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THEALABAMAWISEWOMAN

POLICYANDPROCEDUREMANUAL

December2014

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TableofContents

INTRODUCTION…………………………………………………………………………………………………………………………………........5

Purpose………………………………………………………………………………………………………………………………………..5

Mission…………………………………………………………………………………………………………………………………………5

FundingResponsibilites…………………………………………………………………………………………………………………5

ADPHRESPONSIBILITIES…………………………………………………………………………………………………………………………6

PROVIDERRESPONSIBILITIES…………………………………………………………………………………………………………………7

HIPAA……………………………………………………………………………………………………………………………………………7

PatientRights………………………………………………………………………………………………………………………………...7

InformedConsent……………………………………………………………………………………………………………………………7

PatientEnrollment………………………………………………………………………………………………………………………….8

RecordKeeping………………………………………………………………………………………………………………………………8

ReportingRequirements…………………………………………………………………………………………………………………8

Contracts/Reimbursement……………………………………………………………………………………………………………..8

ALWISEWOMANPATIENTFLOW……………………………………………………………………………………………………………..9

IntegratedOfficeVisit…………………………………………………………………………………………………………………….9

CVDScreening………………………………………………………………………………………………………………….9

RiskReductionCounseling……………………………………………………………………………………………….10

HealthyBehaviorOptionsSession……………………………………………………………………………………10

FollowUpAFTERIntegratedOfficeVisit……………………………………………………………………………………….10

NutritionalCounseling…………………………………………………………………………………………………….10

OneMonthMedicalFollowupOfficeVisit………………………………………………………………………..10

FollowupAssessment……………………………………………………………………………………………………..10

FollowUpServicesthroughtheALWISEWOMANSocialWorker…………………………………………………..10

ALWISEWOMANFLOWCHART………………………………………………………………………………………………………………12

ALWISEWOMANSCREENINGTESTS……………………………………………………………………………………………………….13

Height/Weight/BMI……………………………………………………………………………………………………………………..13

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FastingLipidProfile…………………………………………………………………………………………………………………….13

FastingGlucose……………………………………………………………………………………………………………………………13

A1C……………………………………………………………………………………………………………………………………………..13

BloodPressure…………………………………………………………………………………………………………………………….13

HYPERTENSIONPOLICY…………………………………………………………………………………………………………………………14

ALERTVALUEPROTOCOL………………………………………………………………………………………………………………………15

ALERTANDDISEASE‐LEVELVALUES…………………………………………………………………………………………………….16

Glucose………………………………………………………………………………………………………………………………………..16

Cholesterol/Lipids……………………………………………………………………………………………………………………….16

BloodPressure…………………………………………………………………………………………………………………………….16

UNCONTROLLEDHYPERTENSIVEPARTICIPANTS………………………………………………………………………………….17

DATACOLLECTIONFORMS…………………………………………………………………………………………………………………....18

Purpose………………………………………………………………………………………………………………………………………18

DataCollectionRequirements………………………………………………………………………………………………………18

ALWWDataCollectionForm:BASELINE/RISKREDUCTION…………………………………………………………18

HICF1500BillingForm……………………………………………………………………………………………………………….18

ALWWHealthCoachingContactForm…………………………………………………………………………………………19

HowtoChangePatientInformation………………………………………………………………………………………………19

BILLINGANDREIMBURSEMENT…………………………………………………………………………………………………………….19

Requirements……………………………………………………………………………………………………………………………...19

IntegratedOfficeVisitReimbursement…………………………………………………………………………………………19

ClinicalLabTests…………………………………………………………………………………………………………………………20

RiskReductionCounselingCodes…………………………………………………………………………………………………20

NutritionalCounselingSessionCodes…………………………………………………………………………………………...20

MedicalFollowUpOfficeVisitCodes…………………………………………………………………………………………….20

APPENDICES……………………………………………………………………………………………………………………………………………21

A:NationalClinicalGuidelines,p.22‐25

B:AuthorizationforServices,p.26‐27

C:ABCCEDP/ALWWInformedConsent/ReleaseofInformation,p.28‐29

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D:HypertensionFlowchart,p.30

E:ProgramDataForms,p.31

Baseline/RiskReductionForm,p.31‐32

ALWWContactForm,p.33‐34

HomeMonitoringBPAgreementContract,p.35

HICF1500Form,p.36

F:CPT/ReimbursementTable,p.37

G:ClearanceLetterforParticipationinPhysicalActivity,p.38

H:BloodPressureMeasurementProcedure,p.39

I:NEWLEAFHealthCoaching,AlabamaExpandedFoodandNutritionEducationProgram(EFNEP),Health

CoachingandLSPFlowChart,Community‐BasedResources,p.40‐44

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INTRODUCTION

PURPOSE

In1993,theCentersforDiseaseControlandPrevention(CDC),withintheDivisionforHeartDiseaseandStrokePrevention(DHDSP),wasgivenauthoritybyCongresstofacilitatetheWISEWOMAN(Well‐IntegratedScreeningandEvaluationforWomanAcrosstheNation)program,withtheclearaimsofhelpingwomenages40to64yearstounderstand:1)theirriskfactorsfordevelopingCVDand/orotherchronicdiseasessuchasdiabetes,hyperlipidemia,andhypertension,and2)howtomakelifestylechangestopreventdiseaseandtoproduceoverallhealth.

Inthesummerof2013,CDCofferedtheopportunityforfederalfundingtostateswithcurrentbreastandcervicalcancerscreeningprogramstoapplyforadditionalfundingforWISEWOMANProgramservices.TheAlabamaBreastandCervicalCancerEarlyDetectionProgram(ABCCEDP)oftheAlabamaDepartmentofPublicHealth(ADPH)appliedforandwasgrantedfundingtoconducttheAlabamaWISEWOMANProgram(ALWISEWOMAN),operatingfromJuly01,2013throughJune29,2017.TheAlabamaDepartmentofPublicHealthisaccountabletotheCDCfortheappropriateuseofthesefunds.

MISSION

ThemissionofALWISEWOMANistomanageandreducecardiovasculardiseaseriskfactorsamongunderservedwomen,ages40to64inMobileCounty,Alabama.ALWISEWOMANwillprovidecomprehensivecardiovasculardiseaseriskfactorscreeningsforwomen40‐64receivingbreastandcervicalcancerscreeningsthroughABCCEDPatFranklinPrimaryHealthCareCenter(FPHC)andMobileCountyHealthDepartment(MCHD).Allprogramcomponentsarerelatedtothedeliveryofscreeninganddiagnosticservices,anddeliveryofsupporttothoseinneed.

AmongMobileCountywomen,ourtargetpopulation,deathratesarehighercomparedtoUSwomenforallmajorcauses;CVD‐relateddeathratesare19%higher,diabetes‐relatedratesare37%higher;canceris5%higher,cardiovasculardiseaseis14%higherandstroke‐relateddeathratesare36%higher.Alabama’s2010age‐adjustedmortalityratesreportedlargehealthdisparitiesexistingbetweenBlackwomenandWhitewomenlivinginMobileCounty.ComparedtoMobileCountyWhitewomen,MobileCountyBlackwomenhad:1)a31%highermortalityratefromCVD,2)a117%highermortalityratefromdiabetes,and3)a60%higherratefromstroke.Thesedatademonstrateasignificantneedtomonitorthecardiovascularhealthofat‐riskMobilewomenandtoprovidethemnecessaryskills,likethosefoundinevidence‐basedlifestyleprograms,forimprovingandmaintaininghealthybehaviors.

