PEDIATRIC - INFANCY PREVENTIVE HEALTH CARE GUIDELINES

Transcription

1 PEDIATRIC - INFANCY AGE SCREENING ASSESSMENT/EDUCATION RISK ASSESSMENT IMMUNIZATIONS (if indicated) Newborn Length/Height and Weight Physical Examination/Unclothed Hep B #1 Blood Pressure Head Circumference History-Initial/Interval (At Birth) Vision Screening Weight for Length Developmental Surveillance Newborn Metabolic/Hemoglobin Psychosocial/Behavioral Assessment Hearing Screening Critical Congenital Heart Disease 3-5 Days Length/Height and Weight Physical Examination/Unclothed Hep B #1 Blood Pressure 48 hr-72 hr Head Circumference History-Initial/Interval Hearing Screening Post Weight for Length Feeding Vision Screening Discharge Newborn Metabolic/Hemoglobin Jaundice Developmental Surveillance Psychosocial/Behavioral Assessment By 1 Month Length/Height and Weight Physical Examination/Unclothed Hep B #2 Blood Pressure Head Circumference History-Initial/Interval Hearing Screening Weight for Length Developmental Surveillance Vision Screening Newborn Metabolic/Hemoglobin Psychosocial/Behavioral Assessment Tuberculin test 2 MONTHS Length/Height and Weight Physical Examination/Unclothed Rotavirus #1 Blood Pressure Head Circumference History-Initial/Interval DTaP #1 Hearing Screening Weight for Length Developmental Surveillance Hib #1 Vision Screening Newborn Metabolic/Hemoglobin Psychosocial/Behavioral Assessment PCV #1 IPV #1 Hep B #2 4 MONTHS Length/Height and Weight Physical Examination/Unclothed Rotavirus#2 Blood Pressure Head Circumference History-Initial/Interval DTaP #2 Hearing Screening Weight for Length Developmental Surveillance Hib #2 Vision Screening Psychosocial/Behavioral Assessment PCV #2 Hematocrit or IPV #2 Hemoglobin 6 MONTHS Length/Height and Weight Physical Examination/Unclothed Influenza-yearly Blood Pressure Weight for Length Developmental Surveillance Hep B #3 Vision Screening Psychosocial/Behavioral Assessment Rotavirus #3 Lead Screening DTaP #3 Tuberculin test Hib #3 Oral Health PCV #3 IPV #3 9 MONTHS Length/Height and Weight Physical Examination/Unclothed Influenza-yearly Blood Pressure Weight for Length Developmental Surveillance Review & update Vision Screening Psychosocial/Behavioral Assessment Please refer to Lead Screening Tuberculin test nip Oral Health * Consider Combination Vaccines When Possible Administer highlighted vaccines if not previously given. Guidelines are based on American Academy of Pediatrics Recommendations for Preventive Pediatric Health Care. The immunization schedule is based on the Recommended Immunization Schedule for persons aged 0-6 years-united States, 2016 Guidelines are for preventive care, other services may be required based on individual member s needs or risk factors.

2 PEDIATRIC - MIDDLE CHILDHOOD AGE SCREENING ASSESSMENT/EDUCATION IMMUNIZATIONS RISK ASSESSMENT (If Indicated) 5 Years Height and Weight Physical Examination/Unclothed Influenza yearly Hematocrit or Hemoglobin BMI (Percentile) History-Initial/Interval 1 or 2 dose IIV or LAIV Lead screening Blood Pressure Developmental Surveillance DTaP #5 Tuberculin Test Vision Screening Psychosocial/Behavioral Assessment IPV #4 Urinalysis MMR #2 Varicella #2 Hep A 6 Years Height and Weight Physical Examination/Unclothed Influenza yearly Hematocrit or Hemoglobin BMI (Percentile) History-Initial/Interval 1 or 2 dose IIV or LAIV Lead Screening Blood Pressure Developmental Surveillance DTaP #5 Tuberculin Test Vision Screening Psychosocial/Behavioral Assessment IPV #4 Dyslipidemia Screening Hearing Screening MMR #2 Urinalysis Oral Health Oral Health Varicella #2 Hep A 7 Years Height and Weight Physical Examination/Unclothed Influenza yearly Vision Screening BMI (Percentile) History-Initial/Interval 1 or 2 dose IIV or LAIV Hearing Screening Blood Pressure Developmental Surveillance Hematocrit or Hemoglobin Psychosocial/Behavioral Assessment Review & Update Tuberculin Test Please refer to Urinalysis 8 Years Height and Weight Physical Examination/Unclothed Influenza yearly Hematocrit or Hemoglobin BMI (Percentile) History-Initial/Interval 1 or 2 dose IIV or LAIV Tuberculin Test Blood Pressure Developmental Surveillance Review & Update Dyslipidemia