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Preventive Health Care Grids (Adults)

Preventive Health Care Grids (Adults) - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Clinical Practice Guidelines, Preventive Health, Related


ADULTS
Table 1. Adult Preventive Health Care Summary (Men and Non-pregnant Women)
ALL ADULTS 18-29 yrs. 30-39 yrs. 40-49 yrs. 50-64 yrs. 65-69 yrs. 70 yrs. and older
Alcohol
Screening should take place at least annually. (UW Health Very low quality evidence, weak/conditional recommendation)
Adults should be screened using the AUDIT-C. (UW Health Low quality evidence, strong recommendation)
Adult patients who screen positive for unhealthy alcohol use should receive a brief counseling intervention. (UW Health Moderate quality evidence, weak/conditional
recommendation) Adult patients who are likely to have an alcohol use disorder should receive further assessment and/or a referral to treatment with a specialist in
alcohol and drug related issues. (UW Health Moderate quality evidence, weak/conditional recommendation)
Aspirin
(81 mg daily)
Aspirin can be considered
following shared decision making
in patients younger than 40 yrs.
at very high risk for
cardiovascular disease. (UW
Health Very low quality evidence,
weak/conditional recommendation)
However, aspirin use in patients
younger than 21 yrs. is not
recommended.
(UW Health Low quality evidence,
weak/conditional recommendation)
Aspirin is not recommended
for ASCVD prevention in
adults aged 40-49 yrs. with
diabetes at low ASCVD risk
(< 5%). (ADA Grade C)
Aspirin may be used on an
individual basis in patients
aged 40-49 yrs. with diabetes
at intermediate ASCVD risk
(5-10%), following
consideration of the benefits
and harms of initiation.
(UW Health Very low quality
evidence, weak/conditional
recommendation)
Initiating low-dose aspirin for primary prevention is
recommended in adults aged 50-59 yrs. who have a 10% or
greater 10-yr. cardiovascular disease risk, are not at increased
risk for bleeding, have a life expectancy of at least 10 yrs., and
are willing to take low-dose aspirin daily for at least 10 yrs.
(USPSTF Grade B)
The decision to initiate low-dose aspirin for primary prevention of
CVD and CRC in adults aged 60-69 yrs. who have a 10% or
greater 10-yr. CVD risk should be an individual one.
(USPSTF Grade C)
Due to the increased
risk of bleeding with
age, initiation of aspirin
for primary prevention
may be considered on
an individual basis.
(UW Health Very low quality
evidence, weak/conditional
recommendation)
It is recommended to use the ACC/AHA ASCVD Risk Estimator to evaluate 10-yr. cardiovascular disease risk (http://tools.acc.org/ASCVD-Risk-Estimator/).
(UW Health Low quality evidence, strong recommendation)
Cognitive
Screening
Routine screening is not recommended. (USPSTF I Statement)
However, if performing a CMS Annual Wellness Visit,
screening should be completed annually.
(UW Health Low quality evidence, weak/conditional recommendation)
Reference: UW Health Preventive Health Care – Adult/Pediatric – Ambulatory Guideline
Copyright © 2017 Univ ersity of Wisconsin Hospital s and Clinics Authority
Contact: Lee Vermeulen, CCKM @uwhealth.org Last Revised: 05/2017CCKM@uwhealth.org

