Guideline:
Adult preventive services (ages 50 - 65)
Bibliographic Source(s)
- Michigan Quality Improvement Consortium. Adult preventive services (ages 50-65+). Southfield (MI): Michigan Quality Improvement Consortium; 2008 Sep. 1 p.
Guideline Status
This is the current release of the guideline.
This guideline updates a previous version: Michigan Quality Improvement Consortium. Adult preventive services (ages 50-65+). Southfield (MI): Michigan Quality Improvement Consortium; 2006 Sep. 1 p.
Guideline Category
Counseling
Prevention
Risk Assessment
Screening
Intended Users
Advanced Practice Nurses
Health Plans
Physician Assistants
Physicians
Guideline Objective(s)
- To achieve significant measurable improvements in the management of adult preventive services (ages 50 to 65+) through the development and implementation of common evidence-based clinical practice guidelines
- To design concise guidelines that are focused on key management components of adult preventive services (ages 50 to 65+) to improve outcomes
Target Population
- Adult patients ages 50 to 64 years
- Adult patients age 65+ years
Interventions and Practices Considered
Screening/Prevention
- Health maintenance exam including height and weight; risk evaluation and counseling (e.g. nutrition physical activity tobacco use sexual health); safety assessment (e.g. domestic violence seat belts firearms); behavioral assessment (e.g. depression suicide threats alcohol/drug use)
- Blood pressure monitoring
- Screening for the following diseases/conditions:
- Dyslipidemia
- Diabetes mellitus
- Osteoporosis
- Colorectal cancer
- Glaucoma
- Cervical cancer
- Breast cancer
- Prostate cancer
- Immunizations (tetanus diphtheria acellular pertussis/tetanus-diphtheria [TdaP/Td] varicella zoster influenza pneumonia)
Major Outcomes Considered
Not stated
Methods Used to Collect/Select Evidence
Searches of Electronic Databases
Description of Methods used to Collect/Select the Evidence
The Michigan Quality Improvement Consortium (MQIC) project leader 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.
Number of Source Documents
Not stated
Methods Used to Assess the Quality and Strength of the Evidence
Weighting According to a Rating Scheme (Scheme Given)
Rating Scheme for the Strength of the Evidence
Levels of Evidence for the Most Significant Recommendations
- Randomized controlled trials
- Controlled trials no randomization
- Observational studies
- Opinion of expert panel
Methods Used to Analyze the Evidence
Review
Description of the Methods Used to Analyze the Evidence
Not stated
Methods Used to Formulate the Recommendations
Expert Consensus
Description of Methods Used to Formulate the Recommendations
Using information obtained from literature searches and available health plan guidelines on the designated topic the Michigan Quality Improvement Consortium (MQIC) project leader 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 project leader 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.
Rating Scheme for the Strength of the Recommendations
Not applicable
Cost Analysis
A formal cost analysis was not performed and published cost analyses were not reviewed.
Method of Guideline Validation
External Peer Review
Internal Peer Review
Description of Method of Guideline Validation
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 (project leader distributes final draft to medical directors' committee measurement and implementation groups to solicit feedback).
The MQIC project leader also forwards the approved guideline draft to appropriate state medical specialty societies 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 updated guideline in September 2008.
Major Recommendations
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.
Health Assessment Screening History and Counseling
Ages 50 to 64 years
One health maintenance exam (HME) every 1 to 3 years according to risk status [D]
Age 65+ years
One HME at least every 2 years
Each HME should include:
- Height weight and body mass index (BMI)
- Risk evaluation and counseling (nutrition obesity physical activity dental health tobacco use [A] immunizations human immunodeficiency virus (HIV) prevention [B] sexually transmitted infections prevention [B] and sexual health sexual abuse polypharmacy including over-the-counter and herbal preparations when appropriate sun exposure)
- Safety (domestic violence seat belts helmets firearms smoke and carbon monoxide detectors)
- Behavioral assessment (depression suicide threats alcohol/drug use anxiety stress reduction coping skills)
Blood Pressure Monitoring [A]
Ages 50 to 65+ Years
At every office visit and at minimum every 2 years. If blood pressure (BP) 120-139/80-89 or higher and/or presence of risk factors more frequent monitoring is recommended.