Screening Vision Screening Psychosocial/Behavioral Assessment Urinalysis Hearing Screening 9 Years Height and Weight Physical Examination/Unclothed Influenza yearly Vision Screening BMI (Percentile) History-Initial/Interval Hearing Screening Blood Pressure Developmental Surveillance Review & Update Hematocrit or Hemoglobin Dyslipidemia Screening Psychosocial/Behavioral Assessment Please refer to Tuberculin Test Once 9-11yr Urinalysis 10 YEARS Height and Weight Physical Examination/Unclothed Influenza yearly Hematocrit or Hemoglobin BMI (Percentile) History-Initial/Interval Tuberculin Test Blood Pressure Developmental Surveillance Review & Update Dyslipidemia Screening Vision Screening Psychosocial/Behavioral Assessment Urinalysis Hearing Screening Dyslipidemia Screening ADOLESCENCE RISK ASSESSMENT (If AGE SCREENING ASSESSMENT/EDUCATION IMMUNIZATIONS indicated) YEARS Height and Weight Physical Examination-Unclothed Year Olds Vision Test BMI (Percentile 11y-21) Breast &/or Testicular Exam Influenza yearly 11yr, 13yr 14yr, Blood Pressure History Initial/Interval TdaP - MCV 16yr-21yr Vision Test Development Surveillance HPV (series of 3) Hearing Test 12yr, 15yr, 18yr Psychosocial/behavioral Year Olds Alcohol & Drug Use Dyslipidemia Screening Influenza yearly Tuberculin Test (Once 9-11yr and 18-21yr) MCV Booster 16-18yr Dyslipidemia Screening Depression 11-21yr (1 dose if first dose) 12-17yr Cervical Dysplasia at 21 yr MenB 16-18yr Hematocrit or Hemoglobin HIV once 16-18yr All college kids in dorms STI / HIV Chlamydia Please refer to Urinalysis (if sexually active) *Consider Combination Vaccines When Possible Administer highlighted vaccines not previously given. AAP recommends annual visits ages 11-21yrs. Guidelines are based on the American Academy of Pediatrics Recommendations for Preventive Pediatric Health Care. The immunization schedule is based on the Recommended Immunization Schedule for persons aged 0-6 and 7-18 years-united States, 2016 These guidelines are for preventive care, other services may be required based on individual member s needs or risk factors.

3 PEDIATRIC - EARLY CHILDHOOD RISK ASSESSMENT AGE SCREENING ASSESSMENT/EDUCATION IMMUNIZATIONS (if indicated) 12 MONTHS Length/Height and Weight Physical Examination/Unclothed Influenza yearly Blood Pressure Weight for Length Developmental Surveillance DTaP #4 Vision Screening Hematocrit or Hemoglobin Psychosocial/Behavioral Assessment (6M after 3rd dose) Tuberculin Test Blood Lead Level Hib #4 Lead Screening Oral Health PCV #4 MMR #1 Varicella #1 Hep A #1 (2 doses 6M apart) Hep B #3 IPV #3 15 MONTHS Length/Height and Weight Physical Examination/Unclothed Influenza yearly Blood Pressure Weight for Length Developmental Surveillance Vision Screening Psychosocial/Behavioral Assessment *PCV13 Hematocrit or Hemoglobin 18 MONTHS Length/Height and Weight Physical Examination/Unclothed Influenza yearly Blood Pressure Weight for Length Developmental Screening Hep B #3 Vision Screening Oral Health Autism Screening IPV #3 Hematocrit or Hemoglobin Psychosocial/Behavioral Assessment DTaP #4 Lead Screening (6M after 3 Dose) Hep A #1 (2 doses 6M apart) *PCV13 24 MONTHS Length/Height and Weight Physical Examination/Unclothed Influenza yearly Blood Pressure Head Circumference History-Initial/Interval 1 or 2 dose IIV or LAIV Hearing Screening Body Mass Index (BMI) Developmental Surveillance Vision Screening (Percentile) Autism Screening *PCV13 Hematocrit or Hemoglobin Blood Lead Level Psychosocial/Behavioral Assessment Review & Update Tuberculin test Oral Health Please refer to Dyslipidemia Screening Lead Screening 30 MONTHS Length/Height and Weight Physical Examination/Unclothed Influenza yearly Blood Pressure Body Mass Index (BMI) History-Initial/Interval 1 or 2 dose IIV or LAIV Hearing Screening (Percentile) Developmental Screening Vision Screening Oral Health Psychosocial/Behavioral Assessment *PCV13 Hematocrit or Hemoglobin Same as above 3 YEARS Length/Height and Weight Physical Examination/Unclothed Influenza yearly Blood Pressure Body Mass Index (BMI) History-Initial/Interval 1 or 2 dose IIV or LAIV Vision Screening (Percentile) Developmental Surveillance *PCV13 Hearing Screening Oral Health Psychosocial/Behavioral Assessment Review & Update Hematocrit or Hemoglobin Please refer to Lead Screening Tuberculin test 4 YEARS Length/Height and Weight Physical Examination/Unclothed Influenza yearly Blood Pressure Body Mass Index (BMI) History-Initial/Interval 1 or 2 dose IIV or LAIV Vision Screening (Percentile) Developmental Surveillance DTaP #5 Hearing Screening Psychosocial/Behavioral Assessment IPV #4 Hematocrit or Hemoglobin MMR #2 Lead Screening Varicella #2 Tuberculin Test *PCV13 Dyslipidemia Screening Hep A (2 doses 6M apart) *Consider Combination Vaccines When Possible. Administer highlighted vaccines not previously given. * Children months need at least 1 dose of PCV13 if PCV 7 series completed Guidelines are based on American Academy of Pediatrics Recommendations for Preventive Pediatric Health Care. The immunization schedule is based on the Recommended Immunization Schedule for persons aged 0-6 years-united States, 2016 These guidelines are for preventive care, other services may be required based on individual member s needs or risk factors.

4 ADULT FEMALE Years Height History Influenza - yearly Weight Aspirin Therapy* Tdap x 1 dose; then Td BMI Drug/Alcohol use every 10 years Blood Pressure Tobacco Cessation HPV < 26 years x 3 doses Colorectal Screening > 50 Years of age Diet and Exercise Varicella x 2 doses *(earlier if at risk) Obesity Screening Zoster > 60 FOBT- Series of 3; ifobt- Annually (BMI>30 kg/m2) MMR 1 or 2 doses and/or Flexible Sigmoidoscopy every 5 years Sexual Behavior/ ( (20-55 year olds) or Colonoscopy every 10 years Contraception *Risk Group Bone Density Screening 60-64* (if at risk) Calcium Intake Hepatitis A* Clinical Breast Exam - Annually* Dental Health Hepatitis B Screening* Mammogram > 40 - annually Depression Hepatitis C screening* LAB STUDIES Violence/Abuse PPD* Pap Test / cytology- Ages every 3 years OTC Vitamins, Pneumococcal* (Prefer >30 co-test cytology with HPV testing every 5 years) Supplements & Meningococcal* Chlamydia, Gonorrhea & Syphilis Screening Medications Hib* (sexually active females aged < 24 years High Blood Pressure Lung Cancer Screening* and older women at increased risk for infection) Behavioral Counseling* Fasting lipoprotein profile > 20 years every 4-6 years BRCA Risk Assessment* (Total Cholesterol, LDL, HDL and Triglycerides) Breast Cancer Rubella serology/vaccination hx Preventive Medications* HIV (non-pregnant adults) Blood Glucose* MALE Years Height History Influenza - yearly Weight Aspirin Therapy* Tdap x 1 dose; then Td BMI Drug/Alcohol use every 10 years Blood Pressure Tobacco Cessation HPV < 26 years x 3 doses Colorectal Screening > 50 Years of age Diet and Exercise Varicella x 2 doses *(earlier if at risk) Obesity Screening Zoster > 60 FOBT- Series of 3; ifobt - Annually (BMI>30 kg/m2) MMR - 1 or 2 doses and/or Flexible Sigmoidoscopy every 5 years Sexual Behavior/ (20-55 year olds) or Colonoscopy every 10 years Contraception *Risk Group Prostate Screening Calcium Intake Hepatitis A* (as recommended by physician with informed consent) Dental Health Hepatitis B Screening* LAB STUDIES Depression Hepatitis C Screening * Fasting lipoprotein profile > 20 years every 4-6 years Violence/Abuse PPD* Hib* (Total Cholesterol, LDL, HDL and Triglycerides) OTC Vitamins, Pneumococcal* HIV Supplements & Meningococcal* Syphilis* Medications Lung Cancer Screening* High Blood Pressure Behavioral Counseling* Blood Glucose* *See specific guidelines for at risk groups Guidelines are recommendations for periodic assessments from the United States Preventive Services Task Force based on AHRQ Home/Clinical Information/U.S. Preventive Services Task Force, American College of Obstetricians and Gynecologists guidelines for cervical and breast cancer screening, ACC/AHA (American College of Cardiologists/ American Heart Association) and recommendations are the guidelines used for cholesterol screening. Immunization Schedule from Center for Disease Control "Recommended Immunizations for Adults by Age 2016". Guidelines are for preventive health care, other services may be required based on individual member s needs and risk factors.

