Guideline Title
Routine preventive services for children and adolescents (ages 2 - 21).
Bibliographic Source(s)
| Michigan Quality Improvement Consortium. Routine preventive services for children and adolescents (ages 2-21). Southfield (MI): Michigan Quality Improvement Consortium; 2011 May. 1 p. |
Guideline Status
This is the current release of the guideline.
This guideline updates a previous version: Michigan Quality Improvement Consortium. Routine preventive services for children and adolescents (ages 2-21). Southfield (MI): Michigan Quality Improvement Consortium; 2009 May. 1 p.
UMLS Concepts ( what's this?)
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ICD9CM:
Accident caused by unspecified firearm missile (E922.9); Acute poliomyelitis, unspecified, poliovirus, unspecified type (045.90); Administration of measles-mumps-rubella vaccine (99.48); Anxiety state, unspecified (300.00); Burn of unspecified site, unspecified degree (949.0); Counseling on other sexually transmitted diseases (V65.45); Counseling on substance use and abuse (V65.42); Diphtheria, unspecified (032.9); Human immunodeficiency virus [HIV] disease (042); Injury by burns or fire, undetermined whether accidentally or purposely inflicted (E988.1); Major depressive disorder, recurrent episode, unspecified degree (296.30); Major depressive disorder, single episode, unspecified degree (296.20); Malignant neoplasm of cervix uteri, unspecified (180.9); Measles without mention of complication (055.9); Meningitis, unspecified (322.9); Mumps without mention of complication (072.9); Other and unspecified alcohol dependence, unspecified drinking behavior (303.90); Overweight (278.02); Rubella without mention of complication (056.9); Tetanus (037); Tobacco use disorder (305.1); Unspecified accident (E928.9); Unspecified disorder of lipoid metabolism (272.9); Unspecified drug dependence, unspecified use (304.90); Unspecified visual disturbance (368.9); Venereal disease, unspecified (099.9); Whooping cough due to bordetella pertussis [B. pertussis] (033.0)
MSH:
Accident Prevention; Accidents; Accidents, Traffic; Adaptation, Psychological; Adolescent Health Services; Adolescent Nutritional Physiological Phenomena; Alcohol-Related Disorders; Alcoholism; Anxiety; Body Mass Index; Burns; Chickenpox; Chickenpox Vaccine; Child Abuse; Child Health Services; Child Nutritional Physiological Phenomena; Dental Health Services; Depression; Diphtheria; Diphtheria-Tetanus-acellular Pertussis Vaccines; Exercise; HIV Infections; Hypercholesterolemia; Immunization; Immunization Programs; Immunization Schedule; Influenza Vaccines; Influenza, Human; Lipid Metabolism Disorders; Mass Screening; Measles; Measles Vaccine; Measles-Mumps-Rubella Vaccine; Meningitis; Meningococcal Vaccines; Mumps; Mumps Vaccine; Overweight; Papillomavirus Vaccines; Patient Education as Topic; Poisoning; Poliomyelitis; Poliovirus Vaccines; Pregnancy, Unplanned; Preventive Health Services; Risk Assessment; Rubella; Rubella Vaccine; Sexually Transmitted Diseases; Stomatognathic Diseases; Stress, Psychological; Substance-Related Disorders; Suicide; Tetanus; Tobacco Smoke Pollution; Tobacco Use Disorder; Uterine Cervical Neoplasms; Vaccines, Combined; Violence; Vision Disorders; Vision Tests; Whooping Cough; Wounds and Injuries
MTH:
Accidents; Accidents, Traffic; Alcoholic Intoxication, Chronic; Anxiety; Anxiety state; Body mass index procedure; Burn injury; Chickenpox; Chickenpox Vaccine; child abuse behavior; Child Health Services; Cholesterol measurement test; Contraception care education; Diphtheria; Drug abuse; DRUG DEPENDENCE; Exercise; HIV Infections; Hypercholesterolemia; Immunization; Influenza; Influenza virus vaccine; Injury; Malignant tumor of cervix; Measles; Measles Vaccine; Measles-mumps-rubella vaccination; Measles-Mumps-Rubella Vaccine; Meningococcal vaccine; Mental Depression; Mumps; Mumps Vaccine; OVERWEIGHT; Pap smear; Patient education (procedure); Pertussis; Poisoning; Poliovirus Vaccines; Psychological adjustment; Rubella; Rubella virus vaccine; Screening for venereal disease; Sexually Transmitted Diseases; Stress, Psychological; Substance abuse problem; Suicide; Tetanus; Tobacco Use Disorder; Unplanned pregnancy; Uterine Cervical Neoplasm; Vision Disorders; Vision Tests; Visual disturbance; Wounds and Injuries
PDQ:
Pap test; substance abuse disorder; tobacco use disorder
SNOMEDCT:
