1. Preventive Screening Update Joel Buchanan, MD Juanita Halls, MD Mark Linzer, MD Tosha Wetterneck, MD Primary Care Conference June 30, 2004

2. Outline  Learner Self-Assessment (ML)  Screening Tests: Evidence (JH)  Screening Tests: Costs (JB)  Screening Tests: Availability (JB)  Distribute Section Statistics (ML and JH)  Discussion of Proposed Protocol (JB, SM)  Preventive Screening Needs Procedure (JB)  Distribute Preventive Screening Needs spreadsheets (ML,JH,TN)

3. Learner Self-Assessment  Please fill in your answers by 8: 10 AM

4. Learning Goals  Clinician will know the USPSTF “strength of evidence” definitions  Clinician will know the strength of evidence grades for Pap smear, mammography, and cholesterol screening in the general population  Clinician will know the benchmark compliance rates for the above tests  Clinician will be familiar with methods to improve compliance rates as recorded in WISCR

5. The Four Disclaimers (courtesy of Whad'Ya Know?)  Mark has no financial ties to the preventive screening industry  Juanita has no financial ties to the preventive screening industry  Joel has no financial ties to the preventive screening industry  Tosha has no financial ties to the preventive screening industry

6. CURRENT NATIONAL PREVENTIVE HEALTH CARE GUIDELINES Juanita Halls, M.D.

7. Charges, Preventive Screening Tests June, 2004 (some will in change July, 2004) TestUWHC FeeMD ChargeTotal Mammogram$175$64$239 Pap Smear, Regular Pap Smear, Thin Prep $31 $44 $98 $129 $142 Cholesterol, Total Cholesterol, Total & HDL Lipid Panel $15.90 $15.90 + $41 = $56.90 $95 000000 $15.90 $56.90 $95 FOBT, 3 cards$22.200 Colonoscopy$1190 1 $1538$2728 Virtual Colonoscopy$1250 2 $366.50$1616.50 1 Confirmed by the UWHC Price Line Service 2 Not yet confirmed by UWHC Price Line Service

8. Test Availability Test NameWait Time Colonoscopy1 year Virtual Colonoscopy2-3 weeks

9. Section Statistics You are receiving a bar graph. This is based on data extracted in May, 2004

10. Section Statistics One might ask: How can I raise the compliance rate of my patients (as derived from WISCR data)?

11. How can I raise the compliance rate of my patients? These are suggestions only. See what may fit into your practice style: 1.Think prevention at every visit (High performers think screening tests at every visit) 2.Look at the Preventive Screening WISCR Screen with the patient

13. How can I raise the compliance rate of my patients? 3.Look at the Visit Data Form (That piece of paper ain’t just for the vital signs and meds) 4.Write on WISCR Visit Data Form (VDF) (Your MA updates your patient’s medications and preventive screening information after the visit. When a patient tells you about a test done outside UW Health, write that on the VDF. It does you more good here than in your dictation!!!) 5.Prune your panel (Keep your denominator as low as possible by reviewing your panel every February or anytime else you want. Call Teena Nelson anytime for a copy of your panel. Teena is at 2-5278. We will be developing a protocol for auto-pruning.) 6.Help implement the PSOP (Preventive Screening Order Protocol) 1.Think prevention at every visit (high performers think screening tests at every visit) 2.Look at the Preventive Screening WISCR Screen with the patient

14. PSOP: Preventive Screening Order Protocol (Proposed) Goal = Ease burden of the physician. Have a longer lunch! Go home earlier at the end of the day! No longer require the doctor to order the test. Have the system order the test.  Medical Assistants will look at Preventive Screening Data while rooming the patient  If patient is in need of the screening test, then MA will fill out: –Mammogram: Order sheet –Cholesterol: Order sheet –Pap Smear: Return Visit Schedule request  The test will be done unless the physician “cancels” the order  Pilot later this summer or fall

15. Preventive Screening Needs Spreadsheets: Pass out lists New Features for 2004  UWMF Clinic Data (“Park Street” Data) is included  Hysterectomies for ~last 5 years has been analyzed. If appropriate, we changed Pap to “Never Indicated Again”  NP’s get their own list. This displays the patients for whom the NP is “Primary Care Provider” and “Provider Routinely Seen”  Colon cancer screening will not be mentioned in the 2004 letters. Watch for the return of colon cancer screening in 2005!

16. What do I do with this thing?  We suggest that you scan the list for: –Patients with terminal or complex illnesses which preclude the usual screening tests  The “Send Letter” column is provided for your convenience only  After you mark you list, your MA must make the updates in WISCR and return the PSN by August 16(If this is a problem, please contact your clinic manager or Susan Marks)  It is perfectly fine to not review your list.

17. References 1. U.S. Preventive Services Task Force (USPSTF) Web Site http ://www.ahrq.gov/clinic/uspstfix.htm 2. Computerized Reminders for Five Preventive Screening Tests: Generation of Patient-Specific Letters Incorporating Physician Preferences; Proceedings of the 2000 AMIA Annual Symposium: 600-604, 2000.

18. Preventive Screening Update Joel Buchanan, MD Juanita Halls, MD Mark Linzer, MD Tosha Wetterneck, MD Primary Care Conference June 30, 2004

20. Factors which may affect data  A surprising number of patients have not had the “required” screening tests, even by “minimally invasive” criteria  Patients are in physician panel who have moved or died (“Denominator is too big”)  Test performed outside of UW Health are not included (“Numerator is too small”)  Compliance is defined by completion of the test.  Just requesting the test does not give “credit”  Variation in panel makeup –Socioeconomic factors, etc.