Using USPSTF Recommendations in VHA Clinical Practice (Text Version)

Slide Presentation from the AHRQ 2008 Annual Conference

On September 9, 2008, Linda Kinsinger, made this presentation at the 2008 Annual Conference. Select to access the PowerPoint® presentation (2.4 MB).

Slide 1

Using U.S. Preventive Services Task Force (USPSTF) Recommendations
In Veterans Health Administration (VHA) Clinical Practice

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

Slide 2

Veterans Health Administration

• U.S.'s 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 <$26,000)
  • Sicker (more physical and mental health diagnoses)
  • Mostly men (5% women now but % increasing)

Slide 3

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

Slide 4

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

Slide 5

Prevention-Related Performance Measures

• Other prevention-related measures:
  • Cardiovascular:
    • Hypertension control, low-density lipoprotein (LDL) in ischemic heart disease
  • Diabetes:
    • Hypertension control
    • Foot sensory exam
    • HbA1c control
    • LDL control
    • Retinal exam
  • Infectious Diseases
    • Influenza immunization
    • Pneumococcal immunization

Slide 6

Delivery of Clinical Preventive Services

The table presents the results for "VA [Department of Veterans' Affairs] and Non-VA 2000;" and for "VA and Non-VA 2004" for various tests.

Ross et al. Arch Intern Med 2008;168:950-8

Slide 7

VA National Center for Health Promotion and Disease Prevention (NCP)

• 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)

Slide 8

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

Slide 9

The slide shows a screen shot of the home page from the VA National Center for Health Promotion and Disease Prevention's Web site.

Slide 10

Clinical Prevention Policy and Practice: USPSTF Cardiovascular Recommendations

• Inter-agency agreement with AHRQ to develop patient and provider resources on USPSTF cardiovascular preventive services recommendations:
  • General cardiovascular disease (CVD) Recommendations (hypertension [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

Slide 11

Patient Brochures

The slide shows a photograph of a set of patient brochures on USPSTF recommendations for cardiovascular disease.

Slide 12

Patient Brochure for Screening for Abdominal Aortic Aneurysm (AAA)

The slide shows a copy of the outside of the patient brochure for screening for abdominal aortic aneurysm.

Slide 13

Patient Brochure for Screening for AAA

The slide shows a copy of the inside of the patient brochure for screening for abdominal aortic aneurysm.

Slide 14

Provider Fact Sheets

The slide shows a photograph of Provider Fact Sheets, which complement the patient brochures on USPSTF cardiovascular disease screening recommendations.

Slide 15

Provider Fact Sheet on Screening for AAA

The slide shows the front page of a Provider Fact Sheet on screening for abdominal aortic aneurysm.

Slide 16

Provider Fact Sheet on Screening for AAA

The slide shows the back page of the Provider Fact Sheet on screening for abdominal aortic aneurysm.

Slide 17

VHA Adaption of UPSPTF Recommendation for Screening for AAA

• Adaptations for VHA implementation:
  • Ultrasound preferred but computed tomography (CT) or magnetic resonance imaging (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

Slide 18

Clinical Prevention Policy and Practice: USPSTF 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

Slide 19

Clinical Prevention Policy and Practice: Comprehensive Clinical Preventive Services Policy

• No one VHA policy or set of guidelines addressing all recommended clinical preventive services
• NCP developing a dynamic Web site with:
  • VHA recommendations (most based on USPSTF recommendations)
  • Information about implementation in VHA
  • Patient education materials
  • Provider information/resources

Slide 20

Clinical Prevention Policy and Practice: Comprehensive Clinical Preventive Services Policy

The slide shows a draft graphic of a Web site listing an "At-A-Glance Summary" of VHA Clinical Preventive Services Policy.

Slide 21

Clinical Prevention Policy and Practice: Comprehensive Clinical Preventive Services Policy

The slide shows a draft graphic of a Web site providing details about VHA Clinical Preventive Services Policy statements.

Slide 22

MOVE! Weight Management Program

• Comprehensive weight management program for veterans (http://www.move.va.gov)
• Available in every VA facility
• Based on National Institutes of Health (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).

Slide 23

Conclusion

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