Improving Preventive Health Care Success Stories: USPSTF and ePSS at San Francisco General Hospital

Slide presentation from the AHRQ 2009 conference.

On September 15, 2009, Alice Hm Chen, MD, MPH made this presentation at the 2009 Annual Conference. Select to access the

Slide 1

Slide 1. Improving Preventive Health Care Success Stories: USPSTF and ePSS at San Francisco General Hospital

AHRQ 2009 Conference
Alice Hm Chen, MD, MPH

 

Slide 2

Slide 2. SFGH Acknowledgements

 

Slide 3

Slide 3. Outline

 

Slide 4

Slide 4. Why focus on preventive care?

 

Slide 5

Slide 5. Barriers to Screening in the Safety Net

 

Slide 6

Slide 6. Whose guidelines should we be following, anyways?

 

Slide 7

Slide 7. SFGH Approach

 

Slide 8

Slide 8. San Francisco Safety Net

 

Slide 9

Slide 9. Screen Capture of Clinical Alerts page

 

Slide 10

Slide 10. Screen Capture of the Female Health Maintainance Screen

 

Slide 11

Slide 11. Screen Capture of the Treatment and Referral Guidelines

 

Slide 12

Slide 12. Screen Capture of the Health Maintenance screen

 

Slide 13

Slide 13. Screen Capture of the Health Maintenance screen continued

 

Slide 14

Slide 14. Screen Capture of the Health Maintenance screen continued

 

Slide 15

Slide 15. Screen Capture of the Browse Topic screen

 

Slide 16

Slide 16. Screen Capture of the Search for Recommendation screen

 

Slide 17

Slide 17. Colorectal Cancer Screening

 

Slide 18

Slide 18. Screen Capture of search result of colorectal cancer screening

 

Slide 19

Slide 19. Screen Capture of Screening for Colorectal Cancer screen

Slide 20

Slide 20. Screen Capture of the Colon Cancer Screening and Surveillance Guidelines

Slide 21

Slide 21. Flu-FOBT Program

Flu-FOBT Program

  • Strategy: offer FOBT in combination with flu shots
  • Initial pilot results
    • Flu only: 52.9% à57.3% eligible completed FOBT
    • Flu + FOBT: 54.5% à 84.3% eligible completed FOBT
    • Difference of 25.4 points, p<0.001

      Potter MB, Phengrasamy L, Hudes ES, McPhee SJ, Walsh J. Offering annual fecal occult blood tests at annual flu shot clinics increases colorectal cancer screening rates. Annals of Family Medicine 2009; 7:17-23.
  • SF DPH program at Chinatown Public Health Center  led by Mike Potter and Albert Yu, funded by CDC Slide courtesy of Albert Yu and Mike Potter

 

Slide 22

Slide 22. Outreach Materials

Outreach Materials

Images of outreach materials in English and other language.

Slide courtesy of Albert Yu and Mike Potter

 

Slide 23

Slide 23. Designed at Request of CPHC Staff with Patient Input

Designed at Request of CPHC Staff with Patient Input

Image of approved and non approved items.

Slide courtesy of Albert Yu and Mike Potter

 

Slide 24

Slide 24. CPHC Preliminary Results

CPHC Preliminary Results

Efficacy among 50-80 year olds who came in for primary care visit during flu shot season

 Got Flu Shot
(n=1286)		Didn't Get Flu Shot
(n=588)
Up to date 9-29-0851.2%60.2%
Up to date 3-31-0975.2%64.8%
Change+25.0%+4.6%

Slide courtesy of Albert Yu and Mike Potter

Slide 25

Slide 25. SF DPH Screening Rates

SF DPH Screening Rates

Graph showing percentages of patients aged 51-75 with completed colorectal cancer screening.

 

Slide 26

Slide 26. Breast Cancer Screening Challenges

Breast Cancer Screening Challenges

  • Primary care quality improvement committee uses USPSTF guidelines, but specialty society (radiology) recommendations different
  • Difficulties hiring mammographers had led to significant wait times for both screening and diagnostic mammograms
  • Conflicting information given to patients
  • Low mammography rates due to CBE requirement

 

Slide 27

Slide 27. Screen Capture of the search results for Breast Cancer Screening

 

Slide 28

Slide 28. Screen Capture of the Screening for Breast Cancer screen

 

Slide 29

Slide 29. Screen Capture of the CHN Guideline for Use of Mammography in Breast Cancer Screening screen

 

Slide 30

Slide 30. Screen Capture of the Mammogram Referral screen

 

Slide 31

Slide 31. Scanned image of a letter issued indicating the person had not had a mammogram in more than 1 year

 

Slide 32

Slide 32. Breast Imaging Request Form, highlighting the date of last clinical breast exam

 

Slide 33

Slide 33. SF DPH Mamography Rates

SF DPH Mammography Rates

Graph showing the percentage of women ages 42-69 who have had a mammogram in the past 2 years. Excluding data "not indicated" but does not give credit for "declined."

 

Slide 34

Slide 34. Conclusions

Conclusions

  • USPSTF guideline process (rigorous, evidence-based, ongoing) critical to reliability and credibility.
  • AHRQ ePSS enables easy access to updated USPSTF guidelines, especially with linkages EMR.
  • Challenges remain with systems barriers that can only be addressed on an institutional level.

 

Slide 35

Slide 35. Questions? 

Questions?

Alice Hm Chen, MD, MPH
Assistant Professor of Medicine, UCSF
Medical Director, Adult Medical Center, SFGH
achen@ medsfgh.ucsf.edu

Current as of December 2009
Internet Citation: Improving Preventive Health Care Success Stories: USPSTF and ePSS at San Francisco General Hospital. December 2009. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/events/conference/2009/chen/index.html