VA-WH DISCUSS BREAST CA SCREEN WOMAN 40-49 (178)    REMINDER DEFINITION (811.9)

Name Value
NAME VA-WH DISCUSS BREAST CA SCREEN WOMAN 40-49
PRINT NAME Discuss Breast CA Screen: Age 40-49
DO IN ADVANCE TIME FRAME 2M
IGNORE ON N/A S
SEX SPECIFIC FEMALE
CLASS NATIONAL
SPONSOR VHA National Center for Health Promotion and Disease Prevention (NCP) and VHA Office of Women's Health
USAGE CR
EDIT HISTORY
  1. EDIT DATE:   2013-07-16 10:23:15
    EDIT BY:   USER,SEVENTEEN
    EDIT COMMENTS:   
    Exchange Install
    
DESCRIPTION
This is a new reminder in 2013 with the release of PXRM 2.0*28.
One-Time discussion on preferences for mammogram for women ages 40-49
 
If the discussion occurs,as indicated by one of the following health 
factors, the reminder is resolved permanently and the frequency is changed
to 99Y. 
      VA-WH BR CA 40-49 BEGIN AGE 50 
      VA-WH BR CA 40-49 WANTS SCREEN
 
The health factor VA-WH BR CA 40-49 WANTS SCREEN includes the patient age 
40-49 in the cohort of reminder: VA-WH MAMMOGRAM SCREENING
It is intended to facilitate the implementation of the following VHA 
 
If the patient has or has had a mammogram, the reminder is resolved after 
the procedure and the frequency changes to 2 years.  The discussion can 
occur at that time (2 years after the most recent mammogram) and then the 
discussion would resolve the reminder permanently. 
     VA-WH MAMMOGRAM SCREEN DONE 
     VA-WH MAMMOGRAM SCREEN IN RAD PKG   
     VA-WH MAMMOGRAM SCREEN IN WH PKG
 
If the patient and provider agree to defer the decision/discussion for 6M,
Guidance: 
1Y or 5Y, then the reminder frequency is changed to that time period but
this would be overridden by the performance of a mammogram (resolves for
2Y) or having the discussion (resolved permanently).
 
 
The setting of the Custom Date Due prevents the following problem: 
patient has a mammogram, then 2 years later the reminder shows and the 
discussion is deferred 6 months.  Without the CDD, the reminder would be 
due 2 years later instead of 6 months later.
 
"The decision to start regular screening every 2 years with mammography 
for average risk women age 40 to 49 years should be an individual 
decision and take the patient's values into account including values 
about specific benefits and harms." 
 
FINDINGS
  1. FINDING ITEM:   VA-WH BILATERAL MASTECTOMY
    NO. OF FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
    USE IN PATIENT COHORT LOGIC:   AND NOT
  2. FINDING ITEM:   VA-WH MAMMOGRAM SCREEN IN WH PKG
    MINIMUM AGE:   40
    MAXIMUM AGE:   49
    NO. OF FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
    USE IN RESOLUTION LOGIC:   OR
  3. FINDING ITEM:   VA-BREAST TUMOR
    NO. OF FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
    USE IN PATIENT COHORT LOGIC:   AND NOT
  4. FINDING ITEM:   WH BR CA 40-49 BEGIN AGE 50
    WITHIN CATEGORY RANK:   0
    NO. OF FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
    USE IN RESOLUTION LOGIC:   OR
  5. FINDING ITEM:   VA-WH BR CA 40-49 WANTS SCREEN TERM
    WITHIN CATEGORY RANK:   0
    NO. OF FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
    USE IN RESOLUTION LOGIC:   OR
  6. FINDING ITEM:   WH BR CA 40-49 DEFER 6M
    MINIMUM AGE:   40
    MAXIMUM AGE:   49
    NO. OF FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
    USE IN RESOLUTION LOGIC:   OR
    BEGINNING DATE/TIME:   T-6M
  7. FINDING ITEM:   WH BR CA 40-49 DEFER 1Y
    MINIMUM AGE:   40
    MAXIMUM AGE:   49
    NO. OF FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
    USE IN RESOLUTION LOGIC:   OR
    BEGINNING DATE/TIME:   T-1Y
  8. FINDING ITEM:   WH BR CA 40-49 DEFER 5Y
    MINIMUM AGE:   40
    MAXIMUM AGE:   49
    NO. OF FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
    USE IN RESOLUTION LOGIC:   OR
    BEGINNING DATE/TIME:   T-5Y
  9. FINDING ITEM:   VA-WH MAMMOGRAM SCREEN NOT INDICATED
    NO. OF FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
    USE IN PATIENT COHORT LOGIC:   AND NOT
  10. FINDING ITEM:   VA-WH MAMMOGRAM SCREEN DONE
    MINIMUM AGE:   40
    WITHIN CATEGORY RANK:   0
    MAXIMUM AGE:   49
    NO. OF FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
    USE IN RESOLUTION LOGIC:   OR
    BEGINNING DATE/TIME:   T-2Y
  11. FINDING ITEM:   VA-WH MAMMOGRAM SCREEN IN RAD PKG
    MINIMUM AGE:   40
    MAXIMUM AGE:   49
    NO. OF FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
    USE IN RESOLUTION LOGIC:   OR
FUNCTION FINDINGS
  1. FUNCTION FINDING NUMBER:   1
    LOGIC:   (FN(1)!FN(2)!FN(3))&(FN(4)>FN(5))&(PXRMAGE>39)&(PXRMAGE<50)&'FN(6)&'FN(7)
    REMINDER FREQUENCY:   2Y
    FUNCTION STRING:   (FI(8)!FI(9)!FI(10))&(MRD(8,9,10)>MRD(4,5,6))&(PXRMAGE>39)&(PXRMAGE<50)&'FI(2)&'FI(3)
    NO. FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
    FUNCTION LIST:
    1. FUNCTION NUMBER:   1
      FUNCTION:   FI
      FUNCTION PARAMETER LIST:
    2. FUNCTION NUMBER:   2
      FUNCTION:   FI
      FUNCTION PARAMETER LIST:
    3. FUNCTION NUMBER:   3
      FUNCTION:   FI
      FUNCTION PARAMETER LIST:
    4. FUNCTION NUMBER:   4
      FUNCTION:   MRD
      FUNCTION PARAMETER LIST:
    5. FUNCTION NUMBER:   5
      FUNCTION:   MRD
      FUNCTION PARAMETER LIST:
    6. FUNCTION NUMBER:   6
      FUNCTION:   FI
      FUNCTION PARAMETER LIST:
    7. FUNCTION NUMBER:   7
      FUNCTION:   FI
      FUNCTION PARAMETER LIST:
TECHNICAL DESCRIPTION
  Technical Description: 
      satisfy this reminder: 
         VA-WH MAMMOGRAM SCREEN DONE 
             Some mapping may be appropriate. This reminder term will use 
             the previously distributed VA-MAMMOGRAM/SCREEN taxonomy to 
             find ICD DIAGNOSIS or CPT coded results.  
       
