ASaP Screening Methods Improvement Facilitator Training Session 1 Day 2

Objectives To discuss the concepts of opportunistic and outreach screening methods To consider different delivery options within clinics and organizations

Once the maneuver bundle has been selected, providers may choose to do opportunistic or outreach offers of screening, or both. ASaP Screening Methods

Opportunistic A process designed to identify patients who are due for a maneuver when they come in for any appointment, and offer them screening.

Physician Completes encounter Sample Screening Process (Opportunistic) Escorts Patient to Exam Area Mammogram Due? prints req for pt Mammogram Due? prints req for pt PAP Due? offers today, or advises to book PAP Due? offers today, or advises to book MOA Checks Reminders in Patient Chart Colorectal Due? leaves FOBT kit out for physician Colorectal Due? leaves FOBT kit out for physician Greets patient Validates in EMR: Address/phone Primary provider Status (active) Validates in EMR: Address/phone Primary provider Status (active) Reception Patient >18? Checks Height & Weight Rooms Patient opens EMR chart enters Ht & Wt Rooms Patient opens EMR chart enters Ht & Wt BP Due? check BP enter in EMR BP Due? check BP enter in EMR Exercise Due? # minutes/week update in EMR Exercise Due? # minutes/week update in EMR Tobacco Use Due? check status update in EMR Tobacco Use Due? check status update in EMR Alcohol Use Due? drinks/week update in EMR Alcohol Use Due? drinks/week update in EMR Patient >40? DM & Plasma Lipid Profile Due provide lab req and instructions DM & Plasma Lipid Profile Due provide lab req and instructions Patient >50? MOA exits Physician enters Addresses primary reason for visit Scans MOA’s Chart Entries, and as needed: counsels patient makes colonoscopy referral, if needed completes PAP, if requested Scans MOA’s Chart Entries, and as needed: counsels patient makes colonoscopy referral, if needed completes PAP, if requested CV Risk Due? enters values into Framingham Risk Calculator CV Risk Due? enters values into Framingham Risk Calculator Retrieves printed reqs; places by EMR for physician

Screening Methods Outreach A process designed to “comb” the panel for those who are due or overdue for screening, then use that list to contact patients to offer screening.

Outreach Screening - Recommendations 1.Telephone call Direct contact on behalf of provider Scripted calls and voic messages* 2.Written reminder* Letter, Confidentiality Specifies maneuver(s) due *Not an “offer” until the patient contacts office

Process performed once/month for each physician's panel Each MOA responsible for 2 physicians’ panels Over a 1 year period, each maneuver provides the basis for the search once A patient chart may come up during consecutive months, serving as a further reminder to complete screening For patients who decline particular maneuvers, exemptions can be made in the EMR Process performed once/month for each physician's panel Each MOA responsible for 2 physicians’ panels Over a 1 year period, each maneuver provides the basis for the search once A patient chart may come up during consecutive months, serving as a further reminder to complete screening For patients who decline particular maneuvers, exemptions can be made in the EMR Sample Screening Process (Outreach) Consults ‘Monthly Maneuver List’* MOA Opens each patient chart on the list and checks status of all 12 maneuvers Selects appropriate maneuver for current month Using EMR, generates list of patients overdue for that maneuver Phones Patient Informs of all overdue screening maneuvers As appropriate, offers appointment or to fax req(s) to lab of choice. Documents offer(s) of screening in patient chart Monthly Maneuver List* January - BP February – Height/Weight March - Exercise Assessment April – Pap test May – Tobacco Use Assessment June –Alcohol Use Assessment July – Plasma Lipid Profile August – Diabetes Screen September – Colorectal Screen October - Mammography November – CV Risk Calculator December – Influenza Vaccine

The Screening “Bundle” with Method For each maneuver in the bundle, the provider will decide HOW they will screen – opportunistically or through outreach or both For example: Cardiovascular Risk - bothTobacco Use Status - OPPAP - both Blood Pressure - bothHeight & Weight - OPMammography - both Lipids - bothFlu Vaccine - ORColorectal - both Diabetes - bothExercise - OP Alcohol - OP

ProviderClinicOrganization Opportunistic Outreach Methods Delivery Options

Dr. Jones is a provider at a paper chart clinic who uses the Health Screen in Action checklist at any appointment (not just PHEs). Screening Method? Delivery Level? Opportunistic Provider

The Springfield PCN has staff who work within the clinics. They use the EMRs to set up “screening reminders” that providers can check when a patient is in for any appointment. Screening Method? Delivery Level? Opportunistic PC Organization

Linda is the clinic POET (proactive office encounter technician). She runs regular searches for patients due for screening. She sends patients a letter of invitation for screening, and when possible, includes requisitions. Screening Method? Delivery Level? Outreach Clinic

Susan (MOA) runs a search of patients coming in today who need screening, and reviews it with providers during the morning ‘huddle’. Screening Method? Delivery Level? Opportunistic Clinic

Jennifer is a Nurse Practitioner who has shown her receptionist, Wendy, how to use the EMR to generate lists of her patients who are due for PAPs. Once the list is generated, Wendy phones the patients and invites them to make an appointment. Screening Method? Delivery Level? Outreach Provider

The Edmonton Oliver PCN has “Screeners” (MOAs) who review charts in the Allin Clinic (and others) to identify and phone patients who are due for screening. Screening Method? Delivery Level? Outreach PC Organization A8

Summary Opportunistic screening focuses on adding offers of screening during appointments for other reasons Outreach screening involves tracking patients who are due and inviting them to make a screening appointment These methods can involve the provider, the clinic team and/or the primary care organization Providers and clinics are encouraged to use both screening methods