FUNDINGREQUIREMENTS

CDCrequires60%ofADPHgrantfundsbeusedforexpensesdirectlyforALWISEWOMANclinicalservices,suchas:

Screeningclinicalandbloodtestswithdiagnostictestingasneeded RiskAssessmentandRiskReductionCounseling NutritionalCounseling Reviewandinterpretationofclinicalandbloodtests,bothinwritingandorally SocialWorkServices Referralforcommunitysupportservicesusedtomaximizeparticipationinscreeningandrisk

reductionservicesClinicalservicesmustbeprovidedinaccordancewithNationalClinicalGuidelineslistedinAppendixA.

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CDCalsorequiresnomorethan40%ofgrantfundsbeusedforactivities/servicesnotdirectlybenefitingALWISEWOMANparticipants,suchas:

Managementactivities* Recruitmentandoutreach Professionaldevelopment Datamanagement,qualityassurance,andqualityimprovement Developmentandmaintenanceofpartnerships Communityengagement Surveillanceandevaluationactivities Travel Evaluation

*Nomorethat10%ofADPHfundscanbeusedforadministrativecosts.The10%administrativecostsareconsideredtobepartofthe40%distribution

Note:NofundsmaybeusedtopayforinpatienthospitalservicesforALWISEWOMANparticipants

ADPHRESPONSIBILITIES

CDCprovidesaframeworkandguidelinesthatADPHischargedwithfollowingasarecipientofCDCWISEWOMANfunds.TheseguidelinesareimplementedthroughADPHincombinationwithADPHfiscalandprogrammaticguidelinesandestablishthebasisforcontractedproviderstoplan,implement,andevaluatetheprovisionofservices.ADPHisresponsibletoensureALWISEWOMANprovidersprovidequalitypatientcareinallfacetsoftheprogram,including:1)allcomponentsoftheIntegratedOfficeVisit,2)allALWISEWOMANSocialWorkerfollowupservices,and3)therescreeningservicesat12‐18months.

ADPHhascontractedwithtwohealthcareagencies,FranklinPrimaryHealthCareCenterandtheMobileCountyHealthDepartment,toprovidefortheALWISEWOMANProgram,thefocusofwhichiscardiovasculardiseaseprevention.

ADPHensurescontractedprovidersuseestablishedCDC‐approvedprotocolsforALWISEWOMANservicedelivery.

ContractedprovidersareaccountabletotheADPHfortheappropriateuseoffunds. SupervisionofALWISEWOMANstaffwillbeperintuitionalguidelinesandincompliancewithstate

licensurerequirements.

Inadditiontoprovidingfinancialsupport,ADPHwillassistcontractedprovidersthrough:

GuidanceinhiringoftwolicensedsocialworkerswhowillserveasALWISEWOMANSocialWorkers,oneperfacility

Professionaleducation,programdevelopmenttrainings,datamanagementtrainings,andmeetingsforcontractedproviderstaff

Technicalassistancewithprogramplanning,development,implementation,operations,andevaluationinaccordancewithfederalandstategovernmentdirectives

Programguidanceinimplementingandmaintaininganelectronictracking/follow‐upandreferralsystemforthedeliveryofprogramservices

Technicalassistancewithqualityassuranceandimprovementactivities Assistancewithenhancingand/ordevelopingpublic/participanteducationactivities Assistancewithprogrampromotionandrecruitmentofeligibleparticipants Standardizedformsandtemplatesforallmandatoryfiscalandprogrammaticreportingrequirements List(s)ofallowableCPTcodesandreimbursementratesforprogramservices

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Annualupdatesofeligibilityguidelinesincludingincomeeligibility Regularprograminformation/updatesviae‐mail,conferencecalls,trainings,webinars,meetings,and

sitevisits

PROVIDERRESPONSIBILITIES

TheAlabamaWISEWOMANPolicyandProcedureManualprovidesprogramguidanceforALWISEWOMANproviders,FranklinPrimaryHealthCareCenterandtheMobileCountyHealthDepartment,indeliveringappropriatescreeningservicesforALWISEWOMANparticipants.

A. HIPAA

ALWISEWOMANprovidersarerequiredtofollowtheU.S.DepartmentofHealthandHumanServicesPrivacyRuleandimplementtherequirementsoftheHealthInsurancePortabilityandAccountabilityActof1996(“HIPAA”).TheStandardsforPrivacyofIndividuallyIdentifiableHealthInformation(“PrivacyRule”)establishesasetofnationalstandardsfortheprotectionofcertainhealthinformation.TheU.S.DepartmentofHealthandHumanServices(“HHS”)issuedthePrivacyRuletoimplementtherequirementoftheHealthInsurancePortabilityandAccountabilityActof1996(“HIPAA”).ThePrivacyRulestandardsaddresstheuseanddisclosureofindividuals’healthinformation—called“protectedhealthinformation”byorganizationssubjecttothePrivacyRule—called“coveredentities,”aswellasstandardsforindividuals'privacyrightstounderstandandcontrolhowtheirhealthinformationisused.WithinHHS,theOfficeforCivilRights(“OCR”)hasresponsibilityforimplementingandenforcingthePrivacyRulewithrespecttovoluntarycomplianceactivitiesandcivilmoneypenalties.

B. PatientRights

ALWISEWOMANcontractedprovidersarerequiredto:

Protecttheuse/disclosureofanywoman’smedicalorsocialinformationofaconfidentialnature Considermedicalservicesandinformationcontainedinmedicalrecordsasconfidential Disclosethewoman’smedicalrecordstocontractedABCCEDPphysiciansormedicalfacilitiesaccepting

thewoman Disclosethewoman’smedicalrecordstotheABCCEDPStateOffice Disclose—insummaryorotherform—informationwhichdoesnotidentifyindividualsorproviders,if

suchinformationisincompliancewithapplicablefederalandstateregulations,andtheexchangeofmedicalrecordinformationisinkeepingwithestablishedmedicalstandardsandethics

C. InformedConsentParticipantsoftheALWISEWOMANagreetohavepersonalandfamilyhistoryinformationcollectedandsharedwiththeADPH. BysigningtheALWISEWOMANconsentform,theparticipantgrantspermissiontohealthcare

providerstoreportallinformationconcerningscreeningstestsandprocedures,treatment,patientnavigationservices,andanyrelatedcareoractivitytoADPH.

ThisformmustbecompletedatthetimewhentheparticipantenrollsintheALWISEWOMANProgram. Anewconsentformmustbesignedateachannualrescreening.Verbalconsentatthetimeofannual

rescreeningisnotacceptable.SeeAppendixB,AuthorizationforServicesForm

D. PatientEnrollment

ForenrollmentintoALWISEWOMAN,thescreeningprovidermustcompletethefollowing:

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Determineeligibilitybasedonincome,age,andinsurancestatus ObtainatrackingnumberforallWISEWOMANparticipantsthroughtheweb‐basedEnrollmentsite

Med‐IT@http://Med‐ITweb.comduringthepatient’sinitialorannualvisit InordertocreateaWISEWOMANtrackingnumberinMed‐IT,firstselectthecorrectpatientor

createanewpatientandthenclick“SetAppointment”ontheMed‐ITEnrollmentPage ThencheckWISEWOMANboxonthe“ScreeningGuidelines”pagealongwithBCC,thencreatean

appointmentdate TheWISEWOMANtrackingnumberwillhavea“W“beforethenumber

E. Record‐Keeping

Copiesofthesignedpatientconsentforms,theWISEWOMANbaselinedata/riskreductionform,andallALWWContactformsaretobeenteredintothepatient’spermanentmedicalrecord/E.H.R.maintainedbytheprimaryprovider.

