Guideline:Routine preventive services for children and adolescents (ages 2 - 21). Measure Summary

Preventable diseases or conditions such as:

• Infectious diseases including diphtheria, tetanus, pertussis, poliomyelitis, measles, mumps, rubella, varicella, influenza, meningitis, sexually transmitted infections including human immunodeficiency virus (HIV) infection
• Overweight
• Oral and dental diseases
• Mental stress, anxiety, and depression
• Harm from violence or abuse
• Alcohol and drug abuse
• Injuries due to motor vehicles, bicycles, burns, poisoning, injury
• Tobacco use/exposure to second-hand smoke
• Hypercholesterolemia
• Cervical cancer
• Unintended pregnancy
• Vision disorders

Children and adolescents ages 2 to 21 years

Not stated

The Michigan Quality Improvement Consortium (MQIC) health care analyst conducts a search of current literature in support of the guideline topic. Computer database searches are used to identify published studies, existing protocols and/or national guidelines on the selected topic developed by organizations such as the American Diabetes Association, American Heart Association, American Academy of Pediatrics, etc. If available, clinical practice guidelines from participating MQIC health plans and Michigan health systems are also used to develop a framework for the new guideline.

Not stated

Levels of Evidence for the Most Significant Recommendations

1. Randomized controlled trials
2. Controlled trials, no randomization
3. Observational studies
4. Opinion of expert panel

Not stated

Using information obtained from literature searches and available health plan guidelines on the designated topic, the Michigan Quality Improvement Consortium (MQIC) health care analyst prepares a draft guideline to be reviewed by the Medical Directors' committee at one of their scheduled meetings. Priority is given to recommendations with [A] and [B] levels of evidence (see "Rating Scheme for the Strength of the Evidence" field).

The initial draft guideline is reviewed, evaluated, and revised by the committee, resulting in draft two of the guideline. Additionally, the Michigan Academy of Family Physicians participates in guideline development at the onset of the process and throughout the guideline development procedure. The MQIC guideline feedback form and draft two of the guideline are distributed to the Medical Directors, as well as the MQIC measurement and implementation group members, for review and comments. Feedback from members is collected by the MQIC health care analyst and prepared for review by the Medical Directors' committee at their next scheduled meeting. The review, evaluation, and revision process with several iterations of the guideline may be repeated over several meetings before consensus is reached on a final draft guideline.

Not applicable

A formal cost analysis was not performed and published cost analyses were not reviewed.

When consensus is reached on the final draft guideline, the Medical Directors approve the guideline for external distribution to practitioners with review and comments requested via the Michigan Quality Improvement Consortium (MQIC) health plans (health care analyst distributes final draft to Medical Directors' committee, measurement and implementation groups to solicit feedback).

The MQIC health care analyst also forwards the approved guideline draft to appropriate state medical specialty societies and physicians with expertise in the related field for their input. After all feedback is received from external reviews, it is presented for discussion at the next scheduled committee meeting. Based on feedback, subsequent guideline review, evaluation, and revision may be required prior to final guideline approval.

The MQIC Medical Directors approved this guideline in May 2011.

The level of evidence grades (A-D) are provided for the most significant recommendations and are defined at the end of the "Major Recommendations" field.

The following guideline provides recommendations for routine preventive services for children and adolescents ages 2-21 years. Children at increased risk may warrant additional services, e.g. Early Periodic Screening, Diagnosis, and Treatment Program (EPSDT)¹.

Abbreviations: BMI, body mass index; CPR, cardiopulmonary resuscitation; HIV, human immunodeficiency virus

¹Early Periodic Screening Diagnosis and Treatment: age specific exam and anticipatory guidance template (http://ihcs.msu.edu/quality/early_periodic_screening.php )

²Family history, eating/sleeping habits, adequate fluoridation, and home oral care may provide possible/potential/visible abnormalities and a visit to the dentist for early evaluation may be recommended.

³AAP Policy Statement-Child Passenger Safety (http://pediatrics.aappublications.org/content/127/4/788.full )

Immunizations

• Consult the Advisory Committee on Immunization Practices (ACIP) website (http://www.cdc.gov/vaccines/recs/acip/ ) for the most updated immunization schedules for routine and high risk populations.
• Use combination vaccines to minimize the number of injections.
• Update the Michigan Care Improvement Registry (MCIR).

