ZZVA-*COLORECTAL CANCER SCREEN (SIG.) (15)    REMINDER DEFINITION (811.9)

At least one sigmoidoscopy examination in their lifetime for patients age
 
    Target Condition: Early detection of colon cancer or its predecessors.
 
    Target Group: All persons ages 50 and older.
 
    Recommendation: All persons age 50 and older should receive an annual
    fecal occult blood test or undergo a sigmoidoscopy examination
    (periodicity unspecified).
 
    Goals for FY 2000: For persons age 50 and older, 50 percent of those
50 and older, or a fecal occult blood test yearly.  This reminder uses 5
    enrolled in primary care clinics have received fecal occult blood
    testing within the preceding year and 40 percent have received at
    least one proctosigmoidosopy examination in their lifetime.
years, rather than 99Y for "ONCE" as originally published in the VA
Guidelines.  The 5 years is a conservative period recommended by a blue
ribbon panel publishing their findings in the February 1997 issue of
"Gastroenterology" magazine.
 
This reminder is based on the "Colorectal Cancer Detection" guidelines
specified in the VHA HANDBOOK, APPENDIX A.

• FINDING ITEM:   FOBT(CLINIC)
  NO. OF FOUND TEXT LINES:   0
  NO. NOT FOUND TEXT LINES:   0
  USE IN RESOLUTION LOGIC:   OR
• FINDING ITEM:   ZZVA-FLEXISIGMOIDOSCOPY
  MINIMUM AGE:   50
  NO. OF FOUND TEXT LINES:   0
  NO. NOT FOUND TEXT LINES:   0
  REMINDER FREQUENCY:   5Y
  RANK FREQUENCY:   2
  USE IN RESOLUTION LOGIC:   OR
• FINDING ITEM:   ZZVA-FOBT
  MINIMUM AGE:   50
  NO. OF FOUND TEXT LINES:   0
  NO. NOT FOUND TEXT LINES:   0
  REMINDER FREQUENCY:   1Y
  RANK FREQUENCY:   3
  USE IN RESOLUTION LOGIC:   OR
• FINDING ITEM:   ZZVA-COLORECTAL CANCER SCREEN
  NO. OF FOUND TEXT LINES:   0
  NO. NOT FOUND TEXT LINES:   0
• FINDING ITEM:   INACTIVATE SIGMOIDOSCOPY
  MINIMUM AGE:   50
  NO. OF FOUND TEXT LINES:   0
  NO. NOT FOUND TEXT LINES:   0
  REMINDER FREQUENCY:   0Y
  RANK FREQUENCY:   1
  USE IN PATIENT COHORT LOGIC:   AND NOT
• FINDING ITEM:   ACTIVATE SIGMOIDOSCOPY
  NO. OF FOUND TEXT LINES:   0
  NO. NOT FOUND TEXT LINES:   0

The next time a SIG is due is 1 year from the last FOBT, or 5 years from
the SIG is due again.  If the most recent health factor finding, between
INACTIVATE and ACTIVATE is INACTIVATE with its rank of 1, the reminder
will be "N/A" (not applicable to the patient), and the frequency is 0Y.
 
Check the Taxonomy Findings entries representing flexisigimoidoscopy and
FOBT procedures. This represents coded standard entries in the CPT file
and ICD Operation/Procedure file.  If the taxonomies need modification,
copy the taxonomy to a new taxonomy for your site, and make the
appropriate modifications.  Then, copy this reminder to a new reminder for
your local sites modifications, and change the Taxonomy Findings to use
the last SIG.
the new taxonomies.
 
The reminder type is EXAM, and the Baseline AGE RANGE and FREQUENCY is 50
and older and 1Y - so that the SIG will be due a year from the last FOBT
done in the clinic.  The AGE RANGE and FREQUENCY are modified to 50 and
older and 5Y if a prior SIG has been received by the patient.  The Rank
of 2, on the VA-FLEXISIGMOIDOSCOPY taxonomy match fields, will cause a
match of a SIG to take precedence over the FOBT findings to establish when

• REMINDER FREQUENCY:   1Y
  MINIMUM AGE:   50
  AGE MATCH TEXT:   

  SIG due every 5 years for patients 50 and older, or FOBT annually.
  

  AGE NO MATCH TEXT:   

  Flexisigmoidoscopy not indicted for patients under 50.
  

  NO. OF AGE MATCH LINES:   1
  NO. OF AGE NO MATCH LINES:   1