![](media/image1.png){width="5.96875in" height="0.41944444444444445in"}

Top of Form

## Complete Summary

#### GUIDELINE TITLE

Adult preventive services (ages 50 - 65+).

#### BIBLIOGRAPHIC SOURCE(S)

Michigan Quality Improvement Consortium. Adult preventive services (ages
50-65+). Southfield (MI): Michigan Quality Improvement Consortium; 2006
Sep. 1 p.

#### GUIDELINE STATUS

**Note**: This guideline has been updated. The National Guideline
Clearinghouse (NGC) is working to update this summary.

### COMPLETE SUMMARY CONTENT

 SCOPE\
 METHODOLOGY - including Rating Scheme and Cost Analysis\
 RECOMMENDATIONS\
 EVIDENCE SUPPORTING THE RECOMMENDATIONS\
 BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS\
 QUALIFYING STATEMENTS\
 IMPLEMENTATION OF THE GUIDELINE\
 INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT
CATEGORIES\
 IDENTIFYING INFORMATION AND AVAILABILITY\
 DISCLAIMER

### SCOPE

#### DISEASE/CONDITION(S)

Preventable diseases and conditions, such as

-   Overweight/obesity

-   Hypertension

-   Dyslipidemia

-   Diabetes Mellitus

-   Osteoporosis

-   Colorectal cancer

-   Glaucoma

-   Cervical cancer

-   Breast cancer

-   Prostate cancer

-   Tetanus

-   Diphtheria

-   Pertussis

-   Influenza

-   Pneumonia

#### GUIDELINE CATEGORY

Prevention\
Screening

#### CLINICAL SPECIALTY

Family Practice\
Geriatrics\
Internal Medicine\
Obstetrics and Gynecology\
Preventive Medicine

#### INTENDED USERS

Advanced Practice Nurses\
Health Plans\
Physician Assistants\
Physicians

#### GUIDELINE OBJECTIVE(S)

-   To achieve significant, measurable improvements in the management of
    adult preventive services (ages 50 to 65+) through the development
    and implementation of common evidence-based clinical practice
    guidelines

-   To design concise guidelines that are focused on key management
    components of adult preventive services (ages 50 to 65+) to improve
    outcomes

#### TARGET POPULATION

-   Adult patients ages 50 to 64 years

-   Adult patients age 65+

#### INTERVENTIONS AND PRACTICES CONSIDERED

**Screening/Prevention**

1.  Health maintenance exam including height and weight; risk evaluation
    and counseling (e.g., nutrition, physical activity, tobacco use,
    sexual health); safety assessment (e.g., domestic violence, seat
    belts, firearms); behavioral assessment (e.g., depression, suicide
    threats, alcohol/drug use)

2.  Blood pressure measurement

3.  Screening for the following diseases/conditions:

    -   Dyslipidemia

    -   Diabetes mellitus

    -   Osteoporosis

    -   Colorectal cancer

    -   Glaucoma

    -   Cervical cancer

    -   Breast cancer

    -   Prostate cancer

4.  Immunizations (tetanus diphtheria acellular
    pertussis/tetanus-diphtheria \[TDaP/Td\], influenza, pneumonia)

#### MAJOR OUTCOMES CONSIDERED

Not stated

### METHODOLOGY

#### METHODS USED TO COLLECT/SELECT EVIDENCE

Searches of Electronic Databases

#### DESCRIPTION OF METHODS USED TO COLLECT/SELECT THE EVIDENCE

The Michigan Quality Improvement Consortium (MQIC) project leader
conducts a search of current literature in support of the guideline
topic. Computer database searches are used to identify published studies
and existing protocols and/or clinical practice guidelines on the
selected topic. A database such as MEDLINE and two to three other
databases are used.