Accident caused by firearm missile (218081007); Accident prevention (134185000); Alcohol-induced organic mental disorder (29212009); Alcoholism (284591009); Alcoholism (66590003); Alcoholism (7200002); Anxiety (48694002); Anxiety state (198288003); Burn injury (125666000); Burn injury (48333001); Child abuse (418189009); Child nutrition (87346005); Cholesterol screening (275972003); Cholesterol screening (77068002); Contraception care education (408968008); Diphtheria (276197005); Diphtheria (397428000); Disorder of lipid metabolism (267431006); Disorder of vision (128127008); Disorder of vision (95677002); Drug abuse (26416006); Drug dependence (191816009); Drug dependence (2403008); Drug dependence (6525002); Epidemic acute poliomyelitis (398102009); Epidemic acute poliomyelitis (398256009); Exercise (183301007); Exercise (256235009); Exercise (61686008); Human immunodeficiency virus infection (86406008); Hypercholesterolemia (13644009); Immunization (127785005); Influenza (6142004); Influenza virus vaccine (396425006); Influenza virus vaccine (46233009); Malignant tumor of cervix (363354003); Measles (14189004); Measles + mumps + rubella + varicella vaccine (419550004); Measles vaccine (386012008); Measles vaccine (396427003); Measles, mumps and rubella vaccine (396429000); Measles, mumps and rubella vaccine (61153008); Measles-mumps-rubella vaccination (38598009); Meningitis (7180009); Meningococcus vaccine (423531006); Meningococcus vaccine (424891007); Mumps (240526004); Mumps (36989005); Mumps vaccine (396431009); Mumps vaccine (90043005); Mumps without complication (111870000); Neoplasm of uterine cervix (123841004); Overweight (238131007); Parent education: adolescent (386380002); Parent education: childrearing family (386381003); Patient education (311401005); Pertussis (27836007); Pneumococcal 7-valent conjugate vaccine (125714002); Poisoning (75478009); Poisoning / injury (370122001); Poliovirus vaccine (111164008); Poliovirus vaccine (415129008); Recurrent major depressive episodes (268621008); Recurrent major depressive episodes (66344007); Risk assessment (225338004); Rubella (36653000); Rubella vaccine (386013003); Rubella vaccine (396438003); Rubella without complication (111867004); Sexually transmitted infectious disease (8098009); Single major depressive episode (268620009); Single major depressive episode (36923009); Substance abuse (66214007); Substance abuse counseling (313071005); Suicide (44301001); Tetanus (276202003); Tetanus (76902006); Tobacco dependence, continuous (191887008); Unplanned pregnancy (83074005); Varicella (38907003); Varicella virus vaccine (108729007); Varicella virus vaccine (396442000); Venereal disease screening (171128005); Visual disturbance (131182003); Visual disturbance (63102001); Visual testing (268360001)
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Disease/Condition(s)
Preventable diseases or conditions such as:
- Infectious diseases including diphtheria, tetanus, pertussis, poliomyelitis, measles, mumps, rubella, varicella, influenza, meningitis, sexually transmitted infections including human immunodeficiency virus (HIV) infection
- Overweight
- Oral and dental diseases
- Mental stress, anxiety, and depression
- Harm from violence or abuse
- Alcohol and drug abuse
- Injuries due to motor vehicles, bicycles, burns, poisoning, injury
- Tobacco use/exposure to second-hand smoke
- Hypercholesterolemia
- Cervical cancer
- Unintended pregnancy
- Vision disorders
Guideline Category
Counseling
Prevention
Risk Assessment
Screening
Clinical Specialty
Family Practice
Obstetrics and Gynecology
Pediatrics
Preventive Medicine
Intended Users
Advanced Practice Nurses
Health Plans
Physician Assistants
Physicians
Guideline Objective(s)
- To achieve significant, measurable improvements in the routine preventive services for children and adolescents (ages 2 to 21) through the development and implementation of common evidence-based clinical practice guidelines
- To design concise guidelines that are focused on key management components of routine preventive services for children and adolescents to improve outcomes
Target Population
Children and adolescents ages 2 to 21 years
Interventions and Practices Considered
- Assessment of risk factors
- Parent and child age-appropriate education and counseling regarding:
- Nutrition, physical activity, dental health, violence and abuse, sexually transmitted infection prevention, depression, suicide threats, alcohol and drug abuse, anxiety, stress reduction, coping skills, immunizations
- Motor-vehicle and bicycle safety, poison prevention, burn and injury prevention
- Preconception and pregnancy prevention
