Using USPSTF Recommendations in VHA Clinical Practice

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Using USPSTF Recommendations in VHA Clinical
Practice

• Linda Kinsinger, MD, MPH
• Chief Consultant for Preventive Medicine
• Office of Patient Care Services

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Veterans Health Administration

• USs 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 lt26,000)
• Sicker (more physical and mental health
  diagnoses)
• Mostly men (5 women now but increasing)

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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

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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

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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

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Delivery of Clinical Preventive Services
Ross et al. Arch Intern Med. 2008168950-8
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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)

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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

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(No Transcript)
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Clinical Prevention Policy and PracticeUSPSTF
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

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Patient Brochures

• Picture of patient resources

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Patient Brochure for Screening for AAA
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Patient Brochure for Screening for AAA
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Provider Fact Sheets
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Provider Fact Sheet on Screening for AAA
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Provider Fact Sheet on Screening for AAA
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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

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Clinical Prevention Policy and PracticeUSPSTF
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

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Clinical Prevention Policy and PracticeComprehen
sive 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

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Clinical Prevention Policy and PracticeComprehen
sive Clinical Preventive Services Policy
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Clinical Prevention Policy and PracticeComprehen
sive Clinical Preventive Services Policy
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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).

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Conclusion

• VA endorses and supports USPSTF recommendations
  in many clinical areas.
• We look forward to on-going collaboration with
  AHRQ and the USPSTF.