Theprovidermustdocumentalleducationprovidedtoparticipants. Theprovidermustestablishasystemfortrackingwomenwhichnotifiesherwhenitistimeforroutine

screening,followups,rechecks,andrescreeningvisits. EnsureallwomenfoundtohaveALERTvaluesarereferredformedicalevaluationandtreatment

immediatelyorwithin7days,theintegratedofficevisitcountingasDAY1andthatALERTworkupsarecompletedanddocumentedintheEHR

EnsureallwomenfoundtohaveABNORMAL/DISEASE‐LEVELvaluesarereferredformedicalevaluationandtreatmentimmediatelyorwithin30days,theintegratedofficevisitcountingasDAY1,andthatthisfollowupiscompleteanddocumentedintheHER

F. ReportingRequirement

ToreceivereimbursementbyADPH,thescreeningproviderwillsubmit,bythe15thofthemonth,thefollowing:

ALWISEWOMANDataCollectionForm:Baseline/RiskReduction AnyALWISEWOMANContactForms TheHealthInsuranceClaimForm(HIFA1500)completewithallservicescodesanddateofservice

G. Contract/Reimbursement

ALWISEWOMANprovidersmustmaintaincurrentandapplicablefederaland/orstatelicenses. Allscreeningprovidersmustagreetoaccepttheprogram‐approvedreimbursementfeeaspaymentin

fullforservicesrendered.Thatreimbursement,bylaw,cannotbeoverthecurrentMedicarereimbursementrate.SeeAppendixFforReimbursementTable

H. QualityAssurance/QualityImprovement

ProvidersarerequiredtoparticipateinqualityassuranceandqualityimprovementactivitiesasdeemedappropriatebytheADPH.Thisincludescompliancewithcontractualperformancemeasuresandparticipationinscheduledsitevisitsandprofessionaldevelopmenttrainings.

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ALABAMAWISEWOMANPATIENTFLOW‐seeflowchartonpage12

ALWISEWOMANofferscurrently‐enrolledABCCEDPwomen,ages40to64,thefollowing:

Cardiovasculardiseaseriskfactorscreeningstodetermineriskfactors Riskreductioncounselingtohelpwomenundertheirrisksanddiscusstheparticipant’sreadinessto

embracemorehealthfulbehaviors Healthcoachingandsupporttohelpwomendiscoverhealthylifestylebehaviorstoprevent,minimize,

ordelaytheonsetofchronicdisease

Theprogramincludesabaselinescreeningvisitfollowedbyarescreeningvisitin12‐18months.

BaselineScreening/TheIntegratedOfficeVisit

ALWISEWOMANparticipantswillreceiveanIntegratedOfficeVisitwhichprovides:1)theirannualbreastandcervicalcancerscreeningsand2)cardiovasculardisease(CVD)work‐uptodeterminetheirriskfordevelopingchronicdiseasessuchasheartdisease,stroke,anddiabetes.

ALWISEWOMANparticipantswillbecalledforappointmentschedulingandwillbeaskedtobefastingfortheirscreeninglabtests.

TheIntegratedOfficeVisit

TheIntegratedOfficeVisitconsistsoffourmajorsections:

1. Annualbreastandcervicalcancerscreenings2. CVDriskfactorscreeningtests3. Risk‐reductioncounselingbymedicalstaff4. AHealthyBehaviorSupportOptionsSessionbytheALWISEWOMANSocialWorker

CVDriskfactorscreeningtestsinclude: Highbloodpressure(2bloodpressurereadingswithacalculatedaverage) Highcholesterol(Fastinglipidpanel) Diabetes(Fastingglucosefornon‐diabeticparticipants*;A1CbyPOCfordiabeticparticipants) Height,WeightandBMI,waistandhipmeasurements Smokingstatus Medicalhistoryandriskfactorassessment Healthylifestyleassessment Physicalandemotionalwell‐beingassessment

*Ifnon‐diabeticpatientisnotfastingattimeofappointment,anA1CbyvenipuncturewillbedrawnandtestedatareferencelabapprovedforNGSPcertifiedandstandardizedDCCTassay.

TheRiskReductionCounselingSessionbymedicalstaffwillinclude: Reviewmedicalhistory,healthylifestyleassessment,labandclinicalresults ConductaCVD10‐yearriskcalculationanddiscussCVDrisks Determinehypertensivepatientswiththeirtargetbloodpressurereading Determineparticipant’spriorityareasandreadinesstochange Discussdietandphysicalactivity

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MakereferralstotheALWISEWOMANSocialWorkerforcontinuedLifestyle/HealthCoaching(LSP/HC)sessions Amedicaldeterminationofabilitytoparticipateinphysicalactivity(SeeAppendixGforClearanceLetter) Provideparticipantwithawrittencopyoftheirhealthvalues

HealthyBehaviorSupportOptionsSessionbyALWISEWOMANSocialWorker:

TheALWISEWOMANSocialWorkerwillactasthecoordinatorforsupportofparticipants’needs,providingpracticalstrategiesformakinghealthylifestylechanges.

Usingmotivationalinterviewingtechniquesandsocialworkskills,theALWISEWOMANSocialWorkerwill:

Reviewtheriskreductioncounselingsession Providehealthylifestyleoptions Worktofindspecificandpersonalactionsforachievingahealthierlifestyle IntroduceALWWservices/NewLeafLifestyleprogram* Providehealthcoachingforskill,confidenceandknowledgebuilding Providecommunity‐basedreferralsforotherhealthylifestyleoptions Providemedicationassistancereferrals Providesupportivecounselingtoimproveandmaintainhealthybehaviorovertime

*SeeAppendixIforexpandedexplanationofNewLeaf

FollowUpServicesAFTERtheIntegratedOfficeVisit:

ForALWISEWOMANparticipantswhohavealertordisease‐levelclinicalfindingsattheIntegratedOfficeVisit,theprogramprovidesfortwofollowupreferrals:

1)ANutritionalCounselingsessionwitharegistereddieticianwithin1to2monthsaftertheIntegratedOfficeVisit

2)AMedicalfollowupofficevisitwithmedicalstaffforevaluationorotherassessmentofabnormalvalues,from1weekto1‐2monthpostintegratedofficevisit,onevisitperALWISEWOMANcycle.

3)Atapproximately7months,eachwomanwhocompletedtheLSPand/orhealthcoachingwillhaveafollowupassessment,inordertoevaluateshort‐termprogressandtofacilitategoaladjustmentsasneeded.

Useofmedicationstolowercholesterol,bloodpressureorbloodsugar Bloodpressureself‐monitoring Diet Physicalactivity Smokingandtobaccoexposure Qualityoflifeissues

FollowUpByALWISEWOMANSocialWorker:

Inordertoprovidesupportandreinforcelessonslearned,theALWISEWOMANSocialWorkerwillprovidefollowuptoinclude:

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Supportivecounselingandfollowuponprogresstowardgoals Aninvitationtomonthlysupportmeetingsheldthroughoutthecommunity Followupcallstobemadetoparticipantsbeginningorchanginghypertensionmedicationregimewithin10

days Followupforallcommunityreferralswithin10workingdaysofappointment Schedulingofrescreeningappointmentat12to18months Remindercallsforrescreeningappointment Quarterlycontact,ataminimum Followupasneeded

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Seewww.adph.org/earlydetection,theAlabamaWISEWOMANwebpageforaccesstoallprogramforms.

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ALWISEWOMANSCREENINGTESTS:

ProvidersmustensureallwomenenrolledinALWISEWOMANwithALERTordisease‐level(abnormal)screeningresultshaveaccesstoappropriatemedicalevaluationinthetimeframespecified,thatitiscomplete,andthatisdocumentedintheparticipant’sEHR

ProvidersmustcomplywithCDCNationalClinicalGuidelinesandallADPHprotocols.(SeeAppendixA) Providersmustensureparticipantsarefasting,totheextentisitpossible,fortheirlabtests.Tobe

consideredfasting,awomanmustnothaveneatenortakeninfluidsfor9hours Providersareencouragedtoestablishatrackingsystemthatincludesreminderstoparticipantstokeep

theirappointmentsfortheofficevisit,mammography,laboratorybloodtests,andotherrelatedscreeningtestsorprocedures.

