VA-IHD LIPID PROFILE (70)    REMINDER DEFINITION (811.9)

Name Value
NAME VA-IHD LIPID PROFILE
PRINT NAME IHD Lipid Profile
CLASS NATIONAL
SPONSOR Office of Quality & Performance
USAGE *
EDIT HISTORY
  1. EDIT DATE:   2005-03-11 12:24:12
    EDIT BY:   USER,ONE
    EDIT COMMENTS:   
    Exchange Install
    
DESCRIPTION
The VHA/DOD Clinical Practice Guideline for Management of Dyslipidemia 
applicable to the patient.  
 
A completed LDL lab test (calculated LDL or direct LDL) or documented
outside LDL satisfies the reminder for 12 months.
 
A documented order lipid profile health factor satisfies the reminder for
1 month.
 
A patient's refusal to have an LDL level drawn satisfies the reminder
for 6 months.
recommends that patients with Ischemic Heart Disease have a lipid 
 
Deferring the lipid profile for other reasons satisfies the reminder for
6 months.
profile/LDL every one to two years; and that patients taking lipid 
lowering medications have a lipid profile/LDL at least every year.
 
This national reminder identifies patients with known IHD (i.e., a 
documented ICD-9 code for IHD on or after 10/01/99) who have not had a
serum lipid panel within the last year. If a more recent record
of an UNCONFIRMED IHD DIAGNOSIS is found, the reminder will not be
FINDINGS
  1. FINDING ITEM:   VA-IHD DIAGNOSIS
    USE INACTIVE PROBLEMS:   N
    NO. OF FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   1
    NOT FOUND TEXT:   
    Patient has no IHD Diagnosis on file.
    
    USE IN PATIENT COHORT LOGIC:   AND
    BEGINNING DATE/TIME:   OCT 01, 1999
  2. FINDING ITEM:   VA-UNCONFIRMED IHD DIAGNOSIS
    NO. OF FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
    USE IN PATIENT COHORT LOGIC:   AND NOT
  3. FINDING ITEM:   VA-LIPID LOWERING MEDS
    NO. OF FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   1
    NOT FOUND TEXT:   
    No active lipid lowering agents on file.
    
    BEGINNING DATE/TIME:   T-90D
  4. FINDING ITEM:   VA-LIPID PROFILE ORDERABLE
    NO. OF FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
  5. FINDING ITEM:   VA-LDL
    CONDITION:   I +V>0
    INTERNAL CONDITION:   I +V>0
    NO. OF FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   1
    NOT FOUND TEXT:   
    Patient with IHD and no LDL lab results on file in the past year.
    
    USE IN RESOLUTION LOGIC:   OR
  6. FINDING ITEM:   VA-OUTSIDE LDL <100
    NO. OF FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
    USE IN RESOLUTION LOGIC:   OR
    BEGINNING DATE/TIME:   T-1Y
  7. FINDING ITEM:   VA-OUTSIDE LDL 100-119
    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:   VA-OUTSIDE LDL 120-129
    NO. OF FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
    USE IN RESOLUTION LOGIC:   OR
    BEGINNING DATE/TIME:   T-1Y
  9. FINDING ITEM:   VA-OUTSIDE LDL >129
    NO. OF FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
    USE IN RESOLUTION LOGIC:   OR
    BEGINNING DATE/TIME:   T-1Y
  10. FINDING ITEM:   VA-ORDER LIPID PROFILE HEALTH FACTOR
    NO. OF FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
    USE IN RESOLUTION LOGIC:   OR
    BEGINNING DATE/TIME:   T-1M
  11. FINDING ITEM:   VA-REFUSED LIPID PROFILE
    NO. OF FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
    USE IN RESOLUTION LOGIC:   OR
    BEGINNING DATE/TIME:   T-6M
  12. FINDING ITEM:   VA-OTHER DEFER LIPID PROFILE
    NO. OF FOUND TEXT LINES:   1
    NO. NOT FOUND TEXT LINES:   0
    FOUND TEXT:   
    The lipid profile is deferred for 6 months.
    
    USE IN RESOLUTION LOGIC:   OR
    BEGINNING DATE/TIME:   T-6M
FUNCTION FINDINGS
  1. LOGIC:   FN(1)>FN(2)
    FUNCTION STRING:   MRD(1)>MRD(10)
    NO. FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
    FUNCTION LIST:
    1. FUNCTION NUMBER:   1
      FUNCTION:   MRD
      FUNCTION PARAMETER LIST:
    2. FUNCTION NUMBER:   2
      FUNCTION:   MRD
      FUNCTION PARAMETER LIST:
TECHNICAL DESCRIPTION
This reminder is recommended for use by clinicians at Primary Care Clinics
   IHD DIAGNOSIS
   the clinician finds in a patient's record.  If your site has this
   method in place, copy the reminder dialog to a local reminder 
   dialog and then add the local dialog element for the consult order
   to the reminder dialog so this practice can continue.
                No mapping necessary.  Use the VA-ISCHEMIC HEART DISEASE 
                reminder taxonomy distributed with this term.
 
