Saturday, September 16, 2000

Rules set for health screenings

Collaborative issues unified standards

By Tim Bonfield
The Cincinnati Enquirer

        Tristate women who need mammograms, diabetics who need eye exams and senior citizens who need flu shots should soon find it a bit easier to get routine health services in Greater Cincinnati.

        The Health Improvement Collaborative of Greater Cincinnati on Friday announced a community-wide set of standards for performing four common health services: mammograms, pap smears, adult immunizations and diabetic eye exams.

  To get the full text of the following guidelines, call the Health Improvement Collaborative at 531-0267 or visit the group's Web site at


  Women ages 40-49 should get a mammogram every one to two years and a clinical breast exam every year. Women ages 50 and up should get a mammogram and a clinical breast exam every year.


  Females ages 18 and up, plus younger females who have been sexually active, should get a Pap test every year. After three or more years of normal exam results, the test may be done every one to three years at the physician's discretion.


  For people with Type I diabetes, ages 29 or younger, the first eye exam should be performed within three to five years of diagnosis once the patient is at least 10 years old. Eye exams should be repeated at least every year, and more often if problems are noted.
  For people with Type II diabetes, ages 30 and up, the first eye exam should be performed at the time of diagnosis. Eye exams should be repeated at least every year, and more often if problems are noted.
  For women of child-bearing age with diabetes, a first eye exam should be performed prior to conception and repeated during the first trimester of pregnancy. Follow-up exams as needed.


  All people ages 65 and up and all others over 17 with high-risk health conditions should get an annual flu shot. High-risk conditions include asthma, diabetes, HIV or AIDS, and other immune-compromising illnesses.
  All people ages 65 and up, plus other high-risk adults, should get a pneumonia vaccine. Seniors should get a repeat vaccination at least five years after the first shot.
  All adults who have never had chickenpox or the chickenpox vaccine as a child should get a one-time, two-dose chickenpox vaccine.
  Tetanus boosters should be given every 10 years.
  Adults born after 1956 who never had measles as a child or did not have the childhood vaccine should get a measles-mumps-rubella (MMR) vaccine. Also, adults who got the childhood vaccine but now spend time near schools or other settings with large numbers of young people should get a second MMR vaccine.
 Source: Unified Clinical Guidelines Project

        The unified standards come after nearly 18 months of negotiations and planning among four of the area's biggest health insurers, two of Cincinnati's largest employers and the Tristate's leading physician and hospital groups.

        Sponsors hope the new standards — all based on national recommendations — will lead to more people getting the health screenings they need. That in turn might improve lives by preventing blindness or infectious disease or by catching cancers early enough to treat them.

        In addition, the organiza tions involved hope to work out similar standards for managing diabetes, heart failure or hypertension.

        “There's nothing particularly new in the guidelines themselves. But the fact that four managed care organizations could get together on this takes it to a new level,” said Dr. James Garfield, senior medical director at United Healthcare.

        The health plans involved — United, Humana/ChoiceCare, Anthem Blue Cross & Blue Shield and Aetna U.S. Healthcare — cover more than a half million Tristate residents.

        The project also included the Academy of Medicine of Cincinnati, the Greater Cincinnati Health Council, Proc ter & Gamble and GE Aircraft Engines.

        “As a community we've been putting a lot of effort into women's health issues for more than 10 years,” said Rich Niemeyer, assistant director of employee benefits at Procter & Gamble. “As an employer, we support this because one set of standards will make it easier for physicians and for more people to get the tests, which is what we want to see.”

        Over the years, nearly every managed care plan in town has blitzed doctors with its own standards for screening tests and other services. The result has been confusion for patients and a paperwork headache for doctors' offices, said Dr. Derek van Amerongen, chief medical officer at Humana/ChoiceCare and team leader for the unified guidelines project.

        “The concern has been that one plan would cover these age groups or these immunizations and another would cover slightly different age groups or different immunizations,” Dr. van Amerongen said.

        The “new” standards reflect recommendations from organizations such as the National Cancer Institute and the American College of Obstetricians and Gynecologists. Adopting them won't require major changes for the health plans, officials say.

        Still, local studies indicate doctors and health plans have a long way to go to meet the new community goals.

        For example, in 1998, more than 76 percent of Tristate women over age 52 were getting a mammogram at least every other year, according to an employer-sponsored study.

        The community standard calls for all women over 50 to get a mammogram every year.

        At Humana/ChoiceCare, 30 to 45 percent of diabetics are getting regular eye exams, Dr. van Amerongen said. The community standard calls for all diabetics to get eye exams every year.

        Few if any communities nationwide have been able to bring competing organizations together to implement them, said Dr. Alena Baquet-Simpson, medical director at Anthem.

        “This is very unusual,” she said. “I think it's a great step forward.”

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