- Screening for tobacco use/second-hand exposure, overweight, cholesterol, pregnancy prevention, sexually transmitted infection, cervical cancer, and vision disorders
- Immunizations
- Diphtheria, tetanus, and acellular pertussis vaccine (DTaP), tetanus-diphtheria-acellular pertussis vaccine (Tdap)
- Inactivated poliovirus vaccine (IPV)
- Measles, mumps, rubella (MMR) or measles, mumps, rubella, and varicella vaccine (MMRV)
- Varicella vaccine
- Meningococcal vaccine
- Influenza vaccine
- Human papillomavirus (HPV) vaccine
Major Outcomes Considered
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Methods Used to Collect/Select the Evidence
Searches of Electronic Databases
Description of Methods Used to Collect/Select the Evidence
The Michigan Quality Improvement Consortium (MQIC) health care analyst conducts a search of current literature in support of the guideline topic. Computer database searches are used to identify published studies, existing protocols and/or national guidelines on the selected topic developed by organizations such as the American Diabetes Association, American Heart Association, American Academy of Pediatrics, etc. If available, clinical practice guidelines from participating MQIC health plans and Michigan health systems are also used to develop a framework for the new guideline.
Number of Source Documents
Methods Used to Assess the Quality and Strength of the Evidence
Weighting According to a Rating Scheme (Scheme Given)
Rating Scheme for the Strength of the Evidence
Levels of Evidence for the Most Significant Recommendations
- Randomized controlled trials
- Controlled trials, no randomization
- Observational studies
- Opinion of expert panel
Methods Used to Analyze the Evidence
Review
Description of the Methods Used to Analyze the Evidence
Methods Used to Formulate the Recommendations
Expert Consensus
Description of Methods Used to Formulate the Recommendations
Using information obtained from literature searches and available health plan guidelines on the designated topic, the Michigan Quality Improvement Consortium (MQIC) health care analyst prepares a draft guideline to be reviewed by the Medical Directors' committee at one of their scheduled meetings. Priority is given to recommendations with [A] and [B] levels of evidence (see "Rating Scheme for the Strength of the Evidence" field).
The initial draft guideline is reviewed, evaluated, and revised by the committee, resulting in draft two of the guideline. Additionally, the Michigan Academy of Family Physicians participates in guideline development at the onset of the process and throughout the guideline development procedure. The MQIC guideline feedback form and draft two of the guideline are distributed to the Medical Directors, as well as the MQIC measurement and implementation group members, for review and comments. Feedback from members is collected by the MQIC health care analyst and prepared for review by the Medical Directors' committee at their next scheduled meeting. The review, evaluation, and revision process with several iterations of the guideline may be repeated over several meetings before consensus is reached on a final draft guideline.
Rating Scheme for the Strength of the Recommendations
Cost Analysis
A formal cost analysis was not performed and published cost analyses were not reviewed.
Method of Guideline Validation
External Peer Review
Internal Peer Review
Description of Method of Guideline Validation
When consensus is reached on the final draft guideline, the Medical Directors approve the guideline for external distribution to practitioners with review and comments requested via the Michigan Quality Improvement Consortium (MQIC) health plans (health care analyst distributes final draft to Medical Directors' committee, measurement and implementation groups to solicit feedback).
The MQIC health care analyst also forwards the approved guideline draft to appropriate state medical specialty societies and physicians with expertise in the related field for their input. After all feedback is received from external reviews, it is presented for discussion at the next scheduled committee meeting. Based on feedback, subsequent guideline review, evaluation, and revision may be required prior to final guideline approval.
The MQIC Medical Directors approved this guideline in May 2011.
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Major Recommendations
The level of evidence grades (A-D) are provided for the most significant recommendations and are defined at the end of the "Major Recommendations" field.