   UNCONFIRMED IHD DIAGNOSIS
                Use the UNCONFIRMED IHD DIAGNOSIS health factor
                distributed with this term or add any local health
                factor representing an unconfirmed or incorrect IHD
                diagnosis.
 
(Primary Care/Medicine, GIMC, Geriatric, Women's), Cardiology, Cholesterol
   LDL          Enter the Laboratory Test names from the Lab Package 
                for calculated LDL and direct LDL with "I +V>0" in 
                the CONDITION field.
 
   For the following OUTSIDE LDL Reminder Terms, use the health factors
   distributed with the reminder term or enter the local Health Factor
   used to represent these values.
     OUTSIDE LDL <100
     OUTSIDE LDL 100-119
     OUTSIDE LDL 120-129
Screening and any other specialty clinics where primary care is given.
     OUTSIDE LDL >129 
 
   ORDER LIPID PROFILE HEALTH FACTOR
                Use the health factor distributed with this term or add
                any local health factor representing the order action. 
                Do not add orderable items to this reminder term (see
                LIPID PROFILE ORDERABLE).  This represents the date the
                order was placed, not the date the order will be done in
                the future.  The order placement will cause the reminder 
                to be resolved for 1 month.  (Alternatively, copy this
 
                reminder and add LIPID PROFILE ORDERABLE to the 
                resolution findings if you want the next due date to be
                calculated based on the future date the order is to be 
                done.)
 
   LIPID PROFILE ORDERABLE
                Enter orderable items for lipid panels that include LDL
                tests (calculated LDL and direct LDL).
                The orderable items are informational findings for
                this reminder. The order will not resolve the reminder,
Setup issues before using this reminder:
                but it will display in the clinical maintenance.  
                Ideally, the clinician will look at the clinical
                maintenance display to avoid entering duplicate orders.
                This reminder term is not used in the resolution logic
                since the future order could be for a long distance in 
                the future. (Copy this reminder and add LIPID PROFILE
                ORDERABLE to the resolution findings if you want the
                next due date to be calculated based on the future date
                the order is to be done.)
 
 
   OTHER DEFER LIPID PROFILE
                Enter any local health factors or other findings that 
                should defer the reminder for 6 months.  For example, 
                "LIFE EXPECTANCY < 6M".
 
   REFUSED LIPID PROFILE
                Use the health factor distributed with this term or add
                any local health factor representing refusal of lipid 
                profile test.
 
 1. Use the Reminder Term options to map local representations of
   LIPID LOWERING MEDS
                Enter the formulary drug names for investigation drugs.
                Mapping non-investigative formulary drugs to the
                VA-GENERIC drugs will ensure the lipid lowering 
                medications are found. The medications are informational 
                findings for this reminder.
 
2. Use the Reminder Dialog edit option to define the national reminder
   dialog finding items which should be updated during CPRS GUI reminder
   processing.
    findings:
 
   Add local Order Dialog entries to the Dialog elements used for
   ordering a calculated LDL and/or direct LDL.
 
   Review dialog elements in the national reminder dialog and change any 
   national health factors to local health factors, if necessary.  It is 
   not unusual for local findings to be used in your national dialogs.
   Any local findings used in the national dialogs should be mapped to 
   the appropriate national reminder term.
 
 
3. Alternatively, use the Reminder Dialog options to copy the national
   dialog, dialog elements, and dialog groups to make local changes.
 
   If your site has a Lipid Panel TIU Object, add this TIU Object to the 
   local dialog element header text.  The TIU Object should include Chol,
   Trigly, HDL, LDL-C, Direct LDL values and dates.
 
   Add local dialog elements with local Order Dialogs for additional      
   ordering options for the clinicians. Some sites have clinicians 
   order a consult to a service that corrects unconfirmed diagnoses
CUSTOMIZED COHORT LOGIC FI(1)&FF(1)
INTERNAL PATIENT COHORT LOGIC FI(1)&FF(1)
PATIENT COHORT FINDINGS COUNT 2
PATIENT COHORT FINDINGS LIST 1;FF1
INTERNAL RESOLUTION LOGIC (0)!FI(2)!FI(3)!FI(4)!FI(5)!FI(6)!FI(7)!FI(8)!FI(9)
RESOLUTION FINDINGS COUNT 8
RESOLUTION FINDINGS LIST 2;3;4;5;6;7;8;9
INFORMATION FINDINGS COUNT 3
INFORMATION FINDINGS LIST 10;12;14
WEB SITES
  1. URL:   http://www.oqp.domain.ext/cpg/DL/dl_cpg/algo4frameset.htm
    WEB SITE TITLE:   VHA/DoD CPG for Dyslipidemia
    WEB SITE DESCRIPTION:   
    The VHA/DoD CPG for Management of Dyslipidemia is a comprehensive 
    guideline incorporating current information and practices for 
    practitioners throughout the DoD and Veterans Health Administration 
    system. See Section S, Table 3b for reference to LDL<120 in the 
    Guideline.
    
# OF GEN. COHORT FOUND LINES 0
# GEN. COHORT NOT FOUND LINES 0
# GEN. RES. FOUND LINES 0
# GEN. RES. NOT FOUND LINES 0
BASELINE AGE FINDINGS
  1. REMINDER FREQUENCY:   1Y
    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