95 83 96 87
Regular aspirin use 86 79 90 82
Smoking cessation coun. 78 46 75 55
Influenza vaccination 62 54 72 53
Pneumococcal vacc. 71 62 81 63
Ross et al. Arch Intern Med. 2008;168:950-8
![Page 7: Using USPSTF Recommendations in VHA Clinical Practice](https://reader035.fdocuments.net/reader035/viewer/2022062322/56814eb4550346895dbc5b74/html5/thumbnails/7.jpg)
VA National Center for Health Promotion and Disease Prevention
• Field-based program office of the Office of Patient Care Services, VHA
• Located in Durham, NC
• 20 staff (physicians, nurses, psychologists, health educators, dietitian, physical therapist, program analysts, administrative staff)
![Page 8: Using USPSTF Recommendations in VHA Clinical Practice](https://reader035.fdocuments.net/reader035/viewer/2022062322/56814eb4550346895dbc5b74/html5/thumbnails/8.jpg)
NCP Program Areas
• Clinical Prevention Policy and Practice
• MOVE! Weight Management Program
• HealthierUS Veterans Initiative
• Health Promotion/Employee Wellness
• Veterans Health Education and Information
• Evaluation and Research
![Page 9: Using USPSTF Recommendations in VHA Clinical Practice](https://reader035.fdocuments.net/reader035/viewer/2022062322/56814eb4550346895dbc5b74/html5/thumbnails/9.jpg)
![Page 10: Using USPSTF Recommendations in VHA Clinical Practice](https://reader035.fdocuments.net/reader035/viewer/2022062322/56814eb4550346895dbc5b74/html5/thumbnails/10.jpg)
Clinical Prevention Policy and Practice:USPSTF Cardiovascular Recommendations
• Inter-agency agreement with AHRQ to develop patient and provider resources on USPSTF cardiovascular preventive services recommendations:– General CVD Recommendations (HTN, Lipids)
(patient only)– Screening for Abdominal Aortic Aneurysm– Aspirin for Primary Prevention of CVD – Screening for Peripheral Arterial Disease and Carotid
Artery Stenosis– Screening for Coronary Heart Disease
![Page 11: Using USPSTF Recommendations in VHA Clinical Practice](https://reader035.fdocuments.net/reader035/viewer/2022062322/56814eb4550346895dbc5b74/html5/thumbnails/11.jpg)
Patient Brochures
• Picture of patient resources
![Page 12: Using USPSTF Recommendations in VHA Clinical Practice](https://reader035.fdocuments.net/reader035/viewer/2022062322/56814eb4550346895dbc5b74/html5/thumbnails/12.jpg)
Patient Brochure for Screening for AAA
![Page 13: Using USPSTF Recommendations in VHA Clinical Practice](https://reader035.fdocuments.net/reader035/viewer/2022062322/56814eb4550346895dbc5b74/html5/thumbnails/13.jpg)
Patient Brochure for Screening for AAA
![Page 14: Using USPSTF Recommendations in VHA Clinical Practice](https://reader035.fdocuments.net/reader035/viewer/2022062322/56814eb4550346895dbc5b74/html5/thumbnails/14.jpg)
Provider Fact Sheets
![Page 15: Using USPSTF Recommendations in VHA Clinical Practice](https://reader035.fdocuments.net/reader035/viewer/2022062322/56814eb4550346895dbc5b74/html5/thumbnails/15.jpg)
Provider Fact Sheet on Screening for AAA
![Page 16: Using USPSTF Recommendations in VHA Clinical Practice](https://reader035.fdocuments.net/reader035/viewer/2022062322/56814eb4550346895dbc5b74/html5/thumbnails/16.jpg)
Provider Fact Sheet on Screening for AAA
![Page 17: Using USPSTF Recommendations in VHA Clinical Practice](https://reader035.fdocuments.net/reader035/viewer/2022062322/56814eb4550346895dbc5b74/html5/thumbnails/17.jpg)
VHA Adaption of UPSPTF Recommendation for Screening for AAA
• Adaptations for VHA implementation:– Ultrasound preferred but CT or MRI acceptable– Guidelines on re-screening intervals– No screening needed if had negative study
between ages 60 and 65– Large number of patients in target population –
no deadline set for accomplishing screening of currently eligible patients
– Sample clinical reminder developed– Patient education brochure being developed
![Page 18: Using USPSTF Recommendations in VHA Clinical Practice](https://reader035.fdocuments.net/reader035/viewer/2022062322/56814eb4550346895dbc5b74/html5/thumbnails/18.jpg)
Clinical Prevention Policy and Practice:USPSTF Cardiovascular Recommendations
• Evaluation plans– Pilot-testing of resources with small group of
patient health educators and providers– Outside facilitator to gather feedback– Final edits, then production of materials and
wide dissemination to VHA staff– Survey of providers about 6 months after
dissemination
• Dissemination by AHRQ for broad use
![Page 19: Using USPSTF Recommendations in VHA Clinical Practice](https://reader035.fdocuments.net/reader035/viewer/2022062322/56814eb4550346895dbc5b74/html5/thumbnails/19.jpg)
Clinical Prevention Policy and Practice:Comprehensive Clinical Preventive Services Policy
• No one VHA policy or set of guidelines addressing all recommended clinical preventive services
• NCP developing a dynamic website with: – VHA recommendations (most based on
USPSTF recommendations)– Information about implementation in VHA– Patient education materials– Provider information/resources
![Page 20: Using USPSTF Recommendations in VHA Clinical Practice](https://reader035.fdocuments.net/reader035/viewer/2022062322/56814eb4550346895dbc5b74/html5/thumbnails/20.jpg)
Clinical Prevention Policy and Practice:Comprehensive Clinical Preventive Services Policy
![Page 21: Using USPSTF Recommendations in VHA Clinical Practice](https://reader035.fdocuments.net/reader035/viewer/2022062322/56814eb4550346895dbc5b74/html5/thumbnails/21.jpg)
Clinical Prevention Policy and Practice:Comprehensive Clinical Preventive Services Policy
![Page 22: Using USPSTF Recommendations in VHA Clinical Practice](https://reader035.fdocuments.net/reader035/viewer/2022062322/56814eb4550346895dbc5b74/html5/thumbnails/22.jpg)
MOVE! Weight Management Program
• Comprehensive weight management program for veterans (www.move.va.gov)
• Available in every VA facility• Based on NIH and USPSTF guidelines for
screening and treatment of obesity– USPSTF recommends that clinicians screen
all adult patients for obesity and offer intensive counseling and behavioral interventions to promote sustained weight loss for obese adults (B rating).
![Page 23: Using USPSTF Recommendations in VHA Clinical Practice](https://reader035.fdocuments.net/reader035/viewer/2022062322/56814eb4550346895dbc5b74/html5/thumbnails/23.jpg)
Conclusion
• VA endorses and supports USPSTF recommendations in many clinical areas.
• We look forward to on-going collaboration with AHRQ and the USPSTF.