5 PRENATAL-POSTPARTUM INITIAL EVALUATION SCREENINGS LAB STUDIES ASSESSMENT/EDUCATION Height CBC with differential Complete History Weight - Current & Pre-pregnancy (Hematocrit, Hemoglobin, MCV, Platelets) Estimated Date of Delivery BMI Urine for culture & sensitivity Current Medication (Prescription & OTC) Blood Pressure Pap Smear Tobacco Use Physical Examination ABO/Rh Typing with antibody screen Substance Use Ultrasound Rubella and Varicella Antibody Titer Signs and Symptoms to report to provider Cystic Fibrosis Screening - (optional) Test for Syphilis then VDRL or RPR, FTA, Nutrition (Offered if not done prior to pregnancy) Test for Chlamydia Environmental Exposure Psychosocial Risk Screening Test for Gonorrhea (if indicated) Hot Tub Warning Hepatitis B surface antigen Exercise Cell Free DNA Test HIV antibody testing Evaluate risk for domestic violence (if over 35 yrs. at delivery or at risk) One Hour Glucose Tolerance Test Zika virus education Test for Syphilis and Chlamydia IMMUNIZATIONS Sickle Cell Screen-offered to African Americans Influenza (inactive) during flu season Genetic Risk Assessment and counseling regardless of stage of pregnancy During the initial evaluation, the physician or Certified Nurse Midwife needs to perform a risk assessment. At risk pregnancies need to be referred to Paramount s Case Management Program for follow-up. In addition the initial evaluation needs to include documentation of these guidelines. FOLLOW-UP VISITS SCREENINGS LAB STUDIES ASSESSMENT/EDUCATION Weight Quadruple Screen at Weeks - offered Prenatal Risk Factor Blood Pressure (Alpha-fetoprotein, b-hcg, unconjugated Estriol, Inhipin-A) Safe Infant Sleeping environment Fundal Height Antibody Screen at 28 weeks Rhogam (if appropriate) Fetal Heart Tones (if Rh Negative; prior to giving Rhogam) Exercise Fetal Movement (to be recorded each Hemoglobin or Hematocrit Childbirth Process visit during the 2nd and 3rd trimester) (to be recorded at weeks gestation) Infant Feeding Dipstick Urinalysis CBC with differential Choosing Child s Physician Presence of Contractions (if Hemoglobin<10 or Hematocrit< 32) WIC/Nutrition Presence of Edema Iron studies if low MCV Birth Control Ultrasound (at risk) Hemoglobin Electrophoresis-recommended if indicated Working Sononuchal-lucency weeks One Hour Glucose Tolerance Test at 28 weeks Air travel during pregnancy (at risk) Group B Strep week Postpartum Tubal Ligation Psychosocial Risk Screening HIV antibody testing Circumcision Genetic Studies (as indicated) Vaginal Birth After Cesarean (if indicated) Umbilical cord blood bank Third Trimester testing Tdap during each pregnancy at weeks Test for Syphilis then VDRL or RPR, FTA, (if at risk) gestation Chlamydia and Gonorrhea (if at risk) Follow-Up visits are scheduled every 4 weeks for the first 28 weeks of gestation, every 2 weeks until 36 weeks of gestation and weekly thereafter. The frequency of follow-up visits is determined by the individual needs of the woman and assessment of her risks. POSTPARTUM VISITS SCREENINGS IMMUNIZATIONS ASSESSMENT/EDUCATION Weight Tdap (after delivery if not immunized) Interval History Blood Pressure Assess adaptation to newborn Breasts Physical Exam to evaluate status Abdomen Breastfeeding Pelvic Exam / Pap Test (if needed) Evaluate for Postpartum depression Episiotomy Repair Birth Control Uterine involution Safe Infant Sleeping environment Return to Work Postpartum visits should be scheduled approximately 4-6 weeks after delivery. A visit within 7-14 days of delivery may be advisable after a cesarean delivery or a complicated gestation. Guidelines are recommendations from Guidelines for Perinatal Care Seventh Edition and the American College of Obstetricians and Gynecologists. These are guidelines for members with an uncomplicated pregnancy. Other services may be required based on individual member s needs or risk factors. Services should be performed as needed and are at the discretion of the provider. These guidelines are not considered as standards of care but are developed to enhance the clinician s practice. PARAMOUNT HEALTH CARE OFFERS 2 POSTPARTUM HOME VISITS FOR ALL ADVANTAGE MEMBERS; PLEASE ENCOURAGE OUR MEMBERS TO ACCEPT THESE VISITS AND USE THIS OPPORTUNITY TO HELP THEM ADJUST TO THEIR NEW RESPONSIBILITIES. These guidelines are for Preventive care, other services may be required based on individual member's needs or risk factors.