Abbreviations: DTaP, diphtheria, tetanus, acellular pertussis; IPV, inactivated poliovirus vaccine; MCV4, meningococcal conjugate vaccine; MMR, measles, mumps, rubella; MMRV, measles, mumps, rubella, varicella; Tdap, tetanus-diphtheria-acellular pertussis vaccine

*U.S. Food and Drug Administration (FDA) approved human papillomavirus vaccine for males 9-26 years to reduce their likelihood of genital warts.

Definitions:

Levels of Evidence for the Most Significant Recommendations

1. Randomized controlled trials
2. Controlled trials, no randomization
3. Observational studies
4. Opinion of expert panel

None provided

The type of evidence is provided for the most significant recommendations (see the "Major Recommendations" field).

This guideline is based on several sources, including: Preventive Services for Children and Adolescents, Institute for Clinical Systems Improvement, 2010 (www.icsi.org ) and American Academy of Pediatrics (AAP) Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, 3rd Edition, 2008.

Through a collaborative approach to developing and implementing common clinical practice guidelines and performance measures for routine preventive services for children and adolescents ages 2 to 21, Michigan health plans will achieve consistent delivery of evidence-based services and better health outcomes. This approach also will augment the practice environment for physicians by reducing the administrative burdens imposed by compliance with diverse health plan guidelines and associated requirements.

Not stated

This guideline lists core management steps. Individual patient considerations and advances in medical science may supersede or modify these recommendations.

Approved Michigan Quality Improvement Consortium (MQIC) guidelines are disseminated through email, U.S. mail, and websites.

The MQIC health care analyst prepares approved guidelines for distribution. Portable Document Format (PDF) versions of the guidelines are used for distribution.

The MQIC health care analyst distributes approved guidelines to MQIC membership via email.

The MQIC health care analyst submits request to website vendor to post approved guidelines to MQIC website (www.mqic.org ).

The MQIC health care analyst completes an annual statewide postcard mailing to physicians in all areas of medicine including primary care and specialties. The postcard provides the complete list of MQIC guidelines and includes which guidelines have been recently revised, which are coming up for revision, and any new published guidelines.

The statewide mailing list is derived from the Blue Cross Blue Shield of Michigan (BCBSM) provider database. Approximately 95% of the state's M.D.'s and 96% of the state's D.O.'s are included in the database.

The MQIC health care analyst submits request to the National Guideline Clearinghouse (NGC) to post approved guidelines to NGC website (www.guideline.gov ).

This guideline is based on several sources, including: Preventive Services for Children and Adolescents, Institute for Clinical Systems Improvement, 2010 (www.icsi.org ) and American Academy of Pediatrics (AAP) Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, 3rd Edition, 2008.

Michigan Quality Improvement Consortium

Michigan Quality Improvement Consortium Medical Directors' Committee

Physician representatives from the 13 participating Michigan Quality Improvement Consortium health plans, Michigan State Medical Society, Michigan Osteopathic Association, Michigan Association of Health Plans, Michigan Department of Community Health, Michigan Peer Review Organization, and the University of Michigan Health System

Standard disclosure is requested from all individuals participating in the Michigan Quality Improvement Consortium (MQIC) guideline development process, including those parties who are solicited for guideline feedback (e.g., health plans, medical specialty societies). Additionally, members of the MQIC Medical Directors' Committee are asked to disclose all commercial relationships as well.

This is the current release of the guideline.

This guideline updates a previous version: Michigan Quality Improvement Consortium. Routine preventive services for children and adolescents (ages 2-21). Southfield (MI): Michigan Quality Improvement Consortium; 2009 May. 1 p.

Electronic copies: Available in Portable Document Format (PDF) from the Michigan Quality Improvement Consortium Web site .

The following is available:

• Early Periodic Screening, Diagnosis and Treatment (EPSDT) physician toolkit including HME forms newborn to 20 years of age (MSUCOM Institute for Health Care Studies). Available from the Michigan Quality Improvement Consortium Web site .

None available

This NGC summary was completed by ECRI Institute on March 5, 2008. The information was verified by the guideline developer on March 12, 2008. This NGC summary was updated by ECRI Institute on November 6, 2009. The updated information was verified by the guideline developer on December 10, 2009. This summary was updated by ECRI Institute on November 12, 2010 following the U.S. Food and Drug Administration (FDA) advisory on Afluria (influenza virus vaccine). This summary was updated by ECRI Institute on August 25, 2011. The updated information was verified by the guideline developer on September 2, 2011.

This NGC summary is based on the original guideline, which may be reproduced with the citation developed by the Michigan Quality Improvement Consortium.