Prevention & Early Diagnosis | Disparities | PQRS | Using EHRs for Care Management
Improving Prevention and Early Diagnosis in Physician Offices
Medicare now pays for more preventive services than ever; however, few beneficiaries are taking full advantage of them. Statistics show that Medicare patients visit their doctor six or more times a year, but few are aware of health risks that could be detected by simple tests.
Qsource works to increase the number of Medicare beneficiaries who take advantage of these potentially life-saving preventive services.
Qsource will partner with physician practices to leverage the power of Electronic Health Record (EHR) systems to improve:
Flu immunizations of patients ages 50 and older during the flu season
Flu Immunizations
Approximately 90% of all flu deaths occur in adults over age 65. Even with increased attention given to the importance of timely immunizations, the number of Americans who receive influenza vaccinations is still well below the government’s target rate.
Qsource is working with physician practices to leverage the power of Electronic Health Record (EHR) systems to increase rates of flu immunizations.
Intervention Guide Immunizations
Click these links for more information
Pneumococcal Immunization of Patients Ages 65 and Older
Pheumonia Immunization
The majority of pneumonia deaths occur in adults over age 65. Even with increased attention given to the importance of timely immunizations, the number of Americans who receive pneumococcal vaccinations is still well below the government’s target rate.
Qsource is working with physician practices to leverage the power of Electronic Health Record (EHR) systems to increase rates of pneumococcal immunizations.
Intervention Guide Immunizations
For additional information:
Immunization Action Coalition Tools
U.S. Preventive Services Task Force Tools
This page is funded by our Medicare QIO Program Contract.
Colorectal Cancer Screening in Patients Ages 50-75
Colorectal Cancer Screening
The Centers for Disease Control and Prevention indicates a 90% survival rate for colorectal cancer if it is found early and treated. Screening rates are so low that less than 40% of colorectal cancer is found early.
Qsource is working with physician practices to leverage the power of Electronic Health Record (EHR) systems to increase rates of colorectal cancer screening.
Intervention Guide Breast and Colorectal Cancer
For more information, visit these additional resources:
Calendar of colorectal cancer events
National Colon Cancer Awareness Month – FamilyPLZ website
U.S. Preventive Services Task Force
Medicare Learning Network’s “Cancer Screening” brochure
Centers for Disease Control and Prevention’s “Colorectal Cancer Screening Saves Lives” brochure
Screen for Life Basic Facts on Screening fact sheet
Prevent Cancer Foundation’s Colorectal Cancer fact sheet
CDC’s Screen for Life Campaign poster
eCard
Centers for Disease Control and Prevention (CDC) colorectal cancer resources
National Cancer Institute colon and rectal cancer resources
Medicare colon cancer screening information and resources
Increasing Cancer Screening Through System Change – March 27, 2012 Webinar featuring Dr. Durado Brooks
Breast Cancer Screening in Women Ages 40-69
Breast Cancer Screening
The U.S. Preventive Services Task Force estimates that mammograms every one to two years may reduce the risk of dying from breast cancer by 30%. In fact, when cancer is detected and treated before it has spread outside of the breast, 98% of women survive for five years or more.
Qsource is working with physician practices to leverage the power of Electronic Health Record (EHR) systems to increase rates of breast cancer screening.
This page is funded by our Medicare QIO Program Contract.
Clinical Snapshot Breast Cancer
Intervention Guide Breast and Colorectal Cancer
For more information, visit the additional resources:
U.S. Preventive Services Task Force
Increasing Cancer Screening Through System Change – March 27, 2012 Webinar featuring Dr. Durado Brooks
Low-Dose Aspirin Therapy Use in Patients with Ischemic Vascular Disease
Low-dose Aspirin Therapy
Ischemic vascular disease entails a clogging of the arteries which can restrict blood flow and oxygen to a certain organ or part of the body. Aspirin slows the blood’s clotting action by reducing the clumping of platelets, cells that clump together and help to form blood clots.
There has been a long standing debate about the use of daily aspirin to fight cardiovascular disease. Because aspirin acts on the overall system that affects bleeding, it also increases the risk of gastrointestinal bleeding either from an ulcer or gastritis, and the risk of a rare but dangerous form of stroke caused not by a blood clot, but by bleeding in the brain.
The U.S. Preventive Service Task Force (USPSTF) recently revised guidelines for aspirin therapy tailored to age and gender. They found good evidence aspirin decreases the incidence of heart attack in men and ischemic strokes in women and recommend clinicians discuss aspirin use with high-risk adults and that these discussions also address both the potential benefits and potential harms of aspirin therapy.
The USPSTF recommendations published in March 2009 state:
- Men aged 45 to 79 with heart risk factors should take aspirin if the preventive benefits outweigh the risk of gastrointestinal (GI) bleeding.
- At-risk women aged 55-79 should take aspirin if the odds of reducing a first ischemic stroke outweigh the change of bleeding.
- Aspirin should not be used for stoke prevention in women under 55 and for myocardial infarction prevention in men under 45.
- At this time, current evidence is insufficient to determine whether patients aged 80 and older should take aspirin.
These recommendations apply only to people who have never had a heart attack or stroke.
