LMBR3: 3-Key Clinical Processes Flashcards
Chronic disease, obesity and being overweight are directly correlated with each of the following except:
A) Poor diet
B) Excess calories
C) Physical inactivity
D) Excess sleep
D.
Poor diet, excess calories and physical inactivity are all directly correlated with chronic diseases, obesity and being overweight. Although excess sleep can be related to health concerns and affective disorders, it does not directly correlate with obesity. Actually, sleep deprivation is more likely to cause weight gain.
Which of the following is not true regarding the chart, “Overweight / Obesity Classification by BMI, Waist Circumference, and Associated Disease Risk”?
A) A BMI (kg/m2) of 24 is overweight for an Asian man.
B) A BMI (kg/m2) of ≥ 40 is Class 3 Obesity for a non-Asian woman.
C) A BMI (kg/m2) of 30.0 to 34.9 and waist circumference < 40 in men has a high associated disease risk of type 2 diabetes (DM2), hypertension (HTN) and cardiovascular disease (CVD) compared to a normal weight and normal waist circumference.
D) A BMI (kg/m2) of 29 is overweight for an Asian man.
D.
Classifications for Asians differs from non-Asians. A BMI of 23.0 to 27.9 kg/m2 is considered overweight for Asians. A BMI of ≥ 28.0 is considered obese for Asians. A BMI of 30.0 to 34.9 and waist circumference < 40 in men has high associated disease risk for type 2 diabetes, hypertension and cardiovascular disease compared to normal weight and waist circumference.
Which of the following statements about diabetes diagnosis are true?
A) HbA1c ≥ 6.5% is diagnostic of pre-diabetes.
B) Fasting serum glucose (Glu) ≥ 115 mg/dL (7.0 mmol/L) or one-hour post-prandial glucose ≥ 200 mg/dL (11.1 mmol/L) during an oral glucose tolerance test (OGTT) is diagnostic of diabetes.
C) Fasting serum glucose (Glu) ≥ 126 mg/dL (7.0 mmol/L) or one-hour post-prandial glucose ≥ 200 mg/dL (11.1 mmol/L) during an oral glucose tolerance test (OGTT) is diagnostic of diabetes.
D) A 2-hour serum glucose during an oral glucose tolerance test (OGTT) of 140 to 199 mg/dL (7.8 - 11.0 mmol/L) is diagnostic of pre-diabetes.
D.
HbA1c ≥ 6.5% or two-hour post-prandial glucose ≥ 200 mg/dL (11.1 mmol/L) during an oral glucose tolerance test (OGTT) or fasting serum glucose (Glu) ≥ 126 mg/dL (7.0 mmol/L) is diagnostic of diabetes. A 2-h serum glucose during an oral glucose tolerance test (OGTT) of 140 - 199 mg/dL (7.8 - 11.0 mmol/L) is diagnostic of pre-diabetes.
Which of the following is a key strategy for leveraging the interdisciplinary team to enhance health behavior change interventions?
A) Routinely collect lifestyle medicine vital signs (exercise, nutrition, waist circumference, BMI and physical activity/fitness).
B) Provide basic counseling/instruction (importance of various lifestyle factors).
C) Provide tools and resources (handouts, community resources, online and apps).
D) Help patients identify community resources (where are they and what do they provide).
E) All of the above.
E. All of the above.
An interdisciplinary team should be able to demonstrate which of the following characteristics:
A) Positive leadership and management attributes.
B) Communication strategies and structures.
C) Personal rewards, and training and development.
D) Appropriate resources and procedures.
E) All of the above
E. All of the above.
Which of the following statements about the value of group visits are true?
A) Group visits decrease access to care.
B) Group visits decrease patient and provider satisfaction.
C) DIGMAs are Drop in Group Medical Appointments.
D) They are always billable under Medicare.
E) None of the above are true statements regarding group visits.
C.
Group visits increase access to care. Group visits increase patient and provider satisfaction. DIGMAs are Drop in Group Medical Appointments. They are billable under Medicare only when billing criteria are met.
Which of the following is a process for health care service quality improvement with applications for lifestyle interventions?
A) Electronic health record (EHR/EMR).
B) Plan-Do-Study-Act cycle (PDSA cycle).
C) Value-based care involves financially rewarding institutions for value, not just treatment.
D) The Agency for Healthcare Research and Quality (AHRQ).
E) Innovative Care for Chronic Conditions (ICCC)
B.
Plan-Do-Study-Act cycles (PDSA cycles) are processes that can be used in health care for quality improvement and can be applied to lifestyle interventions.
The EHR/EMR is the electronic health or electronic medical record. Value-based care involves financially rewarding institutions for value not just treatment. The Agency for Healthcare Research and Quality is not a process; rather it’s an agency of the US Department of Health and Human Services that generates the evidence needed to improve the safety, quality and access of health care. The Innovative Care for Chronic Conditions is a template, produced by the World Health Organization, that countries can follow to improve chronic disease management.
Examples of team implementation from demonstrated chronic care models include:
A) Medical Fitness Collaboration
B) Esselstyn Spectrum Program
C) Robert Wood Johnson Foundation
D) Six Sigma
A.
The Medical Fitness Collaboration and the Ornish Spectrum Program are examples of team implementation from demonstrated chronic care models.
The Esselstyn Spectrum Program does not exist. The Robert Wood Johnson Foundation is one of the nation’s largest public health philanthropies focused solely on health. Six Sigma is a quality improvement process that uses a disciplined, data-driven approach and methodology for eliminating defects (driving toward six standard deviations between the mean and the nearest specification limit).
Which statement is true concerning the lifestyle medicine vital signs?
A) The lifestyle medicine vital signs should be considered part of the standard vital signs due to the extensive research behind them.
B) In the diet vital sign, it is important to assess for specific shortfall nutrients.
C) Perceived stress level does not need to be screened for at every visit.
D) The two-item exercise vital sign is a valid measure for classifying inactive, insufficiently active, or sufficiently active levels of exercise.
E) The AUDIT-C questionnaire is insufficient to screen for alcohol use disorder at a yearly physical.
D. The two-item exercise vital sign has been researched and found to be a valid measure of insufficient to sufficient cardiovascular physical activity.
Lifestyle medicine vital signs should not be considered standard vital signs, but rather should be used as ‘check-ins’ about each major healthy lifestyle component at every visit. More research needs to be done before these vital signs can become standards. Since nutrients come in “food packages,” it’s better to assess for whole foods rather than particular nutrients. Perceived stress should be screened for at every visit. The AUDIT-C screening questionnaire is a sufficient screening tool; those who test positive should then be asked to complete the full AUDIT questionnaire.
All of the following are examples of well written lifestyle prescriptions except:
A. The patient has atherosclerosis and should reduce his total fat intake to less than 10% of his total daily caloric intake to reverse disease.
B. The patient has obesity and should include 150 minutes per week of moderate intensity aerobic exercise per week, including two to three times per week of resistance training.
C. The patient has untreated attention deficit hyperactivity disorder (ADHD) and a high stress job; she should consider relaxation techniques, including mindfulness meditation.
D. The patient has an enlarged prostate with minor urinary difficulty; he should consider taking three tablespoons of freshly crushed flax seed daily.
C.
The most important point of a lifestyle prescription that leads into an action plan is that the patient must be able to perform the agreed upon task. There is no specific action plan (time allotted to activity, measurement of achievement) the patient can follow in answer C. Of note, the patient with untreated ADHD may best be served by using exercise to treat stress, as sitting to perform mindfulness meditation may be more difficult.