Height/Weight/BMI/Waist/Hipmeasurements:

EachparticipantmusthaveaheightandweighttakenwithBMIcalculated,alongwithhipandwaistmeasurementswhendesired.

FastingLipidProfile:

ThisfastingprofilewillbeorderedinlieuoftotalcholesterolandHDL‐CsinceALWISEWOMANparticipantsaretobefasting*.Thisprofileincludesatotalcholesterol,LDL‐cholesterol,HDL‐cholesterol,andtriglycerides.

*Forthosewomenwhoarenotfasting,checkonlytheTotalcholesterolandHDL‐cholesterol.

FastingGlucose:

Allparticipantswhoarenotdiabeticwillbescreenedbyfastingglucose.Intheeventthatafastingglucosecannotbedrawnforanon‐diabeticparticipant,anA1CpercentagecanbetestedbutONLYifthebloodiscollectedbyvenipunctureandtestedinalabbyNGSPcertifiedandstandardizedDCCTassay.

NOTE:Afastingglucoseisnotdoneonanyparticipantdiagnosedwithdiabetes;instead,anA1Cisdrawn

A1C:

ParticipantspreviouslydiagnosedwithdiabeteswillreceiveanHbA1Cbyministick.

BloodPressure:Eachparticipantmusthavetwobloodpressuremeasurementstakenandtheaveragecalculated.Theaveragedbloodpressurenumberisthefinalbloodpressurereading.NOTE:Whenthesystolicanddiastolicbloodpressurereadingsfallintotwodifferentcategories,thehighercategoryshouldbeusedtoclassifythebloodpressurelevel.Forexample,160/80mmHgwouldbeStage2hypertension(highbloodpressure).Thehigherreadingofthesystolicbloodpressureof160mmHgdeterminestheclassificationofStage2hypertension.

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HYPERTENSIONDetectionandControl

Long‐termobjectivesfortheWISEWOMANProgramincludedeveloping“systemsthat

monitor,improve,andsustainthecardiovascularhealthofthepopulationserved.”(Version2,WISEWOMANTechnicalAssistanceandGuidanceDocument,page7)Preventing,wheneverpossible,andcontrollinghypertensionarecriticalstepsinaccomplishingthatbroadgoal.

TheAlabamaWWProgramhasmadethedetection,treatment,andmanagementofhypertensionamongparticipantsamajorfocus.ByfollowingscreeningguidelinesrequiredbyCDC,weanticipateidentifying:1)un‐diagnosedhypertensiveparticipants,2)hypertensivewomenwhohavebeendiagnosedinthepastbuttheirdiseaseisuncontrolled,and3)diagnosedhypertensivewomenwhoneedregularmonitoringandmaintenanceinordertoreducefurtherriskforseriouscardiovascularcomplications.

ManagementofStage1andStage2hypertensionisacomplexprocessinvolvingmanyhealthcareproviders:physicians,physicianassistants,nurses,socialworkers,dietaryandpharmacystaff,andmentalhealthpersonnel.Theseprofessionalsareneededtoensurethebestpossibleoutcomesforhypertensivepatients,andAlabamaWISEWOMANisdesignedtoinvolvethisteamintheinstructionandmanagementofitshypertensivewomen.

Inadditiontoteam‐basedefforts,self‐monitoringbloodpressure(SMBP)deviceswillbeavailabletoeligibleWWparticipantsasanotherpracticalandconvenienttoolfortrackingandmonitoringhypertension,outsideofamedicalsetting.Thesemonitorswillbeprovidedtoparticipantsfree‐of‐chargewho:1)havebeendiagnosedwithStage2hypertension,or2)havebeendiagnosedwithStage1hypertensionandwhotakeacholesterolorlipid‐reducingmedication,or3)whotaketwoormorebloodpressuremedications,or4)arerecommendedbytheirphysician.

Inordertoreceiveamonitor,AlabamaWWparticipantsmustagreetothefollowingstipulations:

Tochecktheirbloodpressureatleastonetimeperday,ineacharm,andrecordthe

results Tobringintheirbloodpressuretrackertoalldoctorappointmentssothattheir

readingsmaybesharedwiththeirhealthcareprovider Tocontacttheirhealthcareprovideriftheyhaveanysymptomsorquestionsrelatedto

theirbloodpressurereadings Tocontacttheirhealthcareprovideriftheirbloodpressurereadshigherthana

specifiedlevelasdefinedbytheirphysician Toimmediatelycontacttheirhealthcareprovideriftheirbloodpressurereadingis

180/110orhigher

ProtocolsformanagingallaspectsofhypertensionarefoundintheAlabamaWWPolicyand

ProcedureManual,inthefollowingdocuments: TheAlertValueProtocol,page15 ProceduresformanagingDisease‐levelhypertensionlevels,pages16‐17 TheAlabamaWWHypertensionFlowChart,page30 TheHomeBloodPressureMonitoringSelf‐ManagementPolicyandAgreement,page35

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ALERTVALUEPROTOCOL:

Alertvalues(veryhighvalues)forbloodpressureandglucose,singlyorincombination,cancausedamagetothebloodvessels(arteriosclerosis),brain(stroke),heart(heartattack),kidneys(renalfailure),andeyes(compromisedvision/blindness).

Policy:

TheProviderisresponsibleforensuringWWparticipantswithalertvaluesareevaluatedimmediately,i.e.,thesamedaythereadingsweretaken,orwithin7days—theintegratedofficevisitcountingasDAY1.

Theseriousimplicationsofalertvaluesrepresentforthehealthstatusofprogramparticipants,therearenoexceptionstothispolicy.

Participantswhowereseenrecentlybytheirclinicianorwillbeseenbytheircliniciansoonarenotexceptionstothisguideline.

Providersneedtotrackparticipantsbytelephonetoensurethattheykeeptheirmedicalappointment.

Providersneedtoensurethatallproviderstaffiseducated/re‐educatedconcerningthemanagementofalertvalues.

Ifwomenwithalertscreeningvaluesarenotseenintheexpectedtimeframe,providersshouldconsiderdoinganassessmentofthereferralprocedurestoidentifyareaswhereareasofimprovementareneeded.

AllwomenwithalertvaluesshouldbereferredtotheWISEWOMANSocialWorkertoprovideaccesstoWISEWOMANservices,followuponmedicalmanagement,andassistancewithprescriptionmedications.

DocumentationforAlertValueFollow‐up:

Providersmustdocumentintheparticipant’sEHR,thefollowinginformationforanypatientwithanalertvalue:

Thedatethemedicalevaluationwasstartedandcompleted Alltreatmentinformation Providersmustdocumentanyreasonswhyaparticipantdidnotreceivemedicalevaluationand

treatmentwithinthesevenbusinessdays,inpatient’sEHR

Pleaseseepage30fortheAlabamaWISEWOMANHypertensionFlowChart

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ALERTandDISEASE‐LEVELVALUES:

Womenwithalertlevelglucosereadingsaretobeevaluatedimmediately.Thosewithdisease‐levelreadingswhoarenotalreadytakingmedicationmustbeevaluatedimmediatelyorwithina30‐dayperiod.Theseevaluationsmustbedocumentedonthescreeningformandinthepatient’smedicalrecord.

