Provider Orientation & Resources  

All Ambulatory Care Providers

 

Note: open ALL links and attachments that are applicable to your area(s) of practice.

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Clinical practice: Acute low back pain 
Adult patients presenting to Banner Health Network (BHN) primary care offices with a diagnosis of acute low back pain not associated with trauma or systemic illness will receive assessment and treatment consistent with evidence-based practice.  Includes guidelines for assessment, use of diagnostic imaging and testing, and therapies.


Clinical practice: Type II diabetes care in the primary care setting
Adult patients (ages 18-75) with Type 2 diabetes presenting to primary care offices within the Banner Health Network (BHN) and Banner Medical Group (BMG) will be regularly screened for complications of their diabetes and will receive assistance in managing any associated hypertension, dyslipidemia, obesity and tobacco use.


Clinical practice: Pediatric asthma – inpatient and outpatient management
Pediatric asthma patients (age < 18) will be identified in any Ambulatory Care setting, Emergency Department, General Pediatric Ward or Pediatric Intensive Care Unit (PICU) or throughout the continuum of hospital stay and have standardized interventions of time-sensitive therapy utilizing an asthma severity score to identify patients with mild, moderate, or severe asthma.  The clinical approach to asthma in our pediatric population will focus on four components of asthma care: measures to assess (utilizing an asthma severity score) and monitor asthma, patient and family education, control of environmental factors and other conditions that can worsen asthma, and medications.  For chronic asthma care, management will be based on the 2007 National Health Lung and Blood Institute (NHLBI) recommendations, using a stepwise approach to assess asthma severity, in which rescue and controller medication doses or types are stepped up as needed and stepped down when possible.  All patients in the ambulatory setting and inpatient setting should be discharged with a standardized Home Management Plan of Care.


Clinical practice: Depression screening (adults and adolescents in primary care settings)
It is an expected clinical practice that patients > 12 years of age presenting to primary care offices will be screened for depression using an age-appropriate standardized screening tool. Positive screening results will trigger further evaluation. After diagnosis is confirmed using standard diagnostic criteria, an individual plan of care will be developed for treatment and follow-up.


Clinical Practice: Ambulatory Dementia Care - Adult
It is an expected clinical practice that adult outpatients at risk for dementia according to specific criteria will be screened for possible dementia; those with possible dementia will be given a comprehensive evaluation to confirm presence and severity of dementia as well as determine dementia complexity to establish provisions of care that include pharmacological, psychosocial, and calibrated specialty interventions.


Clinical Practice: Ambulatory Falls Prevention - Adult
It is an expected clinical practice that all patients 65 years or older will be screened for fall risk at least once annually. Patients identified as at risk for falls will have a multifactorial falls assessment performed with interventions based on the assessment results.


Clinical Practice:  Hyperlipidemia Screening- Adult
It is an expected clinical practice that all individuals age 40 to 75 seen in primary care settings and not previously diagnosed with ASCVD or Diabetes will be screened for hyperlipidemia.  Positive lipid panel screening results will trigger further evaluation.  For patients with normal lipid panel results, screening will be repeated every 5 years.


Clinical Practice: Osteoporosis Screening and Management in Primary Care - adult
It is an expected clinical practice that all women 65 yrs. and older will be screened for osteoporosis using Dual-energy X-ray absorptiometry (DXA).  All other adults at risk for osteoporosis as determined by the Fracture Risk Assessment Tool (FRAX) will receive DXA screening.  Management will be based on screening results and fracture risk stratification.  This clinical practice has been defined but not yet fully implemented.


Clinical practice: Preoperative testing for elective surgeries - adults
It is an expected clinical practice that all elective surgery adult patients will receive preoperative testing based only on clinical indication. Avoid routine tests unless testing for specific indications or purpose.


Clinical Practice: Urinary incontinence in women (adult)
It is an expected clinical practice that all women 65 years of age or older will receive an annual screening for urinary incontinence.  A positive screening will lead to referral, testing and therapy for the specific type of incontinence diagnosed.


