%20Futures%20Documents/ External Link: You are leaving Bright Futures is a national health promotion initiative dedicated to the principle that every child deserves to be healthy and that optimal health involves a trusting. Bright Futures/AAP Recommendations for. Preventive Services and EPSDT. Presented by. Janet Sutton, RHIT,CPC. AHIMA Approved ICD Trainer. EPSDT.
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Actionable recommendation statements are both decidable i. Bright futures aap a guideline is actionable or not can be assessed through a formal and validated guideline assessment tool such as the GuideLine Implementability Appraisal v 2.
GLIA was developed by Shiffman et al inand identifies obstacles to the implementation of guidelines [ 10 ]. The instrument has been previously used for a variety of recommendations with multiple publications attesting to its usefulness [ 11—14 ] bright futures aap its ability to assess implementability [ 15 ].
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The most recent version of GLIA consists of one global dimension assessing the guideline as a whole and eight dimensions to assess factors intrinsic to the guideline that may affect successful implementation. Decidability and executability are considered the most bright futures aap criteria for overall computer implementation by the instrument developer.
The computability criteria itself is both setting and electronic health record specific and comes into plays only when the decidability and executability criteria are bright futures aap. The current version of Bright Futures is not organized to easily implement this capability in a computer [ 1 ].
Instead, recommendations are listed according to what should happen at bright futures aap of the 21 pre-defined health supervision visits. A problem with this format is that it assumes that the child will be seen for health supervision at each age and that previous visits have been completed.
However, children may miss or delay visits.
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A child scheduled for a well-child visit may present with an illness bright futures aap concern that takes up most of the visit time, leaving some health supervision topics unaddressed.
If a bright futures aap is not able to address a recommendation at the 4 months visit, he or she has to consider whether to do so at a later visit. Moreover, if an issue has been addressed at one visit, it may not be necessary to address it at subsequent visits. For all these reasons, it would therefore be of great value if recommendations in an electronic version of Bright Futures were based on the age at which the child presents, not based on the specific predefined health supervision visit the child is due for.
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bright futures aap For example, if a clinician was shown what services had already been delivered, and which ones had not yet been delivered but were age-appropriate at the given visit, an electronic version of Bright Futures could support the clinician at any health supervision encounter.
These challenges apply to a broader class of guidelines that recommend specific actions at particular ages, times, or stages of disease, and which recommend bright futures aap actions take place at certain intervals.
Objectives An electronic version of the recommendations in Bright Futures is desired. In this study we aimed to 1 determine the number of actionable recommendations in the current edition of Bright Futures and 2 represent actionable Bright Futures recommendations in a format that would show the age range over which the recommendation is applicable regardless of whether it corresponds to a standard health supervision visit.
Many actions are repeated across health supervision visits or address bright futures aap aspects of the same recommendation. There are, for example, many specific instructions presented as actions under the overall recommendation bright futures aap use a car seat.
To reduce the number of redundant action statements, repeated actions were grouped, and smaller steps were bright futures aap into the larger actions. We excluded 1 items listed under physical examination, and 2 immunizations.
Physical exam was considered a separate part of the encounter unlikely to be considered optional by clinicians. The schedules are not incorporated in the printed version of Bright Futures. All GLIA criteria are valuable for improving guidelines, but it is impossible to create computer implementable decision rules if the bright futures aap statements are vague on the decidability and executability criteria.
Moreover, if these two criteria are not met, assessment of the remaining criteria becomes very difficult. For example, validity including quality of evidence cannot be assessed without knowing what is recommended executability for whom and when decidabilityand the same is true for assessing effect on process bright futures aap care, measurability adherence and identification of outcomesand bright futures aap.
Also, the flexibility criteria actually require that the decidability criteria are met before one can bright futures aap whether the guideline also allows for alternative interpretation, i. The AAP continues to emphasize the great importance of continuity of care in comprehensive health supervision and the need bright futures aap avoid fragmentation of care.
Refer to the specific guidance by age as listed in the Bright Futures Guidelines, 4th Edition. For implementation and coding information for each visit on the Periodicity Schedule, please see the Bright Futures and Preventive Medicine Coding fact sheet.