Risk factors to be considered before deciding whether to use aspirin to prevent heart attacks or stroke include age, diabetes, total cholesterol levels, high-density lipoprotein cholesterol levels, blood pressure and smoking and the risk of gastrointestinal bleeding. The more risk factors people have, the more likely they are to benefit from aspirin.
A chart summarizing the recent USPSTF recommendations for appropriate dosage and risk assessment can be found here.
This page is funded by our Medicare QIO Program Contract.
Blood Pressure Control in Patients with Hypertension
Blood Pressure Control
“Blood pressure” is the force of blood pushing against the walls of the arteries as the heart pumps blood. If this pressure rises and stays high over time, it can damage the body in many ways. High blood pressure is a serious condition that can lead to coronary heart disease, heart failure, stroke, kidney failure, and other health problems.
Patients with coronary artery disease or peripheral vascular disease should set a goal for blood pressure <140/90 mm Hg. Patient should address behavioral and lifestyle risk factors which lead to high blood pressure such as unhealthful diet with too much salt and too little potassium, being overweight or obese and engaging in too little physical activity.
Qsource promotes physician treatment consistent with the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC) practice guidelines. We also collaborate with Community Health Workers to contribute to efforts to obtain higher medication adherence rates and work with the private sector to ensure medication costs are not a barrier to patient adherence.
Following, are links to helpful tools, resources and articles:
CDC Division for Heart Disease and Stroke Prevention (DHDSP)
“Your Guide to Lowering High Blood Pressure”
Million Hearts Blood Pressure Toolkit
Video of Ellsworth Medical Clinic’s success in reducing blood pressure rates among patients
http://www.youtube.com/watch?feature=player_embedded&v=gNS7NOgaSjY
Video of Kaiser Permanente Colorado’s success in reducing blood pressure rates among patients
http://www.youtube.com/watch?feature=player_embedded&v=ZHTugRKUrEQ
LDL-C Control Among Adults with Ischemic Vascular Disease
LDL-Control
LDL cholesterol is called “bad” cholesterol because elevated levels of LDL-c are associated with an increased risk of coronary heart disease. LDL lipoprotein deposits cholesterol on the artery walls, causing the formation of a hard, thick substance called cholesterol plaque. Over time, this plaque causes thickening of the artery walls and narrowing of the arteries.
The National Institute of Health, the American Heart Association and the American College of Cardiology publish the National Cholesterol Education Program (NCEP) guidelines for cholesterol treatment.
The guidelines describe the various levels of risk (very high risk, moderately high risk, moderate risk and low risk patients, based on a 10 year risk of a cardiac event), the desired cholesterol level for each risk category and what should be done at each level in terms of lifestyle changes and medication.
Lifestyle changes involve losing excess weight, exercising regularly, stopping smoking and following a diet low in saturated fat and cholesterol. Saturated fats are the main diet-linked cause of high cholesterol. Medications are prescribed when lifestyle changes cannot reduce the LDL cholesterol to desired levels. The most effective and widely used medications are statins. There are other medications such as a cholesterol absorption inhibitor for those who can’t take statins because of the side effects (muscle discomfort or weakness) and other medications that may be used either alone or in combination with statins.
For example, the NCEP guidelines in 2004 recommend that LDL cholesterol levels be brought below 100 mg/dL in high-risk and moderated risk patients. This is substantially lower than the target levels of 130 mg/dL or below in the past. For those at very high risk for heart disease or have a history of heart trouble, a reading of less than 70 is preferred. The physician should base recommendations on the patient’s risk level and tolerance for the different types of medication.
Useful Tools & Resources —
- Online Risk Calculator — Encourage your partners, providers, stakeholders and staff to have their blood cholesterol levels checked. Using these numbers, they can estimate their 10-year risk of developing cardiovascular disease. Find the calculator at The National Cholesterol Education Program.
- High Blood Cholesterol: What You Need to Know
- Do You Know Your Cholesterol Levels? (English/Spanish)
- Your Guide to Lowering Your Cholesterol with Therapeutic Lifestyle Changes
- Cholesterol Fact Sheet
- At-A-Glance: What You Need To Know About High Blood Cholesterol (poster)
- Know The Facts About High Cholesterol (poster)
- Cardiovascular Screenings that Check Cholesterol and Lipid Levels
- Cardiovascular Disease Behavior Therapy
Useful Websites —
CDC Division for Heart Disease and Stroke Prevention
This page is funded by our Medicare QIO Program Contract.
Tobacco Cessation Intervention Among Adult Patients Who Smoke
Tobacco Cessation
Tobacco use is the single most preventable cause of death and disease in the United States. In spite of all the media and community policies against smoking, an estimated 45 million American adults currently smoke cigarettes. Annually, cigarette smoking causes over 400,000 deaths. For every person who dies from tobacco use, another 20 suffer with at least one serious tobacco-related illness. In 2004, this cost the nation more than $95 billion per year in direct medical expenses as well as more than $97 billion annually in lost productivity. Also, the exposure to secondhand smoke can cause premature death and disease in nonsmokers.