             Use the new WH MAMMOGRAM OUTSIDE health factor to document 
             Mammogram results completed outside the VA when the 
             Mammogram results are not documented in Radiology, Women's
             Health or Consult packages.
       
          * Results, with interpretation, can be entered and verified in 
             Map local findings, such as consult orders related to 
             Mammogram Screening.  Use appropriate condition logic to 
             indicate Mammogram screening has been completed.  
 
        VA-BR CA 40-49 BEGIN AGE 50
             Distributed health factor
       
        VA-BR CA 40-49 WANTS SCREEN
             No mapping necessary.  This term uses distributed health 
             factor WH BR CA 40-49 WANTS SCREENING
            the Radiology package.  
 
        WH BR CA 40-49 DEFER 6M
             Distributed health factor
 
        WH BR CA 40-49 DEFER 1Y
             Distributed health factor
   
        WH BR CA 40-49 DEFER 5Y
             Distributed health factor
          * Results, with interpretation, can be manually entered into 
            the WH package. 
          * Summarized results can be entered as a historical entry
            (health factor or CPT code) in the patient record.
   
 
      Setup of reminder/dialog before using this reminder: 
       
      ==================================================== 
       Use the Reminder Term options to map local representations of 
          findings: 
       
      PATIENT COHORT FINDINGS: 
      ------------------------
      The following reminder terms determine whether the reminder applies 
      to the patient.  
       
  
      This reminder is recommended for use by clinicians at Primary Care 
         VA-WH BILATERAL MASTECTOMY 
             This term will use the VA-WH BILATERAL MASTECTOMY taxonomy 
             to find coded bilateral mastectomies. The health factor WH
             BILATERAL MASTECTOMY distributed with this term may be used
             or add any local health factor that represents the patient
             had a bilateral mastectomy and no longer needs mammogram
             screening.
   
         VA-TERMINAL CANCER PATIENT 
             No mapping necessary.  Use the VA-TERMINAL CANCER PATIENTS 
      Clinics (PACT/Primary Care, Medicine, GIMC, Geriatric, Women's) and 
             reminder taxonomy distributed with this term.  
 
         VA-WH MAMMOGRAM SCREEN NOT INDICATED 
             Use the findings distributed with this reminder term or map 
             any local findings that indicate a Mammogram screen is not 
             indicated for this patient.  
       