#### NUMBER OF SOURCE DOCUMENTS

Not stated

#### METHODS USED TO ASSESS THE QUALITY AND STRENGTH OF THE EVIDENCE

Weighting According to a Rating Scheme (Scheme Given)

#### RATING SCHEME FOR THE STRENGTH OF THE EVIDENCE

**Levels of Evidence for the Most Significant Recommendations**

A.  Randomized controlled trials

B.  Controlled trials, no randomization

C.  Observational studies

D.  Opinion of expert panel

#### METHODS USED TO ANALYZE THE EVIDENCE

Review

#### DESCRIPTION OF THE METHODS USED TO ANALYZE THE EVIDENCE

Not stated

#### METHODS USED TO FORMULATE THE RECOMMENDATIONS

Expert Consensus

#### DESCRIPTION OF METHODS USED TO FORMULATE THE RECOMMENDATIONS

Using the health plan guideline summaries and information obtained from
the literature search, the Michigan Quality Improvement Consortium
(MQIC) director and/or project leader prepare a draft guideline for
review by the MQIC Medical Directors.

The draft guideline and health plan guideline summaries are distributed
to the MQIC Medical Directors for review and discussion at their next
committee meeting.

The review/revision cycle may be conducted over several meetings before
consensus is reached. Each version of the draft guideline is distributed
to the MQIC Medical Directors, Measurement, and Implementation Committee
members for review and comments. All feedback received is distributed to
the entire membership.

Once the MQIC Medical Directors achieve consensus on the draft
guideline, it is considered approved for external distribution to
practitioners with review and comments requested.

#### RATING SCHEME FOR THE STRENGTH OF THE RECOMMENDATIONS

Not applicable

#### COST ANALYSIS

A formal cost analysis was not performed and published cost analyses
were not reviewed.

#### METHOD OF GUIDELINE VALIDATION

External Peer Review

#### DESCRIPTION OF METHOD OF GUIDELINE VALIDATION

Once the Michigan Quality Improvement Consortium (MQIC) Medical
Directors achieve consensus on the draft guideline, it is considered
approved for external distribution to practitioners with review and
comments requested.

The MQIC director also forwards the approved guideline draft to
presidents of the appropriate state medical specialty societies for
their input. All feedback received from external reviews is presented
for discussion at the next MQIC Medical Directors Committee meeting. In
addition, physicians are invited to attend the committee meeting to
present their comments.

### RECOMMENDATIONS

#### MAJOR RECOMMENDATIONS

**Note**: This guideline has been updated. The National Guideline
Clearinghouse (NGC) is working to update this summary. The
recommendations that follow are based on the previous version of the
guideline.

The level of evidence grades (A-D) are provided for the most significant
recommendations and are defined at the end of the \"Major
Recommendations\" field.

**Health Assessment Screening, History, and Counseling**

*Ages 50 to 64 years*

One health maintenance exam (HME) every 1 to 3 years according to risk
status **\[D\]**

*Age 65+ years*

One HME at least every 2 years

Each HME should include:

-   Height, weight, and body mass index (BMI)

-   Risk evaluation and counseling (nutrition, overweight/obesity,
    physical activity, dental health, tobacco use **\[A\]**,
    immunizations, human immunodeficiency virus (HIV) prevention
    **\[B\]**, sexually transmitted diseases prevention **\[B\]** and
    sexual health, sexual abuse, polypharmacy including over-the-counter
    and herbal preparations when appropriate, sun exposure)

-   Safety (domestic violence, seat belts **\[B\]**, helmets, firearms,
    smoke and carbon monoxide detectors)

-   Behavioral assessment (depression, suicide threats, alcohol/drug
    use, anxiety, stress reduction, coping skills)

**Blood Pressure Measurement \[A\]**

*Ages 50 to 65+ Years*

At every office visit and, at minimum, every 2 years. If blood pressure
(BP) 120/80 or higher and/or presence of risk factors, more frequent
monitoring is recommended.

**Cholesterol and Lipid Screening \[B\]**

*Ages 50 to 65+ Years*

Measure a complete fasting lipoprotein profile (i.e., total cholesterol,
low-density lipoprotein cholesterol \[LDL-C\], high-density lipoprotein
cholesterol \[HDL-C\], and triglycerides) every 5 years if initial test
is normal in low-risk adults. If multiple risk factors are present, more
frequent measurements are recommended.

