1
Test T Score P Value Conclusion PGY-3 Screening Colonoscopy 1.1656 0.15 No Significant Difference PGY-3 Hep-C Ab 0.4224 0.5 No Significant Difference PGY-3 Lipid Panel 1.4031 0.1 No Significant Difference PGY-2 Screening Colonoscopy 0.2901 0.1 No Significant Difference PGY-2 Hep-c Ab 2.1209 0.05 Statistically Significant PGY-2 Lipid Panel 2.2358 0.025 Statistically Significant PGY-1s w/ and w/o Screening Tool: Screening Colonoscopy 0.1866 0.5 No Significant Difference PGY-1s w/ and w/o Screening Tool: Hep-C Ab 0.6428 0.5 No Significant Difference PGY-1s w/ and w/o Screening Tool: Lipid Panel 0.9169 0.2 No Significant Difference USPSTF Screening Guideline Table: Improving Screening and Teaching ABSTRACT USPSTF (United State Preven0ve Service Task Force) publishes screening recommenda0ons to which our residency clinic adheres Prior residents have developed a tool to easily visualize recommenda0ons based on age Qualita0ve and quan0ta0ve data was collected on the Banner University Family Medicine South Campus clinic/ residents before and aGer implemen0ng this teaching tool No sta0s0cally significant change in screening tests ordered among 3 rd year residents nor interns Sta0s0cally significant improvement of screening tests ordered by 2 nd years may be due to new clinical tool Pre and post-ques0onnaires suggest improvement of residents’ confidence: - In their knowledge of age-related screening recommenda0ons - In their ability to teach medical students about screening tests BACKGROUND/ PURPOSE USPSTF’s age-related screening recommenda0ons are important in comprehensive primary care A version of the One-Page Adult Preven0ve Health Care Schedule table (as seen on the right) was published in the AFP journal in May 2016 Purpose; - Improve the clinic’s adherence to the USPSTF screening recommenda0ons - Improve residents’ confidence and knowledge of screening guidelines - Improve residents’ confidence in teaching medical students METHOD l Introduc0on of the USPSTF Screening Guidelines Table at the South Campus Clinic and instruc0on on its use (8/26/2016) l Retrospec0ve data on specific screening tests ordered was collected through Epic for the 6 months before (start 1/24/2016) and the 6 months aGer (end 2/26/2017) introducing the tool l 3 marker orders were used to evaluate screening adherence: - Lipid Panel - Hepa00s C Ab - Referral to GI for screening colonoscopy l Data collected: - 3 rd and 2 nd years: number of orders placed for each marker - Interns: number of orders placed for each marker by current interns (those with access to the Guidelines Table) compared to interns of the prior year l Qualita0ve data on confidence collected by ques0onnaire before and 6- months aGer the introduc0on of the Guidelines Table l T Square analysis of quan0ta0ve data was used to assess for significance CONCLUSIONS REFERENCES/AKNOWLEDGEMENTS Dr Kyle Meehan and Dr Lynne Tomasa and Dr Judith Gordon for their help with this research Co-authors of the original version of the preven0ve schedule Paul Swnson, Coya Lindberg, Cynthia Carillo, MD, and Joshua Clucer, MD, "Recommenda0ons for Primary Care Prac0ce." Recommenda0ons for Primary Care Prac0ce - US Preven0ve Services Task Force. N.p., Web. 2016. Swenson, Paul F., and Mark H. Ebell. "Introducing a One-Page Adult Preven0ve Health Care Schedule: USPSTF Recommenda0ons at a Glance." Introducing a One-Page Adult Preven0ve Health Care Schedule: USPSTF Recommenda0ons at a Glance May.2016 (2016): 738-40. Joshua Clucer, MD University of Arizona College of Medicine Family Medicine Residency at South Campus Banner University Medical Center 0 20 40 60 80 100 120 140 Folowing Screening Tool Implementation NUMBER OF SCREENING ORDERS BY RESIDENTS BEFORE AND AFTER THE INTRODUCTION OF THE USPSTF SCREENING GUIDELINE TABLE 0 10 20 30 40 50 60 70 80 Not at all confident Slightly confident Moderatelyconfident Very confident Totally confident Questionnaire Data Post Pre 0 20 40 60 80 100 Feel Confident in Teaching Medical Students About Reference USPSTF Regularly Evaluate Your Patients For Feel Confident in Knowledge Of Reference a Tool For Pre (% Yes) Post (% Yes) How Confident Do You Feel In Your Knowledge of Age Related Screening Recommendations? 0 20 40 60 80 0% 25% 50% 75% 100% Questionnaire Data % of time Post Pre How Often Do You Evaluate What Screening Test Should be Performed On Your Patients Based On Their Age? l Quan0ta0ve Data reveals: - No sta0s0cal change in the number of 0mes third years order age-related screening tests - No sta0s0cal change in the number of 0mes interns ordered the 3 marker tests this year compared to the prior year - Sta0s0cally significant improvement in 2 of the 3 screening tests among the second years l Qualita0ve Data reveals - Improvement of residents’ confidence: l in knowledge about age-related screening recommenda0ons l In ability to teach medical student - Reported % of evalua0ng pa0ents for screening tests needed based on their age QUANTITATIVE RESULTS BEFORE AND AFTER INTRODUCING THE USPSTF SCREENING TOOL T-Square Statistical Analysis QUALITATIVE RESULTS FROM PRE/ POST QUESTIONNAIRES