The following guideline provides recommendations for routine preventive services for children and adolescents ages 2-21 years. Children at increased risk may warrant additional services, e.g. Early Periodic Screening, Diagnosis, and Treatment Program (EPSDT)1.
| Recommendation |
2-6 years |
7-12 years |
13-21 years |
| Annual health, developmental and risk assessments |
X |
X |
X |
Parent and child age-appropriate education and counseling:
- Nutrition, physical activity, dental health2, violence and abuse, sexually transmitted infection prevention, depression, suicide threats, alcohol and drug abuse, anxiety, stress reduction, coping skills, immunizations
- Helmet use and protective gear for bicycle riding, skateboarding, skating, etc. [B]
- Motor vehicle safety3 - Car seat, booster seat, seat belt use [B]
- Poison prevention - Keep National Poison Control number (800-222-1222) readily accessible; use child resistant containers; dispose of expired or unused medications
- Burn prevention - Install smoke detectors and test twice a year; carbon monoxide detectors; water heater temperature and fire prevention
- Injury prevention - Firearm safety; water safety; CPR training
|
X |
X |
X |
| Tobacco use screening: Establish tobacco use and secondhand exposure |
X |
X |
X |
| Weight assessment screening |
Record height, weight and BMI percentile annually |
| Cholesterol screening [A] |
Screen children over age 2 at increased risk for genetic forms of hypercholesterolemia |
| Chlamydia and sexually transmitted infection screening, including HIV screening [A] |
|
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All sexually active adolescents annually |
| Cervical cancer screening (Pap smear) [B] |
|
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Screen for cervical cancer in adolescents and women who have been sexually active and have a cervix. Screen every three years. |
| Preconception and pregnancy prevention counseling, Folic acid 400 µg daily |
|
Preventive counseling beginning at age 12, or earlier if sexually active |
| Vision screening [A] |
X
(prior to school enrollment) |
X
Every 2 years |
X
Every 3 years |
Abbreviations: BMI, body mass index; CPR, cardiopulmonary resuscitation; HIV, human immunodeficiency virus
1Early Periodic Screening Diagnosis and Treatment: age specific exam and anticipatory guidance template (http://ihcs.msu.edu/quality/early_periodic_screening.php  )
2Family history, eating/sleeping habits, adequate fluoridation, and home oral care may provide possible/potential/visible abnormalities and a visit to the dentist for early evaluation may be recommended.
3AAP Policy Statement-Child Passenger Safety (http://pediatrics.aappublications.org/content/127/4/788.full )
Immunizations
- Consult the Advisory Committee on Immunization Practices (ACIP) website (http://www.cdc.gov/vaccines/recs/acip/ ) for the most updated immunization schedules for routine and high risk populations.
- Use combination vaccines to minimize the number of injections.
- Update the Michigan Care Improvement Registry (MCIR).
| Vaccines |
4-6 years |
11-12 years |
15-18 years |
| DTaP [A] |
X |
Tdap |
|
| IPV |
X |
|
|
| MMR (MMRV) [A] |
X |
|
|
| Varicella [A] |
X |
|
|
| Meningococcal (MCV4) |
|
X |
Booster 16-18 years of age |
| Influenza [B] |
Ages 2-8, two doses for the first year; annually thereafter. Age 9 and older, one dose annually. |
| Human papillomavirus* (females ages 11-26, minimum age 9) |
|
Beginning at age 11, 3-dose series |
Abbreviations: DTaP, diphtheria, tetanus, acellular pertussis; IPV, inactivated poliovirus vaccine; MCV4, meningococcal conjugate vaccine; MMR, measles, mumps, rubella; MMRV, measles, mumps, rubella, varicella; Tdap, tetanus-diphtheria-acellular pertussis vaccine
*U.S. Food and Drug Administration (FDA) approved human papillomavirus vaccine for males 9-26 years to reduce their likelihood of genital warts.
Definitions:
Levels of Evidence for the Most Significant Recommendations
- Randomized controlled trials
- Controlled trials, no randomization
- Observational studies
- Opinion of expert panel
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Evidence Supporting the Recommendations
Type of Evidence Supporting the Recommendations
The type of evidence is provided for the most significant recommendations (see the "Major Recommendations" field).
This guideline is based on several sources, including: Preventive Services for Children and Adolescents, Institute for Clinical Systems Improvement, 2010 (www.icsi.org ) and American Academy of Pediatrics (AAP) Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, 3rd Edition, 2008.