Cholesterol and Lipid Screening [B]
Ages 50 to 65+ Years
Measure a complete fasting lipoprotein profile (i.e. total cholesterol low-density lipoprotein cholesterol [LDL-C] high-density lipoprotein cholesterol [HDL-C] and triglycerides) every 5 years if initial test is normal in low-risk adults. If multiple risk factors are present more frequent measurements are recommended.
Diabetes Mellitus Screening
Ages 50 to 65+ Years
Fasting plasma glucose (FPG) every 3 years beginning at age 45. FPG may be performed earlier in patients at increased risk of diabetes (e.g. those with BMI > 25 family history and high-risk ethnic groups - African Americans Native Americans Hispanics and Pacific Islanders)
Colorectal Cancer Screening [B] for Average Risk Adults
Ages 50 to 65+ Years
Fecal occult blood test (FOBT) annually and/or sigmoidoscopy every 5 years; or double contrast barium enema every 5 years; or colonoscopy every 10 years
Glaucoma Screening [C]
Ages 50 to 64 Years
No requirement unless high risk (e.g. increased intraocular pressure family history African Americans people who have diabetes myopia regular/long-term steroid use previous eye injury)
Age 65+ Years
Every 2 years; screen annually if high risk
Osteoporosis Screening [C]
Ages 50 to 64 Years
- Men or women on chronic glucocorticosteroids (prednisone > 7.5 mg/day or equivalent for > 6 months) and those who have received a solid organ transplant > 2 years ago should be screened.
- Post-menopausal women with any of the following: personal history of fracture without substantial trauma > age 40; family history of fracture (hip wrist or spine in first-degree relative > age 50); current smoking; weight in lowest quartile (< 127 lbs); and frailty.
- Bone Mineral Density (BMD) test once for initial diagnosis. Do not repeat test more frequently than every 2 years (per Michigan Quality Improvement Consortium [MQIC Osteoporosis guideline]).
Age 65+ Years
Women age >65 regardless of risk factors
Cervical Cancer Screening [A] Pap Smear
Ages 50 to 64 Years
At least every 3 years unless high risk (i.e. history of abnormal Pap results sexually transmitted diseases or HIV; sexual activity before age 18 or multiple partners; vaginal spotting or bleeding between periods after intercourse or after menopause; tobacco use) (Consider discontinuation for patients with surgical removal of cervix for benign conditions).
Age 65+ Years
May discontinue after age 65 based on clinical judgment according to risk status
Mammography [A] and Clinical Breast Exam [C]
Ages 50 to 70 years
Every 1 to 2 years
Age 70+ years
Shared decision-making after age 70
Prostate Cancer Screening [D]
Ages 50 to 65+ years
Age 50 to 65 years shared decision-making for digital rectal examination (DRE) and/or prostate specific antigen (PSA) testing
Immunizations
Tetanus Diphtheria Acellular Pertussis/Tetanus-diphtheria (TdaP/Td) [A]
Ages 50 to 64 Years
TDaP once after age 11 then Td every 10 years
Age 65+ Years
Td every 10 years
Varicella [C]; Zoster [C]
Ages 50 to 65+ Years
Varicella as indicated by the Advisory Committee on Immunization Practices (ACIP) guidelines. Single dose zoster vaccine at age > 60 years
Influenza [B]
Ages 50 to 65+ Years
Annually
Pneumococcal Vaccine [B]
Ages 50 to 64 Years
No requirement unless high risk
Age 65+ Years
Once at age 65; booster may be needed after 5 years
Definitions:
Levels of Evidence for the Most Significant Recommendation
- Randomized controlled trials
- Controlled trials no randomization
- Observational studies
- Opinion of expert panel
Clinical Algorithm(s)
None provided
Type of Evidence supporting the Recommendations
The type of evidence is provided for the most significant recommendations (see "Major Recommendations" field).
This guideline is based on several sources including: The Guide to Clinical Preventive Services 2007 Recommendations of the U.S. Preventive Services Task Force (http://www.ahrq.gov/clinic/prevenix.htm) and the Advisory Committee on Immunization Practices (ACIP) 2006 Immunization Recommendations (www.cdc.gov).
Potential Benefits
Through a collaborative approach to developing and implementing common clinical practice guidelines and performance measures for adult preventive services (ages 50 to 65+) 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.
Potential Harms
Not stated
Qualifying Statements
This guideline lists core management steps. Individual patient considerations and advances in medical science may supersede or modify these recommendations.