Glucose:

ALERTfastingglucose:≤50mg/dlor≥250mg/dl

ALERTAction:WomenwhohaveAlertfastingglucosevaluesmustreceivemedicalattentionimmediatelyorwithin7days—theintegratedofficevisitcountingasDAY1—attheclinic,officeoremergencyroom.SeeAlertValueProtocol,pg14

Diseaselevelfastingglucose:≥126mg/dl

Disease‐LevelAction:Womenfoundtohavedisease‐levelglucoseresultswhoareNOTalreadybeingtreatedmustreceiveamedicalevaluationimmediatelyorwithin30days—theintegratedofficevisitcountingasDAY1.Cholesterol/lipids:

Diseaselevels:

Disease‐levelAction:Allwomenfoundtohavedisease‐levelfastingcholesterol/lipidresultswhoareNOTalreadybeingtreatedmustreceiveamedicalevaluationimmediatelyorwithin30days—theintegratedofficevisitcountingasDAY1.BloodPressure:(SeeAppendixDandHforHypertensionFlowchartandproperbloodpressuremeasurementprocedures)Eachparticipantmusthavetwobloodpressuremeasurementstakenandtheaveragecalculated.Theaveragedbloodpressurenumberisthefinalbloodpressurereading.NOTE:Whenthesystolicanddiastolicbloodpressurereadingsfallintotwodifferentcategories,thehighercategoryshouldbeusedtoclassifythebloodpressurelevel.Forexample,160/80mmHgwouldbeStage2hypertension(highbloodpressure).Thehigherreadingofthesystolicbloodpressureof160mmHgdeterminestheclassificationofStage2hypertension.

ALERTBloodPressure:SystolicBPof>180mmHgorDiastolicof>110mmHg

AlertAction:AnywomanwhohasanalertBPvaluemustreceiveimmediatemedicalattentionorwithin7days—theintegratedofficevisitcountingasDAY1—attheclinic,officeoremergencyroom.SeeAlertValueProtocol,p.15

Fastingtotalcholesterol ≥240mg/dl

FastingLDL‐cholesterol 160‐189mg/dl

Fastingtriglycerides 200‐499mg/dl

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Disease‐LevelBloodPressure:

*JNC8guidelinefor≥60yearoldswithoutdiabetesorchronickidneydisease(CKD)=<150/90mmHgAction:Allwomenfoundtohavedisease‐levelBPresultswhoareNOTalreadybeingtreatedmustreceiveamedicalevaluationimmediatelyorwithin30days—theintegratedofficevisitcountingasDAY1.

ForUncontrolledHypertensiveParticipants:SeeAppendixDforHypertensionFlowChartAllwomenwithuncontrolledhypertensionmustreceivepatientnavigationservicesandfollowuptoinclude:

Medicationcounselingthroughateamapproachofphysicians,medicalstaff,pharmacists,nutritionistsandSocialWorkers

HealthCoaching/supportivecounseling Counselingontheimportanceofbloodpressuremonitoringandeducatedonbloodpressuremonitoring

opportunitiesinthecommunity

NOTE:Ataminimum,allhypertensiveWISEWOMANparticipantsmusthavetheirbloodpressurecheckedanddocumentedinthepatient’srecordat1,3,and6monthsfromtheenrollmentdate.

HypertensionStage1* Systolic≥140‐159 Diastolic≥90‐99

HypertensionStage2 Systolic≥160 Diastolic≥100

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DATACOLLECTIONFORMS

Purpose

ALWISEWOMANhasmandatoryreportingrequirementsanddataelementsthatarerequiredbytheCDC.ThedatacollectedfromtheWISEWOMANformsprovidesevidencetothefundingagenciesthatmoniesusedbyWISEWOMANprogramsareusedto:

EnsureALWISEWOMANwomenreceivecardiovasculardiseasescreeningtestsinconjunctionwithABCCEDPscreenings

Ensurewomenwithalertvaluesanddisease‐levelvaluesarefollowedaccordingtoCDCguidelines

Ensuretheprogramisreachingthein‐needsegmentofthepopulation

EvaluatetheeffectivenessoftheWISEWOMANProgram

Ensuretheavailabilityofhighqualitydataforprogramplanningaswellasqualityassuranceoftheprogram.

DataCollectionRequirements

ALWISEWOMANprogramusesseveraldatacollectionformsfordatareporting.SeeAppendixE,p.29.

A. AlabamaWISEWOMANDataCollectionForm:Baseline/RiskReductionB. TheAlabamaWISEWOMANContactformC. HICF1500formorUBform

GeneralInformationconcerningallForms

Allformsshouldbefilledcorrectly. TheoriginalformswillbesenttotheProgramManagerwithaninvoicebythe15thofeachmonth. AllformscanbeprintedfromtheMed‐ITEnrollmentwebsite. Copiesofallformsmustbekeptinthewoman’sfile. Theresultsofthelabtestsshouldbecarefullyrecordedsothatwomenreceiveadequatefollowupand

providersreceiveproperpayment. TheALWISEWOMANConsentformappearsonthebackoftheABCCEDPScreeningform.Theconsent

mustbesignedbeforeanyservicesarerendered,andthesigneddocumentmustbemaintainedinthepatient’smedicalrecord.

ALWISEWOMANDataCollectionForm:Baseline/RiskReductionThisformshouldbefilledonallWISEWOMANpatientsattheinitialofficevisitorintegratedofficevisit.ThepurposeoftheBaseline/RiskReductionForm:

Toprovidedocumentationofthepatienthistory,healthassessmentinformation,baselinelabandclinicalvaluesandriskreductioncounselinginformation.

Toserveasthemonthlydatareportonprovideractivityandthedocumentationforbilling. Totrackpatientsregardingmedicationcomplianceandlifestyleprograms,etc. GeneratedbytheprimaryprovideratthetimeoftheWISEWOMANscreening.

TheHICF1500formisthestandardbillingformusedtosubmitchargesaccruedforALWISEWOMANservicestoaccuratelyreimburseproviders.

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TheAlabamaWISEWOMANContactformwillbecompletedwheneverthereisanycontactbetweentheparticipantandtheWISEWOMANSocialWorkerandtheNutritionalCounselor.ThepurposeofthisFormisto:

Collectpatientparticipationinlifestyleprogramandtrackcompletedsessions Providedocumentationofpatientreferralstocommunityresources,includingsmokingcessation

programs ToserveasthemonthlydatareportforSocialWorkeractivity ToprovidetrackinganddocumentationfortheNutritionalCounselingsessions

HowtoChangeClientInformation

Iftherearechangesinclientinformationafteryouhavesubmittedthescreeningformsorfollow‐upformsfortheclient,notifytheWISEWOMANSocialWorkerinwritingofthechangetobemade.Includeinyournotethefollowing,sothatthecorrectrecordischanged:

NamethatiscurrentlyinWISEWOMANprogramrecords SocialSecurityNumber DateofBirth MED‐ITTrackingNumber InitialofficevisitDate Namethatthecurrentnamewillbechangedto

BILLINGANDREIMBURSEMENTCurrentProceduralTerminology(CPTCodes)/Reimbursement

Requirement:ProvidersarerequiredtouseappropriateCPTCodesasdefinedbyCDC.Guidance:CurrentProceduralTerminology(CPT)isalistingofdescriptivetermsandidentifyingcodesforreportingmedicalservicesandproceduresperformedbyphysicians.Thepurposefortheterminologyistoprovideauniformlanguagethatwillaccuratelydescribemedical,surgical,anddiagnosticservices,andwilltherebyprovideaneffectmeansforreliablenationwidecommunicationamongphysicians,patientsandthirdparties.

AL WISEWOMAN funds can only be used to reimburse for services outlined by CDC as approvedproceduresandatthecurrentMedicarereimbursementamounts.

