Clinical Processes

Question 1

Blood pressure measurements
Normal
Elevated
Stage1
Stage2

Answer 1

Normal less than 120/80
Elevated 120-129/80
Stage 1 130-139/80-89
Stage 2 greater than 140/90

Question 2

Waist circumference and waist to hip ratio

Answer 2

M > 40in. 102cm. 0.9
F > 35in. 88cm. 0.85

Question 3

Risk factor measurements
1 Life’s simple 7 questionnaires
2 ASCVD
3 2015 MENSA
4 Reynolds risk score for women

Answer 3

1 Life’s simple - smoking, PA, weight, diet, blood glucose, cholesterol, BP
2 Age 20-79 and no heart disease. Under estimate American Indian and south Asians
Over estimate East Asians
3 multiple ethnicities
4 female, family hx, high sensitivity crp

Question 4

Healthcare effectiveness data and information set
HEDIS

Answer 4

Primary care clinics track data for HEDIS
Vital signs
Lab results
Patient satisfaction

Question 5

Why is tracking essential for patient care?

Answer 5

Helps see effectiveness of intervention
Info for quality improvement
Cost saving analysis
Monitor for reimbursement

Question 6

Using electronic medical records to track lifestyle measures

Answer 6

Know where and how the info is stored
Extract data so it can be used meaningfully
Decide on frequency

Question 7

Evidence for collaborative care in improved lifestyle outcomes

Answer 7

Higher compliance
Improved outcome
Enhanced engagement and maintenance
Increase weight at 1 year compared to standard care

Question 8

Innovative Care for Chronic Conditions

Answer 8

Micro level - pt and family
Meso level - health care organisation and community
Macro level - policy

Question 9

Collaborative care manager model by the agency for healthcare research and quality

Answer 9

Model of integrative care for chronic conditions.
Patient at the centre
Nurse practitioner or Physician Assisstant - 1st point of contact and manages care
Clinical expert
Resident
MDT

Question 10

Guidelines for implementation of chronic care model

Answer 10

Community engagement
Support within health care system
Self management support of pt
System design - strategic visits, recalls, group consultations, co-ordinate with MDT
Evidence based care and appropriate goals for patient

Question 11

Prescription for health model

Answer 11

6 year initiative involving 22 primary care research networks
4 behaviours targeted - tobacco/ alcohol / diet / PA

Substantial practice redesign needed
Possible with right funding and support

Question 12

Plan Do Study Act

Answer 12

Plan - who what when where. Make predictions
Do - carry out plan and document
Study - data analysis, compare to prediction. Summarise lessons learned
Act - what needs to be changed next cycle

Question 13

Root- cause analysis

Answer 13

Some goes wrong or near miss
Ask why x 5
Then so what
Cause and effect diagram
Analysis