6 SENIOR ADULT PREVENTIVE HEALTH GUIDELINES FEMALE 65 YEARS Height History Influenza - every year Tobacco/Drug/Alcohol use: Tdap x 1 dose; then Td - every 10 & Over Weight screening, counseling & years BMI intervention Varicella x 2 doses Blood Pressure Urinary Incontinence (lack evidence of immunity) Colorectal Screening Diet and Exercise Zoster - 1 dose FOBT- series of 3; ifobt Annually and/or Obesity Screening Pneumococcal (PCV13) Flexible Sigmoidoscopy every 5 years (BMI>30 kg/m2) Pneumococcal (PPSV23) or Colonoscopy every 10 years Sexual Behavior *Risk Group Hearing Screening Calcium Intake MMR* Vision Screening Dental Health Hepatitis A* Bone Density Screening - every 2 years Depression Hepatitis B screening* Mammogram - Annually Abuse/Neglect Hepatitis C screening* Clinical Breast Exam - Annually OTC Vitamins, HIV* LAB STUDIES Supplements & Meningococcal* Fasting lipid profile ages 75 every 4-6 years Medications PPD* (Total Cholesterol, LDL, HDL and Triglycerides) Fall risk assessment and Lung cancer* Pap Test - Women who are sexually active & intervention (exercise, Behavioral Counseling* who have a cervix every 3 years physical therapy, vitamin D BRCA testing* (Consider discontinuation of testing > 65 supplement) for high risk Breast cancer preventive if 3 prior screenings were normal & no hx of CIN > 2) community dwelling adults medication* Chlamydia, Gonorrhea & Syphilis Screening High Blood Pressure Blood Glucose* (sexually active women at increased risk for infection) MALE 65 YEARS Height History Influenza - every year Tobacco/Drug/Alcohol use: Tdap x 1 dose; then Td - every 10 & Over Weight screening, counseling & years BMI intervention Varicella x 2 doses Blood Pressure Urinary Incontinence (lack evidence of immunity) Colorectal Screening Diet and Exercise Zoster - 1 dose FOBT- Series of 3 or ifobt - Annually Obesity Screening Pneumococcal (PCV13) and/or Flexible Sigmoidoscopy every 5 (BMI>30 kg/m2) Pneumococcal (PPSV23) years, or Colonoscopy every 10 years Sexual Behavior *Risk Group Hearing Screening Dental Health MMR* Vision Screening Depression Hepatitis A* Prostate Screening Abuse/Neglect Hepatitis B screening* (as recommended by physician with informed consent) OTC Vitamins, Hepatitis C screening* Abdominal Aortic Aneurysm ultrasound with Supplements & HIV* history of smoking (one time screening) Medications Meningococcal* Bone Density Screening - ages 70 Fall risk assessment and PPD* intervention (exercise, Lung cancer* LAB STUDIES physical therapy, vitamin D Behavioral Counseling* Fasting lipid profile ages 75 every 4-6 years supplement) for high risk Blood Glucose* (Total Cholesterol, LDL, HDL and Triglycerides) community dwelling adults Syphilis*SyphilisSyphilis High Blood Pressure Guidelines are recommendations for periodic assessments from the United States Preventive Services Task Force based on AHRQ Home/Clinical Information/U.S. Preventive Services Task Force, *please see specific guidelines for at risk groups. American College of Obstetricians and Gynecologists guidelines for cervical and breast cancer screening. ACC/AHA (American College of Cardiology/American Heart Association) recommendations for cholesterol screening; National Osteoporosis Foundation guidelines for bone density screening. Immunization Schedule from Center for Disease Control Recommended Immunizations for Adults by Age *See specific guidelines for at risk groups Guidelines are for preventive health care, other services may be required based on individual member s needs and risk factors.