Friday, October 27, 11:00
a.m.-12:30 p.m.
Moderator
Helen Burstin, M.D.
Director, Center for Primary Care, Prevention, and Clinical Partnerships
Presentations
NEW "NEWS" FROM THE U.S. PREVENTIVE TASK FORCE
Therese Miller, Dr.P.H.; Claire Kendrick, M.S.Ed.;
Iris Mabry, M.D., M.P.H.; Janice Genevro, Ph.D.
Agency for Healthcare Research and Quality, Rockville, MD
The U.S. Preventive Services Task Force (USPSTF) provides key information to primary care
practitioners on preventive services including screening tests, preventive medications, and
counseling for healthy behaviors. The advice of a trusted clinician is very often the gateway
to healthier practice and, in particular, obtaining preventive screenings. For more than 20
years, the USPSTF has provided authoritative recommendations based on impartial review of
available evidence for preventive services. In 2006, the USPSTF will announce several
developments that reflect research performed to determine how primary care clinicians
prefer to access these recommendations. The goal of the research was to determine how
the recommendations could be most informative and most easily used.
This session will describe the new format of the USPSTF recommendation statement and
a new one-page clinical summary especially targeted at busy clinicians. The new format
of the recommendation statement aims to make more transparent the way in which the
USPSTF assesses the evidence and provides a succinct summary of this evidence. The
one-page summary highlights, in a tabular format, the key elements of the recommendation
statement. These elements are what the recommendation is, to whom it pertains, and how
it should be implemented. The design of the publication makes the information available
at a glance, making it easier for a busy clinician to use the recommendation. The one-page
summary will appear as a companion to the longer, more comprehensive version of the
recommendation statement.
With these developments, the USPSTF and Agency for Healthcare Research and Quality are
putting valuable information into the hands of clinicians to optimize the use of preventive
services by the American public.
USING INFORMATION TECHNOLOGY TO IMPROVE PROVISION AND DOCUMENTATION OF
PREVENTIVE SCREENING
Christopher Lamer, Pharm.D.1; Theresa Cullen, M.D.2; David Taylor, M.H.S.,
R.Ph., R.N.1; Colleen Hayes, M.H.S., R.N.1
1Indian Health Service, Cherokee, NC;
2Indian Health Service, Tucson, AZ
The Indian Health Service (IHS) computer database, developed in the 1970s, is called the
Resource Patient Management System (RPMS). It has been collecting patient data since the mid-1980s.
Implementation of the RPMS Electronic Health Record (EHR) began in 2004, and currently more than 48
IHS sites are documenting patient encounters through this system. Providers are encouraged to
provide and document preventive screening such as vital signs, intimate partner (domestic) violence,
tobacco use, alcohol use, patient education, and other information when using the information
technology services of either the RPMS or RPMS-EHR.
Providing standardized methods of documentation, health maintenance reminders, and evaluation of
the services provided encourages these processes. The RPMS-EHR has increased a wide gamut of
preventive screening provision and documentation within IHS as reflected by data provided by the
Cherokee Indian Hospital, a 29-bed hospital and outpatient clinic located in western North Carolina.
Documentation of information in the RPMS database is highly standardized. Providers using a
paper-based system or the RPMS-EHR document the use of screening tools in a local RPMS database,
which after verification, is passed to a national database called the Data Warehouse. These data
are evaluated at both local and national levels utilizing RPMS applications, such as the Clinical
Reporting System (CRS), which mine the RPMS database. The evaluation looks at the number of
documented screenings provided before and after implementation of the EHR at the Cherokee Indian Hospital.
Documentation of screening interventions increased after implementing the RPMS-EHR. Specific numbers
for the following are pending: weight, body mass index calculations, renal function, intimate partner
(domestic) violence, tobacco exposure, alcohol use, and patient education. Results demonstrate that
use of health information technology drastically increases the provision and documentation of preventive
screening.
COLORECTAL CANCER SCREENING PILOT PROGRAM—A COLLABORATION BETWEEN THE ROCKLAND COUNTY
DEPARTMENT OF HEALTH, GOOD SAMARITAN HOSPITAL, AND ROCKLAND COUNTY GASTROENTEROLOGISTS
Ronda Rosman, M.S., R.N.
Rockland County Department of Health, Pomona, NY
The Rockland County Cancer Institute (RCCI) of the Rockland County Department of Health (RCDOH)
is an outreach, education, screening, and referral program. One of its major successes is the innovative,
free Colorectal Cancer Screening Pilot Program, which provides screening, diagnosis, and treatment of
colorectal cancer. This pilot program, which is funded by RCDOH (1/1/05–6/30/06), is a collaboration
with Good Samaritan Hospital and local gastroenterologists to provide 100 free colonoscopies to
uninsured and underinsured county residents. Eligibility screening is done by RCCI staff, and
patients are scheduled for office consultations with a rotating roster of county gastroenterologists.
After consultation, eligible individuals are scheduled for colonoscopy at Good Samaritan Hospital
on an outpatient basis. RCCI staff (including bilingual outreach workers) promote the program,
schedule appointments, provide reminders, assist with translation and transportation, and act
as a liaison for program participants.
Due to the efforts of program staff, clients kept their colonoscopy appointments 97 percent of
the time. RCCI also provides in-kind translation of preparatory and post-colonoscopy instructions,
assists with health insurance enrollment, and purchases preparatory materials. The gastroenterologists
provide consultation visits in-kind and accept greatly reduced rates for performing colonoscopies.
Also, hospital facility, anesthesiology, pathology, and surgical and oncology consultation fees are
greatly reduced. Patients receive all services free. Providers submit vouchers to Good Samaritan
Hospital for services rendered, and then the hospital submits vouchers to RCDOH for reimbursement.
Funds for treatment are provided for patients diagnosed with colorectal cancer.
To date, 93 colonoscopies have been completed. Adenomatous polyps, which have the potential to become
cancerous according to the American Cancer Society, were found in 16 patients, and hyperplastic and
other types of polyps were found in 11 patients. One patient had a precancerous polyp with high-grade
dysplasia. This successful pilot can be used as a model for screening programs targeting uninsured
and underinsured populations in need.
STEP UP FOR WELLNESS
Katherine Brieger, M.A., R.D., C.D.E.
Hudson River HealthCare, Inc., Peekskill, NY
Hudson River HealthCare, Inc.'s (HRHCare) Step Up for Wellness program, now in its third year, has changed the lives of hundreds of staff members at the Health Center. Making small steps toward big health outcomes has been the goal of this program. HRHCare is a federally qualified health center employing more than 400 racially and ethnically diverse staff to meet the healthcare needs of 42,000 patients annually in medically underserved areas throughout southeastern New York State.
There is a symbiotic relationship between what staff members have experienced from Step Up for Wellness and what they are able to give to patients. Improving their own self-management skills has allowed staff to gain an understanding of the challenges involved for patients taking a similar journey.
The Step Up for Wellness program objective is to improve employee health outcomes by increasing participants' basic health knowledge and encouraging them to improve their lifestyle choices and health behaviors.
Components of Step Up for Wellness include (1) a process component—accumulating activity points (incentives-based), and (2) an outcome component—achieving healthy results.
Data from the first complete program year revealed the following staff outcomes:
- 29 percent of staff met their health goals for the year.
- 26 percent of the smokers quit smoking.
- 13 percent lowered their total cholesterol.
- 22 percent lost weight (a total of 651 pounds).
- 6,320 activity points were earned.
- There was marked improvement in staff satisfaction (annual survey).
Staff benefits are clear: Step Up for Wellness is having a profound and positive impact on participants.
For questions or more information, please contact
summit@hhs.gov.
