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19.3 Weight Management Algorithm for Oveweight Children & Adolescents D i a b e t e s t r e a t m e n t a l g o r i t h m s Weight Management Algorithm for publication # 45-12083 obtain Accurate Height (Ht) & Weight (Wt) 2 Calculate Body Mass Index (BMI-see page 3 of 4) th (refer to gender-specific bMi chart on page 4 of 4) BMI = Wt in kg 2 reinforce Healthy lifestyle, diet, and exercise; 2 2 2 2 >95th%ile bMi for Age & Gender 3 sleep Apnea; pseudotumor cerebri; dyslipidemia (elevated ldl-c and/or tG; low Hdl-c); Htn; nAFld; Gerd; Wt-bearing Joint pain; pcos /Hyperandrogenism; An; psychological Adjustment disorders; t2dM (FpG≥126 mg/dl; post challenge pG ≥200 mg/dl) Assess for Risk Factors and/or Contributing Factors 4 birth Wt; post Malignancy pt/Family not Motivated 5 Offer Medically Supervised Wt educate patient and Family; Manage Management Intervention comorbidities and risk Factors; u reassess readiness periodically u Pubertal: = 10% body Wt loss pt/Family Motivated pt/Family Motivated 85th%ile bMi with comorbidities Pre-pubertal: ≥age 7 = 1–2 lbs per Month Wt loss Education; Lifestyle Changes 2 ; Nutrition; Overweight 2 treatment (Ht in m) 2 pt/Family Motivated degree of Wt loss will depend on the severity of the comorbidity Increased Physical Activity; Behavior Modification; Nutrition/Family Counseling. Approved 04/28/05 = Wt in lb x 703 (Ht in inches) 2 pt/Family not Motivated ≥6 months Consider Obesity Pharmacologic Monotherapy as Adjunct to lifestyle changes if bMi ≥27 with comorbidities or if bMi ≥30 Maintain Healthy lifestyle, diet and exercise; reinforce education; Monitor Wt Weekly for life with periodic Follow-up by Hcp Consider Bariatric Surgery 8 for adolescents who meet criteria. (See page 2) Wt Loss Maintenance targets Maintained Targets Met Motivated & targets not Met ≥6 months Appetite Suppressant Sibutramine 6 contraindicated in: uncontrolled Htn; Glaucoma (narrow-angle); Arrhythmia; cvA; cvd; cHF; concurrent ssri; MAoi therapy; pregnancy; bulimia/Anorexia nervosa Hx Lipase Inhibitor Orlistat 7 contraindicated in: chronic Malabsorption; cholestasis; orlistat Hypersensitivity; concurrent cyclosporin therapy; pregnancy 1 of 4 – Weight Management Algorithm for overweight children and Adolescents – Approved 04/28/05 See disclaimer at www.tdctoolkit.org/algorithms_and_guidelines.asp 158 H EALTH PLANS www.cfhp.com
2 to 20 years: Boys Body mass index-for-age percentiles Date Age Weight Stature BMI* Comments NAME RECORD # BMI 27 26 25 24 23 22 21 20 19 18 17 16 15 14 13 12 kg/m 2 AGE (YEARS) 28 27 26 25 24 23 22 21 20 19 18 17 16 15 14 13 12 kg/m 2 90 85 75 50 25 10 5 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 95 BMI 35 34 33 32 31 30 29 19.4 CDC BMI for Age Percentiles Published May 30, 2000 (modified 10/16/00). SOURCE: Developed by the National Center for Health Statistics in collaboration with the National Center for Chronic Disease Prevention and Health Promotion (2000). http://www.cdc.gov/growthcharts H EALTH PLANS www.cfhp.com 159
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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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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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Page 109 and 110: Risk Factors for Osteoporosis Fract
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Page 119 and 120: TEXAS MEDICAID PROVIDER PROCEDURES
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Page 141 and 142: FIGURE 2: Recommended immunization
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Page 157: PREVENTION RECOMMENDATIONS 1. The E
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