Screening Maneuvers

Improvement Facilitator Training Session 1 Day 1

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

We’ve come a long way, baby…

ASaP Maneuvers

“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.

Alberta‘s Expert Panel

Alberta

Dr. Brad BahlerDr. Shari FallisDr. Todd HamiltonDr. Laura McDougallDr. Patricia SmithDr. Marcello TonelliDr. Huiming Yang

The 12 ASaP Screening Maneuvers

Cardiovascular Risk Tobacco Use Status PAPBlood Pressure Height & Weight Mammography

Lipids Flu Vaccine ColorectalDiabetes Exercise

Alcohol

Clinical Importance

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ASaP Maneuvers A3

Turn page – Practice Points A3

Overview of clinical stuff…

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

Weight & Height

• What is it?Body measurementsUsed to calculate risk for various

conditions

• How is it measured?Scales & measuring stick/tape

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

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 dateCurrent cigarette/chew user: how

much/day since when

Alcohol Use Assessment

• What is it?A question regarding alcoholic beverage

consumption

• How is it measured?Number of alcoholic drinks per week

Influenza Vaccination/Screen

• What is it?A question regarding status of annual flu

vaccination

• How is it measured?Yes or no

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

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

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

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) ORHgb A1c (blood test at lab) ORDiabetes risk calculator (formula)

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) ORFlex sigmoidoscopy (minor surgical

procedure - at hospital with specialist) ORColonoscopy (minor surgical procedure - at

hospital with specialist)

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

The Screening “Bundle”

• Providers will select a bundle maneuvers for developing screening processes.

For example:

Cardiovascular Risk Tobacco Use Status PAP

Blood Pressure Height & Weight Mammography

Lipids Flu Vaccine Colorectal

Diabetes Exercise

Alcohol

Advise providers to start small…

…instead of fewer screening maneuvers!

…with # of patients offered screening, and build…

The Screening “Bundle”

• CV Risk is strongly recommended

Cardiovascular Risk Tobacco Use Status PAP

Blood Pressure Height & Weight Mammography

Lipids Flu Vaccine Colorectal

Diabetes Exercise

Alcohol

“Offers” of Screening

Offer Screening Uptake Results Care Planning

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