Section 3: Key Clinical Processes in LM

Question 1

Vital Signs of LM Exam

Answer 1

• Physical Activity:
  1. How many days/week engage in moderate to strenuous exercise?
  2. How many min. per day do you exercise at this level?
• Diet Vital Sign:
• Stress Vital Sign [Assessed using 10 item questionnaire. or DSSQ Dundee Stress State Questionnaire (24 item)]
• Sleep Vital Sign (Epworth Sleepiness Scale ESS), 8 question assessment for daytime sleepiness.
• Emotional well being vital sign:
  
  1. In most ways, my life is close to my ideal.
  2. I am satisfied with my life
     Come from Satisfaction with Life Scale (SWLF) questionnaire
• Tobacco Use Vital Sign
  
  1. Ask px about tobacco use
• Alcohol Consumption Vital Sign
  1. Scree px at every visit if regularly drinking, if not, screen once a year
  2. AUDIT-C (Alcohol Use Disorder Identification Test-Concise
  
  • How often you have drink containing alcohol?
  • How many drinks containing alcohol do you have on a typical day when you are drinking?
  • How often do you have six or more drinks on one occasion?
• BMI Vital Sign
  
  • kg/height in m2
  • pounds/height in inches x 703
    BMI:
    Underweight: <18.5
    Normal: 18.5 - 24.9
    Overweight 25-29.9
    Obese
    
    • Class 1 - 30.0-34.9
    • Class 2 - 35.0 - 39.9
    • Class 3 - >40 (Extreme Obesity)

ASIAN BMI
Underweight less than 18.5
Normal weight 18.5-22.98
Overweight 23-24.9
Class 1 obese >25

Question 2

In primary care, how much is related to stress consultations?

Answer 2

70%

Question 3

LM Physical Evaluation and Examination

Answer 3

• Wait Circumference Increased if:
  
  • For men >40 inches
  • For women >35 inches
• Waist/Hip Ratio
  
  • for men <0.90
  • for women <0.85
• Bio-impedance analysis
• Pulse
• Blood Pressure..
  Normal <120/80
  Elevated 120-129
  Stage 1: 130-139
  Stage 2: >140

Question 4

Diagnostic Test Relevant to LM

Answer 4

• Complete Metabolic Panel
• CBC
• Lipids
• CRP (chronic marker of inflammation)
• Blood sugar, HbA1c
• VItamin D
• TSH and t4

Question 5

Strategies for effective office systems and tools for tracking

Answer 5

• Electronic medical records (EMR)

Question 6

Examples of Team Implementation Chronic Care Model

Answer 6

Ornish Spectrum Program
- Intensive Cardiac Rehab Program
- Team Based
- Physician, nurse, chef, marketing, etc.

Medical Fitness Collaboration

Question 7

Chronic Care Model

Answer 7

A model helpful in explaining the involvement of the community and heatlh care system in chronic disease care (how everything is related in managing Lifestyle related diseases, from primary care, community, etc.

Question 8

PDSA

Answer 8

Plan, Do, Study, Act

• Tool, cycle used to improve health care service quality

Plan - develop the plan
Do - Carry out the plan
Study - complete data analysis and lessons learned
Act - what needs to be changed in the next cycle

Question 9

Root Cause Analysis

Answer 9

Tool used when something goes wrong or near miss is exprienced
- Ask “Why” five times
- Ask “So what?” - What is the consequence of something not going as planned
- Draw cause and effect diagram