ALWISEWOMANfundscannotbeusedfortreatmentservicesofanykindNOTE:Treatmentservicesincludemedicationandotherhighlyspecializedcounselingsuchasdiabeteseducationprograms.Giventhatno‐costtobaccocessationresourcesanddiabeteseducationprogramsarereadilyavailableandaccessibleinthecommunity,ALWISEWOMANfundscannotbeusedtoreimbursefortheseservices.

ALWISEWOMANfundscannotbeusedtoreimbursecostsrelatedtoALERTvaluemedicalevaluationssuchasambulancetransportationorsubsequenthospitalizations.

AlabamaWISEWOMANPaidServices:

Clinicallaboratorytestsatinitialscreening

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RiskReductioncounselingsessionwithmedicalprofessional

NutritionalCounselingsessionwitharegistereddietician

OneFollowupOfficeVisitwithmedicalprofessional

IntheIntegratedOfficeVisit,theclinicalscreeningportionisfundedthroughABCCEDP.ALWISEWOMANfundspayforlabtestingandtheriskreductioncounselingsegmentoftheIntegratedOfficeVisit.

ClinicalLaboratoryTests:

TheALWISEWOMENprogramwillpayforthefollowingscreeninglabtestsforALWISEWOMANparticipants:83718,82947,80061,82948,or83036

NOTE:NofastingglucoseistobeperformedonanyALWISEWOMANparticipantwhohadbeendiagnosedwithDiabetes.

RiskReductionCounseling:

Med‐ITReimbursementCodes99401,99402,99403willbeusedforWISEWOMANprogramriskreductioncounseling.CDCprotocolsrequiretheprovisionofriskreductioncounselingtoeachWISEWOMANProgramparticipant,includingwomenwithandwithoutrisksforcardiovasculardisease.Providerswillbereimbursedforthetimespentconductingriskreductioncounselingservices.Reimbursementshouldbefortheriskreductioncounselingthatisprovidedandisbilledseparatelyfromthetimespentconductingtheclinicalscreeningservicesthatarepartoftheofficevisit.Theriskreductioncounselingservicescantakeplaceonthesamedayasthescreeningofficevisitoronadifferentdaybutmustbebilledseparately.CDCrequiresriskreductioncounselingtobeprovidedattheofficevisitbaseduponwhateverassessmentsandtestresultsareavailable.Ifalltestresultsareavailable,includingbloodwork,riskreductioncounselingisrequiredtotakeplaceattheofficevisit.Thisisreferredtoascompletedriskreductioncounselingattheofficevisit.Ifpartoftheassessments,measurements,andtestresultsareavailablebutnotallofthem,riskreductioncounselingistobeprovidedontheinformationthatisavailableattheofficevisit,aCDCrequirement.Thisisreferredtoaspartialriskreductioncounselingattheofficevisit.Tocompletetheriskreductioncounselingprovidersarerequiredtofollow‐upwithparticipantsbytelephoneorface‐to‐face.Providersarereimbursedonlyforcompletedriskreductioncounseling.Theuseoftheministickduringtheofficevisitallowsforriskreductioncounselingtobecompletedduringtheofficevisit,eliminatingtheneedtocarryoutfollowupatalatertime.

NutritionalCounselingSessions

OutsideoftheIntegratedOfficeVisit,ALWISEWOMANwillpayforonenutritionalcounselingsessionwitharegistereddietician.AppropriateCPTcodeis:97802or99804

MedicalFollowupOfficeVisit

MedicalstaffwillmeetwithALWISEWOMANparticipantswithALERTorabnormalscreeningtestswhowereputonmedicationorhadachangeindosageforonefollowupvisitperWISEWOMANcycle.ALWISEWOMANfundswillpayforthefollowingcodes:99202,99203,99211,99212,and99213.

FollowupAssessment(Version2,CDCTAmanual,pendingIRBapproval)

Followupassessment,inordertoevaluateshort‐termpatientprogress,isrequiredbyCDCforallwhocompletehealthcoachingand/orLSP.Evaluationmustcover,ataminimum:medications,bloodpressure,diet,physicalactivity,smoking,andqualityoflifeissues.PerCDCTechnicalAssistancemanual,version2.0,thisassessmentmayormaynotincludeanofficevisit.Untilfirmerguidelinesareset,AlabamaWWwillconducttheseassessments,andanyadditionallabtesting,onacase‐to‐casebasis.

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APPENDICES

22

AppendixA:

NationalClinicalGuidelines

Overview National clinical, diet, and lifestyle guidelines translate the best available science

to practice. Guidelines assist clinicians and patients in making health care

decisions. Guidelines do not take the place of the health care provider’s

judgment.

Clinical practice guidelines on Hypertension, Cholesterol, Overweight and Obesity

are developed through collaborative efforts of national organizations. Additional

guidelines on diseases and lifestyle are developed by national organizations such

as the American Heart Association, American Diabetes Association and the

American College of Cardiology. All the national guidelines are based on a

rigorous review process.

Requirements

Grantees must ensure that WISEWOMAN service providers follow standard care

practices, generally the current national guidelines. Each WISEWOMAN health

care facility should have a Medical Director or Board that establishes which

specific set of guidelines that facility will follow and also provides guidance for

situations not addressed by guidelines.

Guidance Grantees should assure the quality of all WISEWOMAN services provided.

Examples of methods to assure standards of care are met for clinical and

preventive services are:

Specify expectations regarding adherence to current guidelines in contractual agreements, training, and program manuals.

Provide professional development and technical assistance on guidelines and quality assurance regarding their use.

Conduct chart audits and/or data audits.

References/

Resources

Cardiovascular Risk and Blood Pressure

Million Hearts® Evidence‐based Treatment Protocols for Improving Blood

Pressure Control

http://millionhearts.hhs.gov/resources/protocols.html

Go AS, Bauman MA, Coleman King SM, Fonarow GC, Lawrence W,

Williams KA, Sanchez E. An effective approach to high blood pressure control: A

Science Advisory From the American Heart Association, the American College of

Cardiology, and the Centers for Disease Control and Prevention. Hypertension.

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2014;63:878–885.

http://hyper.ahajournals.org/content/63/4/878

Centers for Disease Control and Prevention. Hypertension Control: Action Steps

for Clinicians. Atlanta, GA: Centers for Disease Control and Prevention, US Dept. of

Health and Human Services; 2013.

http://millionhearts.hhs.gov/resources/action_guides.html

2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk: A Report from

the American College of Cardiology/American Heart Association Task Force on

Practice Guideline

http://circ.ahajournals.org/content/early/2013/11/11/01.cir.0000437741.48606.

98.citation

Guideline on the Assessment of Cardiovascular Risk Slide Set

The Seventh Report of the Joint National Committee on Prevention, Detection,

Evaluation, and Treatment of High Blood Pressure (JNC 7).

http://www.nhlbi.nih.gov/guidelines/hypertension/

Cholesterol

2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce

Atherosclerotic Cardiovascular Risk in Adults: A Report of the American College of

Cardiology/American Heart Association Task Force on Practice Guidelines.


ee.citation

Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic

Cardiovascular Risk in Adults Slide Set

Diabetes

American Diabetes Association Standards of Medical Care in Diabetes—2014.

http://care.diabetesjournals.org/content/37/Supplement_1/S14.full

Overweight and Obesity

2013 AHA/ACC/TOS Guideline for the Management of Overweight and Obesity in

Adults: A Report of the American College of Cardiology/ American Heart

Association Task Force on Practice Guidelines and The Obesity Society.