USPSTF Screening Guideline Table ... - University of Arizona

  • Upload
    others

  • View
    9

  • Download
    0

Embed Size (px)

Citation preview

Prin%ng:

This poster is 48” wide by 36” high. It’s designed to be printed on a large-format printer.

Customizing the Content:

The placeholders in this poster are formaEed for you. Type in the placeholders to add text, or click an icon to add a table, chart, SmartArt graphic, picture or mul%media file.

To add or remove bullet points from text, just click the Bullets buEon on the Home tab.

If you need more placeholders for %tles, content or body text, just make a copy of what you need and drag it into place. PowerPoint’s Smart Guides will help you align it with everything else.

Want to use your own pictures instead of ours? No problem! Just right-click a picture and choose Change Picture. Maintain the propor%on of pictures as you resize by dragging a corner.

Test T Score P Value Conclusion

PGY-3 Screening Colonoscopy 1.1656 0.15 No Significant Difference PGY-3 Hep-C Ab 0.4224 0.5 No Significant Difference PGY-3 Lipid Panel 1.4031 0.1 No Significant Difference

PGY-2 Screening Colonoscopy 0.2901 0.1 No Significant Difference PGY-2 Hep-c Ab 2.1209 0.05 Statistically Significant

PGY-2 Lipid Panel 2.2358 0.025 Statistically Significant PGY-1s w/ and w/o Screening Tool: Screening Colonoscopy 0.1866 0.5 No Significant Difference

PGY-1s w/ and w/o Screening Tool: Hep-C Ab 0.6428 0.5 No Significant Difference PGY-1s w/ and w/o Screening Tool: Lipid Panel 0.9169 0.2 No Significant Difference

USPSTFScreeningGuidelineTable:ImprovingScreeningandTeaching

ABSTRACT•  USPSTF(UnitedStatePreven0veServiceTaskForce)publishesscreeningrecommenda0onstowhichourresidencyclinicadheres

•  Priorresidentshavedevelopedatooltoeasilyvisualizerecommenda0onsbasedonage

•  Qualita0veandquan0ta0vedatawascollectedontheBannerUniversityFamilyMedicineSouthCampusclinic/residentsbeforeandaGerimplemen0ngthisteachingtool

•  Nosta0s0callysignificantchangeinscreeningtestsorderedamong3rdyearresidentsnorinterns

•  Sta0s0callysignificantimprovementofscreeningtestsorderedby2ndyearsmaybeduetonewclinicaltool

•  Preandpost-ques0onnairessuggestimprovementofresidents’confidence:-  Intheirknowledgeofage-relatedscreeningrecommenda0ons-  Intheirabilitytoteachmedicalstudentsaboutscreeningtests

BACKGROUND/PURPOSE•  USPSTF’sage-relatedscreeningrecommenda0onsareimportantincomprehensiveprimarycare

•  AversionoftheOne-PageAdultPreven0veHealthCareScheduletable(asseenontheright)waspublishedintheAFPjournalinMay2016

