Full Clinical Guidelines - Community First Health Plans.

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CRITERIA REQUIREMENTS 10. HIV Screening HIV Status should be determined on first prenatal visit for high risk patients. FOLLOW-UP VISITS 11. Vital Signs and Weight Vial signs, including blood pressure and weight, to be obtained at each visit. 12. Urine Checks for Protein and Glucose Testing for urinary protein, glucose, and ketones should be done at each prenatal visit. 13. Fundal Height Fundal height should be measured and recorded at each visit. 14. Edema Check The patient should be checked for edema of the hands, face and lower extremities at each visit. 15. Signs & symptoms of preterm labor; or other risk factors Signs and symptoms of preterm labor or other risk factors are assessed and/or counseled with the patient. 16. Fetal Heart Tones FHTs can usually be heard by 10-12 postmenstrual weeks using a hand-held Doppler device and should be documented at each visit. 17. Fetal Movement The first fetal movement is usually appreciated at 17 weeks in the average multipara and at 18 weeks in the average primipara. Documentation of fetal activity should be documented at each visit. FOLLOW-UP LABS 18. Triple Screen Maternal serum alpha-fetoprotein (AFP) should be obtained between 8-20 weeks gestation. 19. Glucose Challenge /H&H/ AbScreen Routine screening consists of determining blood sugar 1 hour after a 50gram oral glucose load. If the plasma blood sugar level is over 135-140mg/dL, a 3 hour glucose tolerance titer should be performed. This screening should occur at 24-28 weeks gestation. 20. GroupB Strep/H&H/VDRL Cultures of the lower vaginal tract for group B streptococcus should be obtained between 35-37 weeks gestation. POST PARTUM CARE 21. Interim History & Physical Exam The first post partum visit should include a nutritional assessment and history of activities post delivery. Physical examination should include a breast examination and a complete rectovaginal evaluation. 22. Evaluation of weight The patient’s weight should be recorded. 23. Vital Signs The patient’s vital signs including blood pressure should be recorded. 24. Cervical Cytology (as needed) 25. Family Planning / Contraceptive Practices The cervix should be inspected and a Papanicolaou (Pap) smear obtained during the post partum visit. (as needed) Contraceptive and family planning methods should be discussed and the patient advised of the relative risks of conception. 26. STD Prevention STD prevention should be discussed in patient physician interview as indicated. 27. Postpartum Depression Assessment for postpartum depression should be recorded. GYN PREVENTIVE CARE 28. Pelvic & Pap Smear A pelvic examination and pap smear should be performed every 2 years between ages 21-29 and every 3 years between ages 30-64 after 3 conscective normal pap tests. Stop screening between ages 65-70, if no abnormal pap tests in 10 years. 29. Mammogram A mammogram should be obtained every 1-2yrs for women 50 & older 30. Rubella Antibody Titer A rubella antibody titer should be performed for women lacking evidence of immunity (proof of vaccination after the first birthday or laboratory evidence of immunity). 31. Family Planning / Contraceptive Practices Contraceptive and family planning methods should be discussed and patient advised of the relative risks of conception. 32. STD Prevention STD prevention should be discussed in patient/physician interview as indicated. 148 H EALTH PLANS www.cfhp.com
CFHP OB/GYN SPECIALTY MEDICAL RECORD AUDIT TOOL Physician: Nurse Reviewer: Date of Review: Provider Number: Provider Type: A. Documentation ______ B. Continuity of Care ______ C. Preventive <strong>Health</strong> ______ _________________________________________ Plan -- Age-- A. DOCUMENTATION 1. Patient identification on each page 2. Personal/Biographical information 3. Allergies prominently noted 4. Problem List (pts w/3 or more visits) 5. Medication List (pts w/3 or more visits) 6. Entries legible 7. All entries contain author identification 8. All entries are dated 9. Advance Directives (Medicaid 18 & older – OB/PCPs) B. Continuity of Care 10. Past medical history (pts w/3 or more visits) 11. Tobacco, alcohol, & other substances use assessed (12 & older) 12. Chief complaint noted 13. History & exam pertinent to complaint 14. Working diagnosis consistent with findings 15. Basic teaching provided 16. Appropriate plan of treatment 17. Appropriate use of consults 18. Appropriate studies ordered 19. Unresolved problems addressed 20. Physician review on studies 21. Results of consultations are reviewed & filed 22. Date of next visit/instructions for follow-up 23. ER and Hospital reports/records 24. Patient is not placed at inappropriate risk 25. Evaluation of Abuse/neglect or other socio environmental factors (Medicaid) VALIDATIONS - √ for compliance (not scored) 26. Diagnosis Validation 27. Claims Validation 1 2 3 4 5 6 7 8 9 10 Y N Y + N S C O R E Y Y+Nx100= % compliance 17.4 OB/GYN Medical Record Review Tool P: Quality Management\Medical Record Review\SFY2012\Audit Tools Revised 12/04, 7/07, 1/10, 8/11 H EALTH PLANS www.cfhp.com 149
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Community First Health Plans Qualit
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10.5 ATP III Classification of Chol
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Such information is released only t
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Non Voting • Martin Jimenez, Dire
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The purpose of these guidelines is
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Table 1. Adult Preventive Services
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Recommended Adult Immunization Sche
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Footnotes — Recommended Adult Imm
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CFHP has adopted the National Asthm
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Patient Name ______________________
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Managing Asthma Long Term 41 FIGURE
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FIGURE 14. CLASSIFYING ASTHMA SEVER
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FIGURE 16. STEPWISE APPROACH FOR MA
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FIGURE 20. CLASSIFYING SEVERITY OF
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II. Some hyperactive-impulsive or i
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COMMUNITY FIRST HEALTH PLANS BEHAVI
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Criteria Requirements 33. Release o
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The evaluation of breast disease is
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Prevent Child Texas, a non-profit o
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AMERICAN ACADEMY OF PEDIATRICS: Fai
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possible), a careful, complete, and
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Examination/Test Oral / Dental Insp
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GLYCEMIC CONTROL BIBLIOGRAPHY • R
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Publication # 45-11647 Targets* A1
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WORKSHEET Revised 10-20-05 Advancin
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D. Optimizing analog insulin use Re
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Publication # 45-11266 Age 126 mg/d
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Hypertension Algorithm for Diabetes
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Lipid Algorithm For Type 1 and Type
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References: Revised 1-24-08 • Col
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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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