ALL ADULTS 18-29 yrs. 30-39 yrs. 40-49 yrs. 50-64 yrs. 65-69 yrs. 70 yrs. and older
Colorectal
Cancer
Screen patients aged 50-75 yrs. (USPSTF Grade A) Routine universal screening should not be
performed in patients 76-85 yrs.; however there may be considerations that support
screening in an individual patient. (USPSTF Grade C)
The most important outcome is that eligible patients are screened. Patient choice has been
independently associated with greater participation and adherence to screening, therefore,
appropriate patient-physician discussion of the screening testing options should occur. (UW
Health High quality evidence, strong recommendation) Optical colonoscopy (UW Health Moderate quality
evidence, strong recommendation), CT colonography (UW Health Moderate quality evidence, strong
recommendation), fecal immunohistochemical test (FIT) (UW Health Moderate quality evidence, strong
recommendation), or multi-target stool DNA (Cologuard®/FIT-DNA) (UW Health Low quality evidence,
weak/conditional recommendation) are recommended for colon cancer screening. Flexible
sigmoidoscopy is also acceptable. (UW Health Moderate quality evidence, strong recommendation)
See text below for the pros and cons of each testing option as well as the screening
intervals.
Patients with a life expectancy of less than 10 yrs. should not be screened.
(UW Health Low quality evidence, weak/conditional recommendation)
Depression Screen annually using the PHQ-2. (UW Health Very low quality evidence, strong recommendation)
If positive screen, complete further assessment using PHQ-9. (UW Health Low quality evidence, strong recommendation)
Diabetes
Screening for type 2 diabetes with an informal assessment of risk factors should be considered in asymptomatic adults. (ADA Grade B) It is reasonable to perform a
risk assessment annually. (UW Health Very low quality evidence, weak/conditional recommendation) Testing for type 2 diabetes should be considered in all adult patients who
are overweight or obese (BMI > 25 kg/m2 or > 23 kg/m2 in Asian Americans) and have one or more risk factors (UW Health Moderate quality evidence, weak/conditional
recommendation) Frequency should be based upon individual clinical judgement that is influenced by the patient’s clinical status, any prior test results, and the
presence of or changes in risk factors. (UW Health Very low quality evidence, weak/conditional recommendation) If prior test results are normal and patients do not demonstrate
other significant risk, testing should not be repeated more frequently than every 3 years. (UW Health Low quality evidence, weak/conditional recommendation)
Falls Risk
Screen patients age 65 yrs. or older annually (AGS Grade A)
using the STEADI screening questionnaire.
If positive screen, complete assessment using the TUG.
Hepatitis B Patients should be screened if at high risk. (USPSTF Grade B) Patients with ongoing risk factors may be tested annually. (UW Health Low quality evidence, weak/conditional recommendation)
Hepatitis C
Patients should be screened once if born between the yrs. of 1945-1965. (USPSTF Grade B)
Patients should be screened if at increased risk. (USPSTF Grade B)
Patients with ongoing risk factors may be tested annually. (UW Health Low quality evidence, weak/conditional recommendation)
HIV
Universal opt-out HIV screening is recommended in average risk patients aged 19-64 yrs. who
were not tested in adolescence, regardless of sexual activity or risk.
(UW Health Very low quality evidence, strong recommendation)

Annual screening is recommended in patients at an increased or high risk for infection.
(UW Health Low quality evidence, strong recommendation)
Screen after age 65 yrs. if at increased risk. (USPSTF Grade A)
Pre-exposure prophylaxis may be indicated if at increased risk. (UW Health High quality evidence, strong recommendation)
Copyright © 2017 Univ ersity of Wisconsin Hospital s and Clinics Authority
Contact: Lee Vermeulen, CCKM @uwhealth.org Last Revised:
 
05/2017CCKM@uwhealth.org

ALL ADULTS 18-29 yrs. 30-39 yrs. 40-49 yrs. 50-64 yrs. 65-69 yrs. 70 yrs. and older
Hypertension Screen adults age 18 yrs. or older. (USPSTF Grade A) Annual screening in adults > 40 yrs. and for all adults at increased risk. (UW Health Moderate quality evidence, strong
recommendation) Patients age 18-30 yrs. with normal blood pressure and no other risk factors should be rescreened every 3-5 yrs. (USPSTF Grade A)
Immunizations Follow ACIP/CDC Schedule. (UW Health High quality evidence, strong recommendation)
Lipids
Complete universal screen once
between 17-21 yrs. using non-
fasting total cholesterol and
HDL. (NHLBI Grade B, strongly
recommended)
Test once every 5 yrs. between
ages of 22-39 yrs. (NHLBI Grade B,
Moderate) using a fasting lipid
panel or non-fasting total
cholesterol and HDL. Patients at
increased risk may be tested
more frequently. If LDL and TG
levels are within normal limits,
subsequent screening may be
delayed until age 35 (men) and
age 45 (women) unless risk
factors develop. (UW Health Low
quality evidence, weak/conditional
recommendation)
Test once every 5 yrs. between ages of 40-75 yrs. (NHLBI Grade B, Moderate) using a fasting lipid panel or non-fasting total
cholesterol and HDL. Patients at increased risk may need to be tested more frequently. If a woman’s 10 yr. cardiovascular risk
is < 2.5% and if LDL and TG levels are within normal limits subsequent screening may be delayed until age 45 unless risk
factors develop.139 It is recommended to use the ACC/AHA ASCVD Risk Estimator to evaluate 10-yr. CVD risk
(http://tools.acc.org/ASCVD-Risk-Estimator/). (UW Health Low quality evidence, weak/conditional recommendation)
Lung Cancer


