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Office of Public Health Adolescent School Health Program

Office of Public Health Adolescent School Health Program. Best Practices for Prevention in SBHCs Screening for High Blood Pressure. Welcome and Introductions. Blue Cross and Blue Shield of Louisiana Foundation Diagnosing and Treating Hypertension in SBHCs. Pilot Program (2009-2010)

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Office of Public Health Adolescent School Health Program

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  1. Office of Public HealthAdolescent School Health Program Best Practices for Prevention in SBHCs Screening for High Blood Pressure

  2. Welcome and Introductions

  3. Blue Cross and Blue Shield of Louisiana FoundationDiagnosing and Treating Hypertension in SBHCs • Pilot Program (2009-2010) • Early Results (June 2010) • Expanded Training (Summer 2010) • Best Practices State-Wide Roll Out (2010-2011)

  4. Screening for High Blood Pressure BEST PRACTICES

  5. Background • Research has confirmed that primary hypertension is detectable in children and occurs commonly • Data on healthy adolescents demonstrated “hypertension in approx. 30% of overweight children (BMI > 95th %)” • Long-term health risks for hypertensive children and adolescents are significant • Critical to detect elevated BP early • Body size is the major (but not only) determinant for elevated BP among children and adolescents

  6. Blood Pressure Screening Children and Adolescents should be SCREENED, starting at AGE 3, on an ANNUAL basis

  7. Hypertensive Screening Form • Vital Signs • Height • Weight • BMI • BMI % • BP %

  8. Body Mass Index (BMI) • To Calculate BMI • Use formula on the Stature-for-age and Weight-for-age percentiles chart (Growth Chart) appropriate for gender • Weight (in pounds) /stature (in inches)/stature (in) x 703 • Weight (in kilograms)/ stature (in centimeters) / stature (cm) x 10,000 • To Calculate BMI Percentage • Use Body mass index-for-age percentiles chart appropriate for gender plotting student’s age and BMI • Record Calculations on top portion of Hypertensive Screening Form

  9. Hypertensive Screening Form • 3 Blood Pressure (BP) readings taken on same visit • Average • < 90% and < 120/80 -- Screen again Next Year (using Quick Glance Chart) • > 90% or > 120/80-- Repeat BP Twice within 2 Weeks on 2 Separate Visits • > 99% or Symptomatic – Promptly Refer for Evaluation and Treatment • Visit #2 • Visit #3

  10. Blood Pressure Screening Complete • Diagnosis • Normal Blood Pressure (using Quick Glance Chart) • SBP and DBP < 90th% for gender, age and height and < 120/80 • Prehypertension • SBP or DBP > 90th% but < 95th% on > 3 occasions OR BP > 120/80 but < 95th% on > 3 occasions • Suspected Hypertension • SBP and/or DBP > 95th% on > 3 occasions

  11. IMPORTANT! Elevated Blood Pressure Reading Clarification

  12. IMPORTANT! • SBP or DBP > 90th% • BP > 120/80 • Quick Glance Chart • Expanded BP Tables

  13. Treatment • Prehypertension (BP > 90th% but < 95th% OR > 120/80) -Comprehensive Physical Exam -Counseling -Pre-test -Program Participant Log -Recheck BP in 6 months; Post-test

  14. Treatment • Suspected Hypertension (BP > 95th%) • Comprehensive Physical Exam • Complete HTN Panel • Counseling • Pre-test • Program Participant Log • Recheck BP in 3 months • Post-test in 6 months

  15. Program Participant Log • Name • BP % • Lab Testing • Lab Results • Diagnosis • External Referral • Pre-Test/Post-Test • Follow-Up Date

  16. Lab and Other Testing • Suspected Prehypertension • Comprehensive Physical Exam • Suspected Hypertension • Comprehensive Physical Exam • Complete HTN Panel • CBC with diff and platelets • Chem 7 • U/A • Urine Culture (if U/A positive) • Non-fasting Lipid Profile • Hemoglobin A1C • EKG