•  Purpose;-  Improvetheclinic’sadherencetotheUSPSTFscreeningrecommenda0ons-  Improveresidents’confidenceandknowledgeofscreeningguidelines-  Improveresidents’confidenceinteachingmedicalstudents

METHODl  Introduc0onoftheUSPSTFScreeningGuidelinesTableattheSouth

CampusClinicandinstruc0ononitsuse(8/26/2016)l  Retrospec0vedataonspecificscreeningtestsorderedwascollected

throughEpicforthe6monthsbefore(start1/24/2016)andthe6monthsaGer(end2/26/2017)introducingthetool

l  3markerorderswereusedtoevaluatescreeningadherence:-  LipidPanel-  Hepa00sCAb-  ReferraltoGIforscreeningcolonoscopy

l  Datacollected:-  3rdand2ndyears:numberofordersplacedforeachmarker-  Interns:numberofordersplacedforeachmarkerbycurrentinterns(thosewithaccesstotheGuidelinesTable)comparedtointernsoftheprioryear

l  Qualita0vedataonconfidencecollectedbyques0onnairebeforeand6-monthsaGertheintroduc0onoftheGuidelinesTable

l  TSquareanalysisofquan0ta0vedatawasusedtoassessforsignificance

CONCLUSIONS

REFERENCES/AKNOWLEDGEMENTS•  DrKyleMeehanandDrLynneTomasaandDrJudithGordonfortheirhelpwiththisresearch•  Co-authorsoftheoriginalversionofthepreven0veschedulePaulSwnson,CoyaLindberg,Cynthia

Carillo,MD,andJoshuaClucer,MD,•  "Recommenda0onsforPrimaryCarePrac0ce."Recommenda0onsforPrimaryCarePrac0ce-US

Preven0veServicesTaskForce.N.p.,Web.2016.•  Swenson,PaulF.,andMarkH.Ebell."IntroducingaOne-PageAdultPreven0veHealthCareSchedule:

USPSTFRecommenda0onsataGlance."IntroducingaOne-PageAdultPreven0veHealthCareSchedule:USPSTFRecommenda0onsataGlanceMay.2016(2016):738-40.

JoshuaClucer,MD

UniversityofArizonaCollegeofMedicineFamilyMedicineResidencyatSouthCampusBannerUniversityMedicalCenter

0 20 40 60 80

100 120 140

Folowing Screening Tool Implementation

NUMBER OF SCREENING ORDERS BY RESIDENTS BEFORE AND AFTER THE INTRODUCTION OF THE USPSTF SCREENING GUIDELINE TABLE

0 10 20 30 40 50 60 70 80

Not at all confident Slightly confident

Moderatelyconfident Very confident

Totally confident

Questionnaire Data

Post Pre

0 20 40 60 80

100

Feel Confident in Teaching Medical Students About

Reference USPSTF

Regularly Evaluate Your Patients For

Feel Confident in Knowledge Of

Reference a Tool For

Pre (% Yes)

Post (% Yes)

How Confident Do You Feel In Your Knowledge of Age Related Screening Recommendations?

0 20 40 60 80

0%

25%

50%

75%

100%

Questionnaire Data

%

of

time

Post Pre

How Often Do You Evaluate What Screening Test Should be Performed On Your Patients Based On Their Age?

l  Quan0ta0veDatareveals:-  Nosta0s0calchangeinthenumberof0mesthirdyearsorderage-relatedscreeningtests

-  Nosta0s0calchangeinthenumberof0mesinternsorderedthe3markerteststhisyearcomparedtotheprioryear

-  Sta0s0callysignificantimprovementin2ofthe3screeningtestsamongthesecondyears

l  Qualita0veDatareveals-  Improvementofresidents’confidence:

l  inknowledgeaboutage-relatedscreeningrecommenda0onsl  Inabilitytoteachmedicalstudent

-  Reported%ofevalua0ngpa0entsforscreeningtestsneededbasedontheirage

QUANTITATIVERESULTSBEFOREANDAFTERINTRODUCINGTHEUSPSTFSCREENINGTOOL

T-Square Statistical Analysis

QUALITATIVERESULTSFROMPRE/POSTQUESTIONNAIRES