Complete annual screening using low dose CT in high-risk patients age 55-80 yrs. who have
a 30 pack-yr. smoking history AND are a current smokers or have quit within the last 15 yrs.
(USPSTF Grade B) Discontinue screening once patient has not smoked for 15 yrs. or develops
a health problem which limits life expectancy. (USPSTF Grade B)
Obesity Measure BMI annually. (ICSI High quality evidence, strong recommendation)
Sexual Activity Provide behavioral counseling if sexually active and at increased risk for sexually transmitted infection. (USPSTF Grade B)
Skin Cancer
Provide behavioral counseling about minimizing exposure to ultraviolet radiation in patients age 18-24 yrs. and at risk. (USPSTF Grade B)
Provide behavioral counseling about minimizing exposure to ultraviolet radiation in all patients aged 25 yrs. or older.
(UW Health Very low quality evidence, weak/conditional recommendation)
Syphilis Screen if at increased risk. (USPSTF Grade A) Screen MSM annually using a complete syphilis serology with confirmatory testing. (UW Health High quality evidence, strong recommendation)
Tobacco Tobacco use status should be assessed and documented at every clinical encounter. (UW Health High quality evidence, strong recommendation)
In non-users, assess secondhand smoke exposure at every clinical encounter. (UW Health Moderate quality evidence, strong recommendation)
Copyright © 2017 Univ ersity of Wisconsin Hospital s and Clinics Authority
Contact: Lee Vermeulen, CCKM @uwhealth.org Last Revised:
 
05/2017CCKM@uwhealth.org

Table 2. Adult Preventive Health Care Summary (Men Only)
ADULT MEN* 18-29 yrs. 30-39 yrs. 40-49 yrs. 50-64 yrs. 65-69 yrs. 70 yrs. and older
Abdominal Aortic
Aneurysm
Screen once between the ages of 65-75 yrs. if patient
ever smoked using abdominal duplex ultrasonography.
(USPSTF Grade B)
Selective screening may be considered in men who have
never smoked with additional risk factors.
(USPSTF Grade C)
Chlamydia or
Gonorrhea
Insufficient evidence in regards to routine screening in heterosexual men (USPSTF I Statement); screening may be considered in settings with high prevalence. (UW Health Low
quality evidence, strong recommendation)
Screen MSM annually, including extragenital sites. (UW Health High quality evidence, strong recommendation)
Osteoporosis
Risk assessment using the NOF guideline criteria
is recommended in men between the ages of 50-69
years. (UW Health Low quality evidence, weak/conditional
recommendation) Central dual-energy X-ray
absorptiometry (DXA) should be completed in
patients who exhibit one or more risk factor. (UW
Health Low quality evidence, weak/conditional recommendation)
Central dual-energy X-ray
absorptiometry (DXA)
should be completed in
men age 70 years or older.
(UW Health Low quality
evidence, weak/conditional
recommendation)
Following completion of the first DXA scan, a FRAX assessment should be
completed using the T-score to determine major osteoporotic fracture risk and
future screening interval.
(UW Health Very low quality evidence, weak/conditional recommendation)
Prostate Cancer
Routine prostate cancer screening
is not recommended.
(UW Health Very low quality evidence,
strong recommendation)

Shared decision making may be
considered in men with increased
risk.
(UW Health Very low quality evidence,
weak/conditional recommendation)
A one-time shared decision making conversation is
recommended. (UW Health Moderate quality evidence,
weak/conditional recommendation)
If the decision made is to screen, PSA testing may
be completed every 1-2 yrs. (UW Health Low quality
evidence, weak recommendation)
Routine prostate cancer
screening is not
recommended.
(UW Health High quality
evidence, strong
recommendation)
Men with a life expectancy of less than 10 yrs. should not be screened.
(UW Health Moderate quality evidence, weak recommendation)
*Sex-based screening should be dependent upon organ inventory and the individual needs of a patient.






Copyright © 2017 Univ ersity of Wisconsin Hospital s and Clinics Authority
Contact: Lee Vermeulen, CCKM @uwhealth.org Last Revised:
 
05/2017CCKM@uwhealth.org

Table 3. Adult Preventive Health Care Summary (Non-pregnant Women Only)
ADULT WOMEN* 18-29 yrs. 30-39 yrs. 40-49 yrs. 50-64 yrs. 65-69 yrs. 70 yrs.
and older
Abdominal Aortic
Aneurysm
Current evidence insufficient to assess
benefits and harms of screening in women
65-75 yrs. who have smoked. (USPSTF I
Statement) It may be appropriate in individual
cases to perform screening. (UW Health Very
low quality evidence, weak/conditional
recommendation)
It is not recommended to screen women who
have never smoked. (USPSTF Grade D)
Breast Cancer