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ee

Guideline for the Management of Overweight and Obesity in Adults Slide Set

Tobacco Control

Best Practices for Comprehensive Tobacco Control Programs—2014; Centers for

Disease Control and Prevention

http://www.cdc.gov/tobacco/stateandcommunity/best_practices/

Diet &Lifestyle Guidelines

The 2013 AHA/ACC Guideline on Lifestyle Management to Reduce Cardiovascular

Risk: A report of the American College of Cardiology/American Heart Association

Task Force on Practice Guidelines.


d1.citation

Million Hearts. Healthy Eating & Lifestyle Resource Center.

http://recipes.millionhearts.hhs.gov/

Dietary Guidelines for Americans, 2010.

http://www.cnpp.usda.gov/DGAs2010‐PolicyDocument.htm

Your Guide to Lowering Your Blood Pressure With DASH: DASH Eating Plan

http://www.nhlbi.nih.gov/health/public/heart/hbp/dash/new_dash.pdf

2008 Physical Activity Guidelines for Americans.

http://www.health.gov/paguidelines/guidelines/default.aspx

Position Stand: American College of Sports Medicine (ACSM) Quantity and

Quality of Exercise for Developing and Maintaining Cardiorespiratory,

Musculoskeletal, and Neuromotor Fitness in Apparently Healthy Adults: Guidance

for Prescribing Exercise. http://journals.lww.com/acsm‐

msse/Fulltext/2011/07000/Quantity_and_Quality_of_Exercise_for_Developing.26

.aspx

GET THE FACTS: Sodium and the Dietary Guidelines.

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http://www.cdc.gov/salt/pdfs/sodium_dietary_guidelines.pdf

The U.S. National Physical Activity Plan, 2010.

http://www.physicalactivityplan.org/theplan.php

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AppendixB:

AuthorizationforServices

TheAlabamaWISEWOMANProgram’saimistohelpyoureduceyourriskofcardiovasculardiseaseandstroke.EligibilitycriteriaforWISEWOMANarecurrentenrollmentintheABCCEDP.Theservicesprovidedthroughthisprogramincludemedicalscreeningstoevaluateyourbloodpressure,glucoseandcholesterollevel.Thesetestsrequirethatyouprovideasmallsampleofblood.Thisroutinefingerprickmaycauseyousomeminordiscomfort.Youwillhaveyourweight,heighttaken,yourBMIcalculated,andwillbeaskedifyouusetobaccoproducts.

Iunderstandifmybloodpressure,glucoseandcholesterollevelsareinthenormalrange,Iwillberescreenedfortheseriskfactorsatmyannualbreastandcervicalcancerscreeningvisitin12to18months.

Iunderstandifmybloodpressure,glucoseorcholesterollevelsareslightlyelevatedIwillbereferredtoaSocialWorker.IunderstandthatIwillbeaskedhealthquestionstodetermineifIamhealthyenoughtoparticipantinphysicalactivity.Iagreetofollowmyprovider’srecommendationregardingparticipatinginanyphysicalactivity.

IunderstandthatasaWISEWOMANparticipant,IwillmeetwithaSocialWorkerwhowillutilizealifestyleprogramshowntobeeffectiveinimprovingcardiovascularhealth.IunderstandImightqualifyforsocialservicesprovidedinthecommunity.IherebygivepermissiontotheAlabamaWISEWOMANProgramtodiscloseinformationaboutmetosocialserviceagencies,communityagencies,andhealthcareprovidersforthelimitedpurposeofconsultationorreferral.Thispermissionmayincludethedisclosureofinformationaboutmymedicalconditionbutdoesnotincludethereleaseofthewrittenmedicalrecord.Ihavebeengivenanopportunitytodiscusshowthisformwillbeused.IknowthatIhavetherighttorevokethispermissionatanytime(excepttotheextentthatactionhasalreadybeentaken).

RISKOFUSINGE‐MAIL

Informationcontainedinemailmessagesmaybeprivilegedandconfidential.Thereissomeriskthatanyprotectedhealthinformationcontainedinanemailmaybedisclosedto,orinterceptedby,unauthorizedpeople.Theseinclude,butarenotlimitedto,thefollowingrisks:

a.TheHealthInsurancePortabilityandAccountabilityActof1996recommendsthatanyE‐mailcontainingprotectedhealthinformationshouldbeencrypted.TheE‐mailssentfromtheAlabamaDepartmentofPublicHealtharenotencrypted,soE‐mailsmaynotbesecure.Therefore,itispossiblethattheconfidentialityofsuchcommunicationsmaybebreachedbyathirdparty.

b.E‐mailcanbecirculated,forwarded,storedelectronicallyandonpaper,andbroadcasttounintendedrecipients.

c.E‐mailsenderscaneasilymisaddressanE‐mail.

d.E‐mailcanbeintercepted,altered,forwarded,orusedwithoutauthorizationordetection.

e.E‐mailcanbeusedtointroducevirusesintocomputersystems.

f.E‐mailcanbeusedasevidenceincourt.

IacknowledgethatIhavereadandfullyunderstandthisconsentform.IunderstandtherisksassociatedwithcommunicationofE‐mailbetweenmeandtheAlabamaDepartmentofPublicHealth/FranklinPrimaryHealthCenterstaff.AnyquestionsImayhavehadwereanswered.IfIprovidemyE‐mailbelow,Iunderstandtherisks,andgivemyconsentfortheAlabamaDepartmentofPublicHealth/FranklinPrimaryHealthCaretocommunicatewithmeregardingmyprotectedhealthinformationbyE‐mail.Thisconsentwillbereaffirmedordiscontinued,atmychoice,ateachclinicvisit.

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Bysigningbelow,IcertifyIhavereadandunderstandtheaboveinformationandgiveconsenttoauthorizeoneormoreoftheabove‐listedservicesformyself.

______IunderstandthatImaywithdrawfromtheWISEWOMANprogramatanytimewhilecontinuingtoreceivescreeningservicesviaABCCEDP.

Unlessotherwiserevoked,thisauthorizationwillexpire18monthsfromthedatesigned.

WISEWOMANSignature:______________________________________Date:_____________________________

Phone#:_______________________________________________________________________

EmailAddress:__________________________________________________________________________

FranklinPrimary/DepartmentofPublicHealthRepresentative Date

Note:TheclinicoryourdoctormaysuggestorofferserviceswhicharenotpartofAlabamaWISEWOMAN.Ifyoudecidetousetheseservices,theywillnotbepaidforbyABCCEDP.

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AppendixC:

29


30

AppendixD:


31

AppendixE:ProgramDataForms


32

33

34

35


36


37


AppendixF:CPT/ReimbursementTable

38


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AppendixH:

BloodPressureMeasurementTechnique

Accuratebloodpressuremeasurementsarecriticalfordetectingandmanaginghighbloodpressure.Bloodpressuremeasurementsshouldbedoneusingthefollowingpropertechnique(adaptedfromJNC6andJNC71): Patientsshouldnotsmoke,exercise,orhavecaffeineforatleast30minutesbeforetheirbloodpressure

ismeasured.

Patientsshouldbeseatedquietlyforatleast5minutesinachair(ratherthanonanexamtable),withfeetonthefloorandarmssupportedatheartlevel.

Anappropriatesizedcuffshouldbeused(cuffbladderencirclingatleast80%ofthearm).

Amercurysphygmomanometer,arecentlycalibratedaneroidmanometer,oravalidatedelectronicdeviceshouldbeused.

Atleasttwomeasurementsshouldbetakenandrecorded,separatedbyaminimumof2minutes.Ifthefirsttworeadingsdifferbymorethan5mmHg,additionalmeasurementsshouldbetaken.