There is much information about tobacco cessation and the various clinical trials and efforts aimed at different populations. Various meta-analysis of these studies indicated that self-help strategies alone generally are ineffective, but counseling and pharmacotherapy used either alone or in combination can improve cessation rates. Intensive interventions (individual, group, or telephone counseling) that provide social support and coaching on problem-solving skills are effective.
FDA-approved pharmacotherapy (e.g., nicotine patch, gum, nasal spray, inhaler, and lozenge as well as non-nicotine medications such as bupropion hydrochloride and varenicline) is also effective in helping people quit smoking. However, combining counseling and medication is most effective. Both physician advice and NRT have been established in controlled clinical trials to have a substantive effect on long-term smoking cessation.
Approximately 70 percent of smokers see a physician each year, creating the potential to reach large numbers of smokers with a cessation message. Thus, the healthcare system is recognized as a productive means of reaching smokers with a cessation message and promoting their successful quitting.
In fact, tobacco use treatment by clinicians can be considered a preventive service more cost-effective than other commonly provided clinical preventive services, including mammography, colon cancer screening, pap tests, treatment of mild to moderate hypertension and treatment of high cholesterol.
The Public Health Service’s evidence-based clinical practice guideline on tobacco cessation states advocates that brief advice by medical providers to quit smoking is an effective intervention. CDC has published the U.S. Public Health Service Clinical Practice Guideline, Treating Tobacco Use and Dependence: 2008 Update which can provide practitioners detailed information on performing tobacco use interventions. The guideline covers clinical interventions for tobacco users who are willing to make a quit attempt, users who are not willing to quit at this time, those who used once and have quit and those who never regularly used tobacco. The authors describe five evidence-based systems-level strategies that can increase the delivery of tobacco dependence treatments. Below is a brief outline of the “5A’s” model for a brief intervention that physicians can use in treating tobacco use and dependence.
- Ask about tobacco use (current, former, never)
- Advise quitting
- Assess the willingness to make a quit attempt (Are you willing to give quitting a try?)
- Assist in the quit attempt
- For those willing to quit
- Offer medication
- Provide or refer for counseling or additional treatment
- For those unwilling to quit
- Use a directive, patient-centered counseling intervention such as Motivational Interviewing (MI), detailed in the guidelines
- Provide interventions designed to increase future quit attempts
- For those willing to quit
- Arrange follow up contacts
All Medicare patients who use tobacco can receive tobacco cessation counseling from a qualified physician or other Medicare recognized practitioner. Previous Medicare policy covered tobacco counseling only for individuals diagnosed with a recognized tobacco-related disease. The physician can bill for counseling that is more than three minutes and this can include up to eight sessions per patient per year, depending on how the counseling is constructed.
A number of materials and resources are available to providers wanting to help smokers quit. One such resource is the National Network of Tobacco Cessation Quitlines which provide callers with easy access to their state’s quitline services through a toll-free number (1-800-QUIT-NOW). Also go to: http://smokefree.gov/
This page is funded by our Medicare QIO Program Contract.
Click below for additional resources and information:
Ending the Tobacco Epidemic: A Tobacco Control Strategic Action Plan
Identifying and Improving Disparities
Identifying and Improving Disparities
Qsource agrees with the Agency for Healthcare Research and Quality (AHRQ) that healthcare providers must “emphasize the need to accelerate progress” if Tennessee is to achieve higher quality and more equitable health care in the near future. Unfortunately, as a recent AHRQ report illustrates:
- Health care quality and access are suboptimal, especially for minority and low-income groups.
- Quality is improving; access and disparities are not improving.
- Urgent attention is warranted to ensure improvements in quality and progress on reducing disparities with respect to certain services, geographic areas, and populations, including:
- Cancer screening and management of diabetes.
- States in the central part of the country.
- Residents of inner-city and rural areas.
- Disparities in preventive services and access to care
We are committed to identifying and improving disparities within indentified communities within our state.
For example, we recently analyzed Medicare claims data for covered preventive services. Qsource found striking differences in rates by race: PPV Immunization: African-American 30.20% – Caucasian 49.73%; Flu Immunization: African-American 31.99% – Caucasian 58.94%; Mammography: African-American 42.91% – Caucasian 52.21%; CRC Screening: African-American 46.91 – Caucasian 52.99%. Because our analysis illustrated a clear need to create healthier urban communities in Memphis, we are seeking partners in a Learning and Action Network to help us reduce disparities and better serve elders and disabled individuals who live in downtown Memphis and the Whitehaven and south Memphis neighborhoods.
The 2011 National Healthcare Quality Report and National Healthcare Disparities Report are available online at: http://www.ahrq.gov/qual/qrdr11.htm
Additional Resources
Improving Health Overview - information on how QSource can help your practice
ICD-10 implementation resources from CMS
ACS Catalog - catalog of helpful resources from the American Cancer Society
Quality Solution Navigator – website with resources on diabetes, cardiovascular disease, asthma, medication adherence, medical home and immunizations
Million Hearts - a national initiative to prevent 1 million heart attacks and strokes over the next five years.
Million Hearts Toolkits for Partners, Grand Rounds, & Blood Pressure.
This page is funded by our Medicare QIO Program Contract.
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