Beginning at age 40 yrs., a shared
decision making conversation is
recommended to determine patient
preferences and assess breast
cancer risk. (UW Health Very low quality
evidence, weak/conditional
recommendation)
Recommend discussion of the risk
and benefits to consider additional
screening every 1-2 yrs. in the
context of patient preferences,
breast density, and other risk
factors. (UW Health Moderate quality
evidence, weak/conditional
recommendation)
Screen women age 50-74 yrs. using 2-D mammography. (UW Health Moderate quality
evidence, strong recommendation) Digital breast tomosynthesis (DBT), a 3-D
mammography method which UW Health has available at most imaging sites,
may be considered. (UW Health Low quality evidence , weak/conditional recommendation)
Biennial or annual screening frequency may be influenced by patient’s expressed
preference during shared-decision making or risk factors such as mammographic
breast density. (UW Health Low quality evidence, weak/conditional recommendation)
Consider mammography screening in women age 75 yrs. or older every 1-2 yrs.
based upon a discussion of the risks and benefits, as well as consideration for life
expectancy. (UW Health Low quality evidence, weak/conditional recommendation)
Women with a life expectancy of less than 10 yrs. should not be screened.
(UW Health Low quality evidence, weak/conditional recommendation)
UW Health Prevention and Tailored Health Screening (PATHS) clinic referral for women at high risk. (Appendix B)
Cervical Cancer
Screening is not
recommended in patients
younger than 21 yrs.
(USPSTF Grade D) unless at
high risk (see Appendix B)
Screen patients age 21-29
yrs. using cytology alone
every 3 yrs. (USPSTF Grade A)
Screen women age 30-65 yrs. with a combination cytology and high risk HPV co-test every
5 yrs. OR screen with cytology alone every 3 yrs. (USPSTF Grade A)
Stop screening at age 65
yrs. if three normal
results OR two negative
high risk HPV results in
the last decade AND no
history of CIN 2, 3, or
cervical cancer in last 20
yrs.
(USPSTF Grade D)

Patients at high risk should follow alternative screening intervals (see Appendix B.)
More frequent screening intervals (i.e., annual) is not recommended for average risk women of any age.
(UW Health High quality evidence, strong recommendation)
Copyright © 2017 Univ ersity of Wisconsin Hospital s and Clinics Authority
Contact: Lee Vermeulen, CCKM @uwhealth.org Last Revised:
 
05/2017CCKM@uwhealth.org

ADULT WOMEN* 18-29 yrs. 30-39 yrs. 40-49 yrs. 50-64 yrs. 65-69 yrs. 70 yrs.
and older
Chlamydia or
Gonorrhea
Screen sexually active
patients 24 yrs. or younger.
(USPSTF Grade B)

Screen sexually active
patients age 25-29 yrs. if at
increased risk.
(USPSTF Grade B)

Patients should be
screened annually. (UW
Health Low quality evidence,
strong recommendation)
Screen sexually active patients age 30-69 yrs. if at increased risk. (USPSTF Grade B)
Patients should be screened annually. (UW Health Low quality evidence, strong recommendation)


Osteoporosis
Assessment using the FRAX is
recommended in postmenopausal
women between the ages of 50-
64 years, especially if the patient
is considered at increased risk.
(UW Health Moderate quality evidence,
weak/conditional recommendation)

Central dual-energy X-ray
absorptiometry (DXA) should be
completed in patients whose
fracture risk is equal to or greater
than that of a 65 year old white
woman who has no additional risk
factors (major osteoporotic
fracture score 9.3%). (UW Health
Moderate quality evidence, strong
recommendation)

In patients without risk factors or
at low risk, risk should be
reassessed every 5 years. (UW
Health Very low quality evidence,
weak/conditional recommendation)
Perform DXA in women age 65 yrs. or older.
(USPSTF Grade B)
Following completion of the first DXA scan, a
FRAX assessment should be completed
using the T-score to determine major
osteoporotic fracture risk and future
screening interval. (UW Health Very low quality
evidence, weak/conditional recommendation)
Intimate Partner
Violence
Screen women of childbearing age (18-46 yrs.) for intimate partner violence (USPSTF
Grade B) using the HITS assessment tool. (UW Health Moderate quality evidence,
weak/conditional recommendation) Screening may be considered annually. (UW Health Very
low quality evidence, weak/conditional recommendation)


*Sex-based screening should be dependent upon organ inventory and the individual needs of a patient.

Copyright © 2017 Univ ersity of Wisconsin Hospital s and Clinics Authority
Contact: Lee Vermeulen, CCKM @uwhealth.org Last Revised:
 
05/2017CCKM@uwhealth.org