Clinical Practice: Cervical cytology screening and HPV management
It is an expected clinical practice that women between the ages of 21-65 who have no known risk criteria will have a cervical cytology screening (pap smear) every 3 years.  For women 30-65 years who have no known risk criteria and want to lengthen the screening interval, cervical cytology screening with a combination of human papillomavirus (HPV) testing should occur at least every 5 years.


Clinical Practice: Treatment of Major Depressive Disorder
It is an expected clinical practice that all patients 12 years of age and older presenting to a primary care clinic who have screened positive for depression using Banner Health’s approved screening process and after further evaluation have been diagnosed with Major Depressive disorder (MDD) will receive treatment based on the severity of symptoms and clinical judgment. This clinical practice has been defined by not yet fully implemented.


Clinical Practice: Gynecologic Oncology Referrals (Adult) Language
It is an expected clinical practice that all adult gynecological oncology patients with confirmed or suspected gynecologic malignancies will be referred to a gynecological oncologist or a physician trained in gynecological surgical procedures to perform debulking and/or staging.


Clinical Practice: Ovarian Cancer Screening
It is an expected clinical practice that only symptomatic women or women meeting specified risk factors such as personal history of BRCA/BRCA2 mutation or family history of breast or ovarian cancer will be screened for ovarian cancer.


Clinical Practice: Gynecologic Office Based Procedures
It is an expected clinical practice that all gynecologic patients meeting criteria for medically indicated or elective surgical procedures approved for the OBGYN office setting and who elect to receive anesthesia will receive monitored anesthesia care.


Clinical Practice: Management of Uncomplicated Deep Vein Thrombosis (Adult)
It is an expected clinical practice that all adult patients presenting to the Emergency Department with uncomplicated Deep Vein thrombosis (DVT) not requiring admission for other reasons will be discharged with anticoagulation and outpatient follow-up.  The management of Deep Vein Thrombosis (DVT) varies among providers.  With the use of low molecular weight heparin and oral Xa inhibitors it has been shown that patients can be safely and effectively be discharged home without increased risk for complications.  With this in mind, following a more structured and consistent approach to the management of patients with uncomplicated DVTs can lead to the safe discharge of this patient population reducing avoidable admissions.  This clinical practice has been defined but not yet fully implemented.


Clinical Practice: Screening and Treatment of Community–Acquired Pneumonia (Pediatric)
It is an expected clinical practice that all pediatric patients, three months to 17 years of age presenting to any outpatient department (including the Emergency Department) for evaluation of cough, difficulty breathing and fever will receive a complete clinical evaluation, assessment and treatment plan for simple primary community-acquired pneumonia (CAP).  This clinical practice outlines an approach for this assessment including guidelines for inpatient and outpatient management.


Clinical Practice: Immunizations
It is an expected clinical practice that all Adult and Pediatric patients/members will be offered vaccinations according to current Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practice (ACIP).


Clinical Practice:  Excisions for Breast Cancer Margins
It is an expected clinical practice that all adult patients with pathologic stage I and II invasive breast cancer treated with breast conserving surgery and whole breast radiation, positive resection margins will be addressed with re-excision, while negative margins provide optimal outcome and re-excision is not indicated.


Clinical Practice: Positron Emission Tomography (PET) Scans in the surveillance of Asymptomatic Patients with Lymphoma
It is an expected clinical practice that All adult patients with aggressive lymphoma who have achieved a complete response will not receive routine surveillance positron emission tomography (PET) scans unless clinically indicated, due to the risk for false positives.


Clinical Practice: AMB Pharmacy Anticoagulation Management
It is an expected clinical practice that all patients on anticoagulation therapy with warfarin in the ambulatory setting will have their medications managed to ensure appropriate dose adjustments are made based on the desired INR range and patient specific, thromboembolic and hemorrhagic risk factors to maximize benefits and reduce adverse effects associated with anticoagulation therapy. This clinical policy has been defined but not yet fully implemented. 


Clinical Practice:  AMB Pharmacy Diabetes Management
It is an expected clinical practice that all patients on medication therapy for Diabetes in the ambulatory setting will have their medications managed to achieve a desired hemoglobin A1C result.  This clinical policy has been defined but not yet fully implemented.


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