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AppendixI:HealthCoaching/NEWLEAFLifestyleProgramHealthCoachingID#:AL13HCG001

KeyElements LifestyleProgram

Setting Athealthfacilityorcommunity‐basedfacility

Timing/OccurrenceAfterriskreductioncounselingoratanypointthatthewomanindicatesreadiness,

Intendedparticipants

Participantswhohaveindicatedaninterestandreadiness

Numberofsessions

3sessions

Deliverymethods

Utilizingmotivationalinterviewing:

1. Session1:Face‐to‐facevisitimmediatelyfollowingriskreductioncounseling(typicallylasting60minutes)

2. Sessions2and3:eitherface‐to‐face,inagroupsettingorbyphone.(typicallylasting15‐60minutesbasedontypeofsessionandparticipantneed)

3. Follow‐upwithinfourweeksaftercompletiontoassessprogressandreinforcegoals.Followupcontact,eitherbyphone,emailorletterasneeded.(Followupviaphoneoremail,5‐10minutes).AftertheNewLeafsessionsarecomplete,contactwithparticipantswillbemaintainedtoprovidecontinuedsupportandensurereturnforannualrescreening.

Content

ThefocusofANewLeaf…ChoicesforHealthyLivingistoprovidepracticalstrategiesforincorporatingchangesindietandphysicalactivitytoprevent/treatcardiovasculardisease,diabetes,obesityandotherchronicdisease.Itisacomprehensiveprogramdesignedtohelpimprovehealthyeatingbehaviors,increasephysicalactivity,controlhypertension,improvelipidprofile,achieveahealthyweightandceasetobaccouse.ThecoreelementsofNewLeafisanassessmentofdiet,physicalactivityandsmoking,goalsetting,selfefficacy,guidelinesandstrategies,feedback,followupandsocialsupport.

Follow‐uprequired

Follow‐upwithinfourweeksaftercompletionofeachsessiontoassessprogressandreinforcegoals.Toencourageparticipationandoffersupport,eachfacilitywillconductmonthlycommunitymeetingsfeaturingdifferenttopics/speakers(12meetingsperyear).Eachmeetingwillincludeademonstrationandrelevantdoorprize.

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LifestyleProgram(LSP)ApprovalForm:AlabamaExpandedFoodandNutritionEducationProgramCriteriaforacceptableWISEWOMANlifestyleprograms(LSP)includesevidencethattheproposedprogramwillresultinimprovementinanindividual’shealthstatusbyincreasingphysicalactivity,improvedhealthyeating,controlofhypertension,weightlosswhenappropriate,and/orsmokingcessation.Granteesmustsubmitthefollowinginformationforeachprogramtheyproposetoofferasalifestyleprogramoption.PartI:Evidence‐Base&BackgroundofProposedProgramLSPID:AL14LSPEFX AlabamaExpandedFoodandNutritionEducation

Program(EFNEP)‐EatingSmart•BeingActive

FocusandOverviewoftheProgramProvideabriefdescriptionoftheprogram.Includelengthoftimeithasbeeninthefield.

TheExpandedFoodandNutritionEducationProgram(EFNEP)conductedthroughoutthenationbytheCooperativeExtensionServicesbeganin1968.In1964,thepilotprojectwasconductedinAlabamaandbeganin5counties.Baldwin,Calhoun,Houston,MarionandWalkercountieswereselectedtotestwaystoreachlimitedresourcefamilieswithhomemakingskillsandeducation.Theremaining57Alabamacountiesbeganprovidingtheprogramin1977.EFNEPtargetstwoprimaryaudiences:low‐incomeyouthandlow‐incomefamilieswithyoungchildren.Theadultprogram“EatingSmartBeingActive”(ESBA)targetslow‐incomehomemakers/individualslivingeitherinruralorurbanareas,whoareresponsibleforplanningandpreparingthefamily’sfood,withemphasisonhouseholdswithyoungchildren.THEEFNEPprogramhasbeeninthefieldsince1968andhasbeenutilizingtheESBAcurriculuminAlabamasince2011.ESBAisdesignedforparaprofessionalnutritioneducatorstousewhenteachinglow‐incomefamilieswhohavechildreninfants‐18yearsofageinthehousehold.Theteachingtechniquesinthelessonplansarebasedontheadultlearningprinciples,dialogue‐basedlearningandlearner‐centerededucation.Thelessonplans,activitiesandparticipantmaterialsweredevelopedusingthistheoryofadultlearning.During2013,2,632headsofhouseholdsfromAlabama’smostvulnerablepopulationscompletedEFNEPESBAcurriculum.99%ofadultsshowed

Exampleoftopics/prizesincludeshealthycookingdemonstrationswithavegetablesteamerasthedoorprize,relaxation/stressreliefwithamanicurehasthedoorprize.ALWISEWOMANwillutilizeTheAlabamaCooperativeExtensionSystemandtheAmericanCancerSociety,toassistwithactivitiestoencourageparticipationaswellasprovidesupportforNewLeafparticipants.

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improvementinoneormorenutritionbehaviorssuchasmakinghealthyfoodchoices,readingnutritionlabels,planningmealsandfeedingchildrenbreakfast.Positivechangesinthesebehaviorswillimproveparticipants’healthandqualityoflife.AlabamaWISEWOMANisusingESBAasanLSPoptionduetotheimpactitwillhaveonourparticipantsandtheirfamilies.

Dosage/intensityoftheprogram(i.e.frequencyofcontactandduration)

TheESBAcurriculumconsistsofeightcorelessonstaughtover5‐7weeks.Each90minutelessonisdesignedtobetaughtinorder.Eachlessonincludesafoodpreparationactivity,handsonlearnercenteredactivitiesandaphysicalactivitysegment.

Keyactivitiesandthemodeofdelivery(e.g.,inperson,byphone)

GroupsessionsareprovidedinEnglish.Thenutritioneducatoractsasa

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Community‐BasedReferrals:

ThegoalsofALWISEWOMANwillbeaccomplishedthroughpartnerships/referralsmadewithcommunityprogramsandwithADPHChronicDiseasepartners,suchas:

TheCardiovascularHealthProgram,theAlabamaTobaccoControlProgram,OfficeofWomen’sHealth,OfficeofMinorityHealth,TheNutritionandPhysicalActivityDivision,LivingWellAlabamaProgramandtheDiabetesPreventionandControlProgram,providingALWISEWOMANwitheducationmaterialsorasareferralsourceforparticipantsseekinganalternativeLSP

TheAlabamaQuitNowTobaccoquitlineandtheAmericanLungAssociation’sFreedomfromSmoking,availableasagroupclinic,anonlineprogramoraself‐helpbook

YMCAprogramspromotinghealthydiets,physicalactivityandprogresstracking,suchastheHealthyFamilyHomeInitiative

TheAlabamaExtensionService,toprovidenutritionalinformationandhealthylivingdemonstrations

TheAlabamaFarmer’sMarketAuthorityandlocalgrowers,tomakehealthyfoodsavailabletoparticipantsintheirownneighborhoods

TheAmericanCancerSocietyandtheircommunityhealthworkers(CHWs)whowillassistinthedevelopmentandcirculationofthequarterlyALWISEWOMANnewsletter,featuringarticlesonhowtoincorporateexerciseintodailylife,successstories,andhealthycookingtechniques/recipes.CHWswillassistin:1)securinglocationsintargetedcommunitiestoholdmonthlysupportmeetings,2)schedulingspeakersandfacilitatingdemonstrations,and3)indatacollection,developmentandmaintenanceofacommunityresourceguide.

Prescriptionmedicationassistanceprograms Communityorganizationsandbusinesses,toprovideaccesstolow‐costresourcesthatpromote

healthybehaviorsandappropriatechronicdiseasemanagementinthecommunity

Documents

THE ALABAMA WISEWOMAN POLICY AND …€¦ · · 2018-04-10Follow Up Services through the AL WISEWOMAN Social Worker ... cervical cancer screening programs to apply for additional