Description of Implementation Strategy
Approved Michigan Quality Improvement Consortium (MQIC) guidelines are disseminated through email U.S. mail and websites.
The MQIC project leader prepares approved guidelines for distribution. Portable Document Format (PDF) versions of the guidelines are used for distribution.
The MQIC project leader distributes approved guidelines to MQIC membership via email.
The MQIC project leader submits request to website vendor to post approved guidelines to MQIC website (www.mqic.org).
The MQIC project leader completes a statewide mailing of the comprehensive set of approved guidelines and educational tools annually. The guidelines and tools are distributed in February of each year to physicians in the following medical specialties:
- Family Practice
- General Practice
- Internal Medicine
- Other Specialists for which the guideline is applicable (e.g. endocrinologists allergists pediatricians cardiologists etc.)
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 project leader submits request to the National Guideline Clearinghouse (NGC) to post approved guidelines to NGC website (www.guideline.gov).
IOM Care Need
Staying Healthy
IOM Domain
Effectiveness
Patient-centeredness
Bibliographic Source(s)
- Michigan Quality Improvement Consortium. Adult preventive services (ages 50-65+). Southfield (MI): Michigan Quality Improvement Consortium; 2008 Sep. 1 p.
Adaptation
This guideline is based on several sources including: The Guide to Clinical Preventive Services 2007 Recommendations of the U.S. Preventive Services Task Force (http://www.ahrq.gov/clinic/prevenix.htm) and the Advisory Committee on Immunization Practices (ACIP) 2006 Immunization Recommendations (www.cdc.gov).
Source(s) of Funding
Michigan Quality Improvement Consortium
Guideline Committee
Michigan Quality Improvement Consortium Medical Director's Committee
Composition of Group that Authored the Guideline
Physician representatives from participating Michigan Quality Improvement Consortium health plans Michigan State Medical Society Michigan Osteopathic Association Michigan Association of Health Plans Michigan Department of Community Health and Michigan Peer Review Organization
Financial Disclosures/Conflicts of Interest
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.
Guideline Status
This is the current release of the guideline.
This guideline updates a previous version: Michigan Quality Improvement Consortium. Adult preventive services (ages 50-65+). Southfield (MI): Michigan Quality Improvement Consortium; 2006 Sep. 1 p.
Guideline Availability
Electronic copies: Available in Portable Document Format (PDF) from the Michigan Quality Improvement Consortium Web site.
Availability of Companion Documents
None available
Patient Resources
None available
NGC STATUS
This NGC summary was completed by ECRI on November 28 2005. The updated information was verified by the guideline developer on December 19 2005. This NGC summary was updated by ECRI on October 16 2006. The updated information was verified by the guideline developer on November 3 2006. This NGC summary was updated by ECRI Institute on November 26 2008. The updated information was verified by the guideline developer on December 4 2008.
COPYRIGHT STATEMENT
This NGC summary is based on the original guideline which may be reproduced with the citation developed by the Michigan Quality Improvement Consortium.
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Guidelines represented on the NGC Web site are submitted by guideline developers and are screened solely to determine that they meet the NGC Inclusion Criteria which may be found at http://www.guideline.gov/about/inclusion.aspx .
NGC AHRQ and its contractor ECRI Institute make no warranties concerning the content or clinical efficacy or effectiveness of the clinical practice guidelines and related materials represented on this site. Moreover the views and opinions of developers or authors of guidelines represented on this site do not necessarily state or reflect those of NGC AHRQ or its contractor ECRI Institute and inclusion or hosting of guidelines in NGC may not be used for advertising or commercial endorsement purposes.
Readers with questions regarding guideline content are directed to contact the guideline developer.
Tools
No Quick Reference tools have been developed.
Details
FDA Warning
- Category:
- Conditions:
- Preventable diseases and conditions including:Overweight/obesityHypertensionDyslipidemiaDiabetes mellitusColorectal cancerGlaucomaOsteoporosisCervical cancerBreast cancerProstate cancerTetanusDiphtheriaPertussisVaricella infectionHerpes zoster infectionInfluenzaPneumococcal pneumoniaDepressionAlcohol and/or substance abuseTobacco abuseDomestic violenceSexual abuse
- Published:
- 2005 Jul (revised 2008 Sep)
- Endorsed by:
- Michigan Quality Improvement Consortium