             This term is distributed with mapping to the following 
             health factors: 
                INACTIVATE BREAST CANCER SCREEN (distributed with the 
      any other specialty clinics where primary care is given to female 
                first version of the Clinical Reminder package in 1996 to
                inactivate the BREAST CANCER reminder).  WH MAMMOGRAM
                SCREEN NOT INDICATED VA LIMITED LIFE EXPECTANCY and the
                taxonomy: VA-TERMINAL CANCER PATIENTS Updated March, 2013
                to include 2 new health factor which both inactivate the
                reminder for 5 years: 
                   WH BR CA SCREEN N/A 5 YRS-LE<5YRS 
                   WH BR CA SCREEN N/A 5 YRS-COMORBIDITIES
       
             Use in National VA-WH MAMMOGRAM SCREENING reminder: 
      patients.  
             This term is used in WH reminders to inactivate Mammogram 
             screening until a clinician overrides the inactivation by 
             selecting a health factor that is used by function findings 
             with frequencies of 4M, 6M, 1Y or 2Y. Begin date of T-6M has 
             been added to HF.VA LIMITED LIFE EXPECTANCY and 
             TX.VA-TERMINAL CANCER PATIENTS so screening will come due 
             again if the patient lives longer than expected or if the 
             patient has been misdiagnosed.  
       
             Sites may prefer to use local LIMITED LIFE EXPECTANCY health 
       
             factors and add their health factors to other reminder 
             terms which cause the Mammogram Screening reminder to be 
             due without requiring a clinician to select a finding to 
             reactivate the reminder. (e.g., Add the local life 
             expectancy health factor for "LOCAL LIFE EXPECTANCY 6M" to
             the VA-WH MAMMOGRAM SCREEN NOT INDICATED term).
        
      RESOLUTION FINDINGS: 
      --------------------
      The following reminder terms resolve the reminder.  These 
      If the mammogram is done in the private sector or at another VAMC 
      resolution terms are defined with a "Use in Resolution Logic".
   
       
         VA-WH MAMMOGRAM SCREEN IN WH PKG 
             No mapping necessary. This term represents mammogram results 
             documented in the Women's Health (WH) Package. The term is 
             mapped to the VA-WH MAMMOGRAM IN WH PKG computed finding 
             which only uses WH findings that are normal or abnormal.
       
         VA-WH MAMMOGRAM SCREEN IN RAD PKG 
      facility, there are three ways the results can be documented to 
             Mapping will be necessary.  This term represent Mammogram 
             results documented in the Radiology package.  Map local 
             radiology procedures that represent the following 
             procedures: 
                MAMMOGRAM BILAT 
                MAMMOGRAM UNILAT 
                MAMMOGRAM SCREEN 
             Each finding should have a condition added to exclude 
             unsatisfactory results.  
       
INTERNAL PATIENT COHORT LOGIC (SEX)&(AGE)&'FI(1)&'FI(7)&'FI(11)
PATIENT COHORT FINDINGS COUNT 5
PATIENT COHORT FINDINGS LIST SEX;AGE;1;7;11
INTERNAL RESOLUTION LOGIC (0)!FI(2)!FI(3)!FI(4)!FI(5)!FI(6)!FI(8)!FI(9)!FI(10)
RESOLUTION FINDINGS COUNT 8
RESOLUTION FINDINGS LIST 2;3;4;5;6;8;9;10
AGE FINDINGS COUNT 1
AGE FINDINGS LIST FF1
WEB SITES
  1. URL:   http://vaww.prevention.domain.ext/Screening_for_Breast_Cancer.asp
    WEB SITE TITLE:   VHA Breast Cancer Screening Guidance
  2. URL:   http://www.prevention.domain.ext/docs/VANCP_BreastCancerFact.pdf
    WEB SITE TITLE:   Clinician Guide
  3. URL:   http://www.uspreventiveservicestaskforce.org/uspstf09/breastcancer/brcanrs.htm
    WEB SITE TITLE:   US Preventive Services - Breast Cancer Screening
    WEB SITE DESCRIPTION:   
    US Preventive Services Task Force Screening for Breast Cancer web site.
    
GENERAL COHORT FOUND TEXT
\\
The decision to start regular screening every 2 years with mammography for
average risk women age 40 to 49 years should be an individual decision and
take the patient's values into account including values about specific
benefits and harms.
\\
# OF GEN. COHORT FOUND LINES 6
# GEN. COHORT NOT FOUND LINES 0
# GEN. RES. FOUND LINES 0
# GEN. RES. NOT FOUND LINES 0
BASELINE AGE FINDINGS
  1. REMINDER FREQUENCY:   99Y
    MINIMUM AGE:   40
    MAXIMUM AGE:   49
    NO. OF AGE MATCH LINES:   0
    NO. OF AGE NO MATCH LINES:   0
  2. REMINDER FREQUENCY:   0Y
    MAXIMUM AGE:   39
    NO. OF AGE MATCH LINES:   0
    NO. OF AGE NO MATCH LINES:   0
  3. REMINDER FREQUENCY:   0Y
    MINIMUM AGE:   50
    NO. OF AGE MATCH LINES:   0
    NO. OF AGE NO MATCH LINES:   0
# SUM. COHORT FOUND LINES 0
# SUM. COHORT NOT FOUND LINES 0
# SUM. RES. FOUND LINES 0
# SUM. RES. NOT FOUND LINES 0