1. Screening Maneuvers Improvement Facilitator Training Session 1 Day 1

2. Objectives To introduce the 12 maneuvers, and review why they were selected for ASaP To briefly review the clinical aspects of the maneuvers To introduce the concept of the ASaP screening bundle

3. We’ve come a long way, baby… ASaP Maneuvers

4. “Evidence-based” Practice : Wikipedia The conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients to estimate the risk of benefit and harm. It is derived from high-quality research on population samples, to inform clinical decision- making.

5. Alberta‘s Expert Panel Dr. Brad Bahler Dr. Shari Fallis Dr. Todd Hamilton Dr. Laura McDougall Dr. Patricia Smith Dr. Marcello Tonelli Dr. Huiming Yang

6. The 12 ASaP Screening Maneuvers Cardiovascular RiskTobacco Use StatusPAP Blood PressureHeight & WeightMammography LipidsFlu VaccineColorectal DiabetesExercise Alcohol

7. Clinical Importance 31 30 9 5 ------ 75%

8. ASaP Maneuvers A3

9. Turn page – Practice Points A3

10. Overview of clinical stuff…

11. Blood Pressure (BP) What is it? The pressure exerted by the blood against the walls of blood vessels How is it measured? Blood pressure cuff (sphygmomanometer) Recorded: e.g. 120/80

12. Weight & Height What is it? Body measurements Used to calculate risk for various conditions How is it measured? Scales & measuring stick/tape

13. Exercise Assessment What is it? A question: How do you exercise and how often? How is it measured? Typically, # of minutes/week and type(s) of exercise

14. Tobacco Use Assessment What is it? A question regarding use of tobacco products How is it measured? Former cigarette/chew user for how long; quit date Current cigarette/chew user: how much/day since when

15. Alcohol Use Assessment What is it? A question regarding alcoholic beverage consumption How is it measured? Number of alcoholic drinks per week

16. Influenza Vaccination/Screen What is it? A question regarding status of annual flu vaccination How is it measured? Yes or no

17. Pap Test What is it? Procedure to collect a sample of cells from the cervix to detect pre-cancerous changes or cancer How is it measured? In clinic exam room; cervical “smear” sent to lab

18. Plasma Lipid Profile - Fasting What is it? A lipid profile is a group of blood tests that measures the quantity of different lipids or fats in the bloodstream. How is it measured? Blood test at a lab

19. CV Risk Calculation What is it? Tool for estimating future risk of cardiovascular disease/events How is it measured? Various factors plugged into formula = risk percentile for heart attack in next 10 years

20. Diabetes Screen What is it? Test for assessing risk of/presence of diabetes (disease: excess sugar in blood) How is it measured? Fasting glucose (blood test at lab) OR Hgb A1c (blood test at lab) OR Diabetes risk calculator (formula)

21. Colorectal Cancer Screen What is it? Tests for indicators of cancer (i.e. blood in stool), or cancerous lesions How is it measured? FOBT/FIT (fecal sample taken to lab) OR Flex sigmoidoscopy (minor surgical procedure - at hospital with specialist) OR Colonoscopy (minor surgical procedure - at hospital with specialist)

22. Mammography What is it? X-ray study of breast tissue to detect possible cancer lesions How is it measured? By a technician at a diagnostic imaging lab

23. The Screening “Bundle” Providers will select a bundle maneuvers for developing screening processes. For example: Cardiovascular RiskTobacco Use StatusPAP Blood PressureHeight & WeightMammography LipidsFlu VaccineColorectal DiabetesExercise Alcohol

24. Advise providers to start small… …instead of fewer screening maneuvers! …with # of patients offered screening, and build…

25. The Screening “Bundle” CV Risk is strongly recommended Cardiovascular RiskTobacco Use StatusPAP Blood PressureHeight & WeightMammography LipidsFlu VaccineColorectal DiabetesExercise Alcohol

26. “Offers” of Screening Offer Screening Uptake Results Care Planning

27. Summary The 12 maneuvers selected for ASaP were selected based on supporting evidence and strong clinical importance Providers and clinics are encouraged to select all 12 maneuvers, if possible CV Risk is especially encouraged due to high clinical value and a current “gap” in care