ASaP Screening Methods

1. ASaP Screening Methods Improvement Facilitator Training Session 1 Day 2

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

3. ASaP Screening Methods Once the maneuver bundlehas been selected, providers may choose to do opportunisticor outreachoffers of screening, or both.

4. 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.

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

6. 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.

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

8. Sample Screening Process (Outreach) MOA Consults ‘Monthly Maneuver List’* Phones Patient • 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 Informs of all overdue screening maneuvers Selects appropriate maneuver for current month As appropriate, offers appointment or to fax req(s) to lab of choice. Using EMR, generates list of patients overdue for that maneuver 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 Opens each patient chart on the list and checks status of all 12 maneuvers Documents offer(s) of screening in patient chart

9. 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:

10. Methods Delivery Options

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

12. 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. Opportunistic Screening Method? Delivery Level? PCOrganization

13. 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. Outreach Screening Method? Delivery Level? Clinic

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

15. 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. Outreach Screening Method? Delivery Level? Provider

16. A8 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. Outreach Screening Method? Delivery Level? PC Organization

17. 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