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Benefits/Harms of Implementing the Guideline Recommendations
Potential Benefits
Through a collaborative approach to developing and implementing common clinical practice guidelines and performance measures for routine preventive services for children and adolescents ages 2 to 21, Michigan health plans will achieve consistent delivery of evidence-based services and better health outcomes. This approach also will augment the practice environment for physicians by reducing the administrative burdens imposed by compliance with diverse health plan guidelines and associated requirements.
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Qualifying Statements
This guideline lists core management steps. Individual patient considerations and advances in medical science may supersede or modify these recommendations.
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Implementation of the Guideline
Description of Implementation Strategy
Approved Michigan Quality Improvement Consortium (MQIC) guidelines are disseminated through email, U.S. mail, and websites.
The MQIC health care analyst prepares approved guidelines for distribution. Portable Document Format (PDF) versions of the guidelines are used for distribution.
The MQIC health care analyst distributes approved guidelines to MQIC membership via email.
The MQIC health care analyst submits request to website vendor to post approved guidelines to MQIC website (www.mqic.org ).
The MQIC health care analyst completes an annual statewide postcard mailing to physicians in all areas of medicine including primary care and specialties. The postcard provides the complete list of MQIC guidelines and includes which guidelines have been recently revised, which are coming up for revision, and any new published guidelines.
The statewide mailing list is derived from the Blue Cross Blue Shield of Michigan (BCBSM) provider database. Approximately 95% of the state's M.D.'s and 96% of the state's D.O.'s are included in the database.
The MQIC health care analyst submits request to the National Guideline Clearinghouse (NGC) to post approved guidelines to NGC website (www.guideline.gov ).
Implementation Tools
Tool KitsFor information about availability, see the Availability of Companion Documents and Patient Resources fields below.
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Institute of Medicine (IOM) National Healthcare Quality Report Categories
IOM Care Need
Staying Healthy
IOM Domain
Effectiveness
Patient-centeredness
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Identifying Information and Availability
Bibliographic Source(s)
| Michigan Quality Improvement Consortium. Routine preventive services for children and adolescents (ages 2-21). Southfield (MI): Michigan Quality Improvement Consortium; 2011 May. 1 p. |
Adaptation
This guideline is based on several sources, including: Preventive Services for Children and Adolescents, Institute for Clinical Systems Improvement, 2010 (www.icsi.org ) and American Academy of Pediatrics (AAP) Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, 3rd Edition, 2008.
Date Released
2007 May (revised 2011 May)
Guideline Developer(s)
Michigan Quality Improvement Consortium - Professional Association
Source(s) of Funding
Michigan Quality Improvement Consortium
Guideline Committee
Michigan Quality Improvement Consortium Medical Directors' Committee
Composition of Group That Authored the Guideline
Physician representatives from the 13 participating Michigan Quality Improvement Consortium health plans, Michigan State Medical Society, Michigan Osteopathic Association, Michigan Association of Health Plans, Michigan Department of Community Health, Michigan Peer Review Organization, and the University of Michigan Health System
Financial Disclosures/Conflicts of Interest
Standard disclosure is requested from all individuals participating in the Michigan Quality Improvement Consortium (MQIC) guideline development process, including those parties who are solicited for guideline feedback (e.g., health plans, medical specialty societies). Additionally, members of the MQIC Medical Directors' Committee are asked to disclose all commercial relationships as well.
Guideline Status
This is the current release of the guideline.
This guideline updates a previous version: Michigan Quality Improvement Consortium. Routine preventive services for children and adolescents (ages 2-21). Southfield (MI): Michigan Quality Improvement Consortium; 2009 May. 1 p.
Availability of Companion Documents
The following is available:
NGC Status
This NGC summary was completed by ECRI Institute on March 5, 2008. The information was verified by the guideline developer on March 12, 2008. This NGC summary was updated by ECRI Institute on November 6, 2009. The updated information was verified by the guideline developer on December 10, 2009. This summary was updated by ECRI Institute on November 12, 2010 following the U.S. Food and Drug Administration (FDA) advisory on Afluria (influenza virus vaccine). This summary was updated by ECRI Institute on August 25, 2011. The updated information was verified by the guideline developer on September 2, 2011.
Copyright Statement
This NGC summary is based on the original guideline, which may be reproduced with the citation developed by the Michigan Quality Improvement Consortium.
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