**Diabetes Mellitus Screening \[C\]**

*Ages 50 to 65+ Years*

Fasting plasma glucose (FPG) every 3 years and at clinical discretion

**Osteoporosis Screening \[C\]**

*Ages 50 to 64 Years*

Beginning at age 60 if high risk (e.g., smoking, weight \<127 lbs.,
estrogen deficiency, alcoholism, personal or family history of
fragility, family history of osteoporosis, age, gender, etc.): Bone
mineral density (BMD) test once for initial diagnosis, repeat test not
more frequent than every 2 years (per the National Guideline
Clearinghouse \[NGC\] summary of the Michigan Quality Improvement
Consortium \[MQIC\]
[Osteoporosis](http://www.guideline.gov/summary/summary.aspx?doc_id=12275&nbr=6329)
guideline).

*Age 65+ Years*

Women age \>65 regardless of risk factors

**Colorectal Cancer Screening \[B\] for Average Risk Adults**

*Ages 50 to 65+ Years*

Fecal occult blood test (FOBT) annually and/or sigmoidoscopy every 5
years; or double contrast barium enema every 5 years; or colonoscopy
every 10 years

**Glaucoma Screening \[C\]**

*Ages 50 to 64 Years*

No requirement unless high risk (e.g., increased intraocular pressure,
family history, African Americans, people who have diabetes, myopia,
regular/long-term steroid use, previous eye injury)

*Age 65+ Years*

Every 2 years; screen annually if high risk

**Cervical Cancer Screening \[A\] Pap Smear**

*Ages 50 to 64 Years*

At least every 3 years, unless high risk (i.e., history of abnormal Pap
results, sexually transmitted diseases, or HIV; sexual activity before
age 18 or multiple partners; vaginal spotting or bleeding between
periods, after intercourse, or after menopause; tobacco use) (Consider
discontinuation for patients with surgical removal of cervix for benign
conditions).

*Age 65+ Years*

May discontinue after age 65, based on clinical judgement according to
risk status

**Mammography \[A\] and Clinical Breast Exam \[C\]**

*Ages 50 to 70 years*

Every 1 to 2 years

*Age 70+ years*

Shared decision-making after age 70

**Prostate Cancer Screening \[D\]**

*Ages 50 to 65 years*

Shared decision-making for digital rectal examination (DRE) and/or
prostate specific antigen (PSA) testing

**Immunizations**

**Tetanus Diphtheria Acellular Pertussis/Tetanus-diphtheria (TDaP/Td)
\[A\]**

*Ages 50 to 65+ Years*

TDaP once after age 11, then Td every 10 years

**Influenza \[B\]**

*Ages 50 to 65+ Years*

Annually

**Pneumonia \[B\]**

*Ages 50 to 64 Years*

No requirement, unless high risk

*Age 65+ Years*

Once at age 65; booster may be needed after 5 years

**Definitions**:

**Levels of Evidence for the Most Significant Recommendation**

A.  Randomized controlled trials

B.  Controlled trials, no randomization

C.  Observational studies

D.  Opinion of expert panel

#### CLINICAL ALGORITHM(S)

None provided

### EVIDENCE SUPPORTING THE RECOMMENDATIONS

#### TYPE OF EVIDENCE SUPPORTING THE RECOMMENDATIONS

The type of evidence is provided for the most significant
recommendations (see \"Major Recommendations\" field).

This guideline is based on several sources, including: *The Guide to
Clinical Preventive Services 2005, Recommendations of the U.S.
Preventive Services Task Force*
([www.preventiveservices.ahrq.gov](http://www.preventiveservices.ahrq.gov/)),
and the *Advisory Committee on Immunization Practices (ACIP) 2006
Immunization Recommendations* ([www.cdc.gov](http://www.cdc.gov/)).

### BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS

#### POTENTIAL BENEFITS

Through a collaborative approach to developing and implementing common
clinical practice guidelines and performance measures for adult
preventive services (ages 50 to 65+), Michigan health plans will achieve
consistent delivery of evidence-based services and better health
outcomes. This approach also will augment the practice environment for
physicians by reducing the administrative burdens imposed by compliance
with diverse health plan guidelines and associated requirements.

#### POTENTIAL HARMS

Not stated

### QUALIFYING STATEMENTS

#### QUALIFYING STATEMENTS

This guideline lists core management steps. Individual patient
considerations and advances in medical science may supersede or modify
these recommendations.