  17. Lab and Other Testing • Additional upon Referral • Renal Ultrasound • Echocardiography • Additional to Consider • Phosphorous • Uric Acid • Drug Screen • Insulin • Polysomnogram • Retinal Exam

  18. Pre and Post Testing • Pre Test • To test patient initial knowledge of elevated BP • Given on date patient diagnosed and put on Program Participant Log • Reviewed with provider • Post Test • To test increased knowledge of elevated BP • Given on or around 6 month follow-up visit • Completed Tests • Stapled together and sent to OPH with next quarterly report

  19. Identifying Sticker • Medical Record • Ability to quickly identify students who have hador do have elevated BP on previous visit(s) to SBHC • Inside Front Jacket

  20. Complete Hypertensive Screening Form • Lab Testing Ordered • Lab Test Results • Follow-Up Visit • Comments • External Referral • Signature

  21. Blood Pressure Screening Flow Chart

  22. Blood Pressure ScreeningHypertension Coding Outline • First BP Screening Visit • Students with a BP reading WNL • Use CODE V81.1 – HTN Screening (only use this code 1 time/year for students with normal BP) • Students with a BP reading > 90th%--99th% • Use CODE V81.1 – HTN Screening AND CODE 796.2—Elevated BP reading w/o diagnosis of HTN

  23. Blood Pressure ScreeningHypertension Coding Outline • Second BP Screening Visit • Use CODE V81.1 – HTN Screening AND CODE 796.2—Elevated BP reading w/o diagnosis of HTN • Or if BP is WNL on this visit, Use Dummy Code NBP (normal BP) instead of 796.2 NOTE—IF YOU CHOOSE THIS CODE (NBP), you must enter comments to note why (or why you think) this student has returned to WNL

  24. Blood Pressure ScreeningHypertension Coding Outline • Third BP Screening Visit • Use CODE V81.1 – HTN Screening AND CODE 796.2—Elevated BP reading w/o diagnosis of HTN • If SBP or DBP > 95th% for gender, age and height measured on > 3 separate occasions ADD Dummy Code SHTN (Suspected Hypertension) • if BP is WNL on this visit, Use Dummy Code NBP (normal BP) instead of 796.2 NOTE—IF YOU CHOOSE THIS CODE (NBP), you must enter comments to note why (or why you think) this student has returned to WNL

  25. Blood Pressure ScreeningHypertension Coding Outline • Visit to Review Lab Test Results (Follow-Up Visit) • Choose from the following CODES • 796.2 –Elevated BP reading w/o diagnosis of HTN • SHTN –Suspected Hypertension (Dummy Code) • Add to 796.2 • ADD any other Diagnosis noted (if necessary)

  26. Blood Pressure ScreeningHypertension Coding Outline • Interval Visits • Choose from the following CODES • 796.2 –Elevated BP reading w/o diagnosis of HTN • SHTN –Suspected Hypertension (Dummy Code) • Add to 796.2 • BP Return to WNL- use Dummy Code NBP (normal BP) for students who have returned to WNL following suspected HTN or pre-HTN NOTE—IF YOU CHOOSE THIS CODE (NBP), you must enter comments to note why (or why you think) this student has returned to WNL • 401.9 –HTN (if student diagnosed with HTN) • ADD any other Diagnosis noted (if necessary)

  27. Blood Pressure ScreeningHypertension Coding Outline • DUMMY CODES • NBP –BP has returned to WNL (Comments Required) • NOTE—IF YOU CHOOSE THIS CODE (NBP), you must enter comments to note why (or why you think) this student has returned to WNL; if reason unknown, put UNKNOWN in comments field • SHTN –Suspected Hypertension

  28. SBHC Encounter Form Hypertension Screening Box

  29. QUESTIONS?

  30. Christine.Armand@la.gov Maxine.Kimbrell@la.gov cvmoore@aol.com wberon@theapollogroup.net

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