AMBULATORY CARE SOP for Breast Cancer Screening (20190628).pdf

AMBULATORY CARE SERVICE

SOP FOR BREAST CANCER SCREENING

REVISION: 20190628

1. Purpose: To establish a Standard Operating Procedure for breast cancer screening for Women Veterans at the VA North Texas Health Care System (VANTHCS).

2. Overview: Breast Cancer Screening (BCS) will be offered to women Veterans in accordance with the guidelines established by the American Cancer Society (ACS) and the Department of Veterans Affairs (VA).

3. Procedures:

a. Every new enrolling women Veteran will be offered assignment to a Designated Women’s Health Primary Care Provider (DWHP).

b. VANTHCS staff will follow the designated guidelines for ordering, scheduling, performing, documenting, and recording all BCS test results (see Appendix A).

c. Each provider will be responsible for the tracking and timely follow-up of findings from BCS of the women Veterans assigned to them.

d. Providers will use the respective Clinical Reminders within the Computerized Patient Record System

(CPRS) to track completion of clinically indicated screenings.

e. Radiology, Mammography Department, will notify the providers, via a CPRS View Alert, when the results of BCS are available for review.

f. Providers will communicate BCS results following the procedures outlined in VANTHCS

Memorandum 11-14.

g. Providers may leverage other members of the Patient Aligned Care Team to assist with results reporting, patient communication, and other coordination duties as allowed and deemed appropriate.

h. Providers will receive frequent (e.g., quarterly) feedback from Ambulatory Care Service regarding their compliance with BCS, along with other pertinent clinical indicators.

i. The VANTHCS Women’s Health Cancer Prevention Coordinator will provide quality assurance through review of BCS results and test result reporting trends. Quality control issues will be addressed as they arrive.

Enclosures (2) Rajani Potu, MD

Associate Chief of Staff Ambulatory Care

APPENDIX A

Breast Cancer Screening Guidelines for Average-Risk Women

Breast Cancer Screening Guidelines—VA Adopts American Cancer Society Guidelines as of 5/9/17.

The American Cancer Society (ACS) guidelines are as follows:

• The ACS recommends that women with an average risk of breast cancer should undergo regular screening mammography starting at age 45 years (strong recommendation).

• Women aged 45 to 54 years should be screened annually (qualified recommendation).

• Women 55 years and older should transition to biennial screening or have the opportunity to continue screening annually (qualified recommendation). Women should have the opportunity to begin annual screening between the ages of 40 and 44 years

(qualified recommendation).

• Women should continue screening mammography as long as their overall health is good, and they have a life expectancy of 10 years or longer (qualified recommendation).

ACS does not recommend clinical breast examination for breast cancer screening among average-risk women at any age (qualified recommendation).

VHA NATIONAL CENTER FOR HEALTH PROMOTION AND DISEASE PREVENTION.

Available at http://vaww.prevention.va.gov/CPS/Screening_for_Breast_Cancer.asp https://www.cancer.org/latest-news/special-coverage/american-cancer-society-breast-cancer-screening-guidelines.html http://vaww.prevention.va.gov/CPS/Screening_for_Breast_Cancer.asp

Note: Self – Referral Direct Scheduling (PSDS) is only offered to Women Veterans Ages 40-74.

**Male Veterans, Transgender women and patients who qualify for Community Care are not eligible for this service. Screening Mammograms can only be offered 365 days after the last screening mammogram

YES

Mammography

Patient Self-Referral Direct Scheduling (PSDS) for Screening Mammography

Does patient meet qualifying criteria

Mammography technologist will book patient appointment indicating #PSDS in appointment manager

Yes

Patient instructed to contact PCP by phone or MyHealthevet to order screening mammogram.

No

Mammography technologist will enter radiology order adding Women’s Health Medical

Director as ordering provider

Mammography technologist will enter radiology order adding PCP as ordering provider or Travelling Veteran coordinator (TVC) if no VANTHCS PCP and is a travelling Veteran.

Yes

Ordering provider or designee will receive the test results and communicate to the patient.

Exam will be completed

Does Patient have a VA Primary Care Provider?

Patient requests screening mammogram

No

Primary Care Provider or designee will order screening mammogram