Full Clinical Guidelines - Community First Health Plans.

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TYPE OF APPOINTMENT Preventive Health Services for Children and Adolescents Preventive Health Services for Adults Physical Therapy Radiology Home Health/DME/Supplies (OT, PT, ST SNV, etc) Provider Office Waiting TIme Requests for Feedback from Pharmacy Related to Prescriptions APPOINTMENT AVAILABILITY Within 60 days of request in accordance with American Academy of Pediatrics periodicity schedule. Within 90 days of request in accordance with US Preventive Service Task Force recommendations. Within 24 hours (urgent) 3 days or less (routine) 14 days or less (follow-up) Within 24 hours (urgent) 7 days or less (MRI/CT Scan) 10 days or less (IVP/UGI) 21 days or less (Mammogram) Within 2 hours for IV therapy or oxygen therapy. Within 24 hours for standard nursing care and delivery of nonurgent equipment. Significant changes in health status of the patient are to be relayed to the attending physician within 4 hours of detection. Within 30 minutes of scheduled appointment time. Within 24 business hours. 10 H EALTH PLANS www.cfhp.com
Table 1. Adult Preventive Services That Providers and Care Systems Must Assess the Need for and Offer to Each Patient. These Have the Highest Priority Value (Level I) SERVICE 21 to 39 Years 40 to 64 Years 65 Years and Older Alcohol abuse; hazardous and harmful drinking screening and brief counseling Aspirin chemoprophylaxis counseling Breast cancer screening Cervical cancer screening No screening before age 21 regardless of age of onset of sexual activity. Screening every 2 years between ages 21-29 and every 3 years after age 30 after 3 consecutive normal Pap tests. Chlamydia screening Colorectal cancer screening Hypertension screening Influenza immunization Lipid screening Pneumococcal immunization Tobacco use screening and brief intervention Identify those with risky or hazardous drinking, as well as those who have carried that behavior to the point of meeting criteria for dependence, and then provide brief intervention. Encourage for men age 45-79 years when the potential benefit of a reduction in myocardial infarctions outweighs the potential harm of an increase in gastrointestinal hemorrhage. Encourage for women age 55-79 years when the potential benefit of a reduction in ischemic strokes outweighs the potential harm of an increase in gastrointestinal hemorrhage. Mammogram every 1 to 2 years for women age 50 to 75 years. (See Annotation #2 for evidence and recommendations for other ages.) Every 3 years after 3 consecutive normal Pap tests. Stop screening between ages 65-70 if no abnormal Pap tests in 10 years. All sexually active women aged 25 years and younger, and older women at increased risk for infection. Age 50 years and older or age 45 years and older for African Americans and American Indians at appropriate intervals as determined by whichever screening method is chosen. Blood pressure every 2 years if less than 120/80; every year if 120 to 139/80 to 89 mm Hg. Annually during entire flu season for individuals age 50 and older, those at high risk, and others. Fasting fractionated lipid screening for men over age 34 every 5 years. Immunize high-risk groups once. Re-immunize those at risk of losing immunity once after 5 years. Fasting fractionated lipid screening for men over age 34 and women over age 44 every five years. Immunize at age 65 if not done previously. Reimmunize once if first received more than 5 years ago and before age 65, or an immunocompromising condition is present. Establish tobacco use status for all patients and reassess at every opportunity. Provide brief intervention. 3.1 Preventive Services for Adults H EALTH PLANS www.cfhp.com 11
Page 1 and 2: Community First Health Plans Qualit
Page 3 and 4: 10.5 ATP III Classification of Chol
Page 5 and 6: Such information is released only t
Page 7 and 8: Non Voting • Martin Jimenez, Dire
Page 9: The purpose of these guidelines is
Page 13 and 14: Recommended Adult Immunization Sche
Page 15 and 16: Footnotes — Recommended Adult Imm
Page 17 and 18: CFHP has adopted the National Asthm
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Page 21 and 22: Managing Asthma Long Term 41 FIGURE
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Page 41 and 42: possible), a careful, complete, and
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Page 45 and 46: GLYCEMIC CONTROL BIBLIOGRAPHY • R
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Page 49 and 50: WORKSHEET Revised 10-20-05 Advancin
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WEIGHT LOSS ALGORITHM FOR OVERWEIGH
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Publication #45-11825 Screening 1 :
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Publication #45-12000 DIABETIC FOOT
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DIABETIC FOOT CARE/REFERRAL ALGORIT
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Publication # 45-12083 WEIGHT MANAG
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9 H EALTH PLANS www.cfhp.com 71
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Revised 10-25-07 IV INSULIN INFUSIO
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Revised 10-25-07 Publication #: 45-
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Revised 2-21-08 Publication #: E45-
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Abbreviations AGI Alpha-Glucosidase
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Orders for Adults with DKA and Hype
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D i a b e t e s t r e a t m e n t a
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CFHP has adopted the National Insti
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No CHD; 0 to 1, or 2+ Risk Factors
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NATIONAL CHOLESTEROL EDUCATION PROG
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NATIONAL CHOLESTEROL EDUCATION PROG
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Identification, Evaluation, and Tre
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11.3 Treatment of Hypertension H EA
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ALGORITHM FOR TREATMENT OF MAJOR DE
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CFHP has established guidelines for
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A. Documentation ______ B. Continui
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CFHP PCP MEDICAL RECORD REVIEW TOOL
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13.3 Specialist Medical Record Docu
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13.4 Specialist Medical Record Revi
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Risk Factors for Osteoporosis Fract
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It is well documented that obesity
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CLASSIFICATION OF OVERWEIGHT AND OB
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16.1.1 Preventive Pediatric Health
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TEXAS MEDICAID PROVIDER PROCEDURES
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CHILDREN’S SERVICES HANDBOOK P h
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CHILDREN’S SERVICES HANDBOOK P R
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FIGURE 2: Recommended immunization
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Comprehensive antepartum care is vi
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The following variables should be e
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CRITERIA 19. Unresolved Problems Fr
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CFHP OB/GYN SPECIALTY MEDICAL RECOR
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CFHP OB/GYN SPECIALTY MEDICAL RECOR
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According to the National Institute
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. aminotransferase (AST) and alanin
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PREVENTION RECOMMENDATIONS 1. The E
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2 to 20 years: Boys Body mass index
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AsthmaMatters is an initiative deve
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According to the Centers for Diseas
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