### IMPLEMENTATION OF THE GUIDELINE

#### DESCRIPTION OF IMPLEMENTATION STRATEGY

When consensus is reached on a final version of the guideline, a
statewide mailing of the approved guideline is completed. The guideline
is distributed to physicians in the following medical specialties:

-   Family Practice

-   General Practice

-   Internal Medicine

-   Other Specialists for which the guideline is applicable (e.g.,
    endocrinologists, allergists, pediatricians, cardiologists)

### INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT CATEGORIES

#### IOM CARE NEED

Staying Healthy

#### IOM DOMAIN

Effectiveness

### IDENTIFYING INFORMATION AND AVAILABILITY

#### BIBLIOGRAPHIC SOURCE(S)

Michigan Quality Improvement Consortium. Adult preventive services (ages
50-65+). Southfield (MI): Michigan Quality Improvement Consortium; 2006
Sep. 1 p.

#### ADAPTATION

This guideline is based on several sources, including: *The Guide to
Clinical Preventive Services 2005, Recommendations of the U.S.
Preventive Services Task Force*
([www.preventiveservices.ahrq.gov](http://www.preventiveservices.ahrq.gov/)),
and the *Advisory Committee on Immunization Practices (ACIP) 2006
Immunization Recommendations* ([www.cdc.gov](http://www.cdc.gov/)).

#### DATE RELEASED

2005 Jul (revised 2006 Sep)

#### GUIDELINE DEVELOPER(S)

Michigan Quality Improvement Consortium - Professional Association

#### SOURCE(S) OF FUNDING

Michigan Quality Improvement Consortium

#### GUIDELINE COMMITTEE

Michigan Quality Improvement Consortium Medical Director\'s Committee

#### COMPOSITION OF GROUP THAT AUTHORED THE GUIDELINE

Physician representatives from participating Michigan Quality
Improvement Consortium health plans, Michigan State Medical Society,
Michigan Osteopathic Association, Michigan Association of Health Plans,
Michigan Department of Community Health, and Michigan Peer Review
Organization

#### FINANCIAL DISCLOSURES/CONFLICTS OF INTEREST

Not stated

#### GUIDELINE STATUS

**Note**: This guideline has been updated. The National Guideline
Clearinghouse (NGC) is working to update this summary.

#### GUIDELINE AVAILABILITY

Electronic copies of the updated guideline: Available in Portable
Document Format (PDF) from the [Michigan Quality Improvement Consortium
Web site](http://www.mqic.org/guid.htm).

#### AVAILABILITY OF COMPANION DOCUMENTS

None available

#### PATIENT RESOURCES

None available

#### NGC STATUS

This NGC summary was completed by ECRI on November 28, 2005. The updated
information was verified by the guideline developer on December 19,
2005. This NGC summary was updated by ECRI on October 16, 2006. The
updated information was verified by the guideline developer on November
3, 2006.

#### COPYRIGHT STATEMENT

This NGC summary is based on the original guideline, which may be
reproduced with the citation developed by the Michigan Quality
Improvement Consortium.

### DISCLAIMER

#### NGC DISCLAIMER

The National Guideline Clearinghouse™ (NGC) does not develop, produce,
approve, or endorse the guidelines represented on this site.

All guidelines summarized by NGC and hosted on our site are produced
under the auspices of medical specialty societies, relevant professional
associations, public or private organizations, other government
agencies, health care organizations or plans, and similar entities.

Guidelines represented on the NGC Web site are submitted by guideline
developers, and are screened solely to determine that they meet the NGC
Inclusion Criteria which may be found at
<http://www.guideline.gov/about/inclusion.aspx> .

NGC, AHRQ, and its contractor ECRI Institute make no warranties
concerning the content or clinical efficacy or effectiveness of the
clinical practice guidelines and related materials represented on this
site. Moreover, the views and opinions of developers or authors of
guidelines represented on this site do not necessarily state or reflect
those of NGC, AHRQ, or its contractor ECRI Institute, and inclusion or
hosting of guidelines in NGC may not be used for advertising or
commercial endorsement purposes.

Readers with questions regarding guideline content are directed to
contact the guideline developer.

Bottom of Form

© 1998-2008 National Guideline Clearinghouse

Date Modified: 11/3/2008