dshs texas newborn screening program processes susan tanksley, phd david martinez april 10, 2008
TRANSCRIPT
DSHS Texas Newborn Screening Program Processes
Susan Tanksley, PhD
David Martinez
April 10, 2008
NBS Case Management Follow-Up Components
Short-Term Follow-Up Frequent Communication with
Health Care Providers Frequent Reporting of follow-up
results Monitoring
NBS Case Management Follow-Up Components continued:
Documentation Family Involvement Continuous Education Long-Term Follow-up Consultants/Sub-specialist Participation
Case Management Process Flowcharts
Case Management (General High Level) Initial Notification of Abnormal Screen
- Case Management activities
- Physician/Facility/Parent activities CAH (Congenital Adrenal Hyperplasia) GAL (Galactosemia)
Case Management Process Flowcharts continued:
Hemoglobinopathy PKU (Phenylketonuria) Hypothyroidism
Case Creation:Abnormal result
notification received
NBS Case Management General Process Flow
Very abnormal specimens are faxedimmediately to CM for immediate actionby nurses. An abnormal result creates acase in LIMS.
InitialNotification of
AbnormalResult
Action takenby PCP/Physician?
Possible Actions Needed -(dependent ondisorder & screen type)-Repeat Screen-Blood work, Diagnostic Testing-Referral to Specialist
Conduct/Continue follow-up activities until resolution.
YES
CM confirms receipt w/lab for very abnormal results.
NO
A
Document clinical feedback in
LIMS to complete short-term follow-up
YES
Patient cleared from DX or
DX patient referred to
Specialist?
NO
A
END
NBS Case Management General Process Flow Continued
Initial Notification of Abnormal Screen
Case Management Responsibilities- Can Doctor be contacted? If yes, provide
results and recommend action
- Determine if baby is in hospital
- Request assistance with locating parent
- Research child and family locations
- Attempt to contact family, provide results obtain doctor information
Initial Notification of Abnormal Screen continued: Case Management responsibilities continued:
- Check Medicaid database, other resources- Utilize Regional Social Workers to assist with locating
a family/connecting family and providers with services
- Involve other agencies including law enforcement if necessary
- Repeat steps necessary to clear a newborn or to obtain a diagnosis
Initial Notification of Abnormal Screen continued: Physician/Facility/Parents Responsibilities
- Doctor agrees to follow-up with newborn/family
- Doctor agrees to scheduling appointments, take necessary steps to obtain confirmed diagnosis
- Hospitals assist with locating parent- CM contacts parents,
Initial Notification of Abnormal Screen continued: Physician/Facility/Parents Responsibilities
- Case Management provides results and recommends action, parents act
- Parent provides PCP information to Case Management
- If no PCP for newborn, parent must obtain PCP, may need to take newborn to ER
- Parent must follow-up to ensure newborn receives treatment and care if diagnosed
ACT Sheets
Act sheets are adapted from the American College of Medical Genetics
ACT sheets are provided to doctors as recommended actions or immediate actions
ACT Sheets continued:
All ACT Sheets contain the following information:- Differential Diagnosis
- Condition Description
- Action Box Medical Emergency: Take the Following
IMMEDIATE Actions You Should Take the Following Actions
ACT Sheets continued:
Diagnostic Evaluation Clinical Observations Additional Information – website resources
Case Management Long-Term Follow-Up Begins at the point a diagnosis is made CM requests periodic reporting of child
progress General Information Requested
- Child still under doctor’s care Moved Lost to follow-up Deceased Referred
Case Management Long-Term Follow-Up continued: Child under treatment/medications/diet Has child been hospitalized? Has child seen specialist? Are parents aware of the diagnosis? Do parents understand the disorder? Has genetic counseling been provided?
Case Management Long-Term Follow-Up continued:
Disorder specific information requested (examples)- PKU – How often phenylalanine levels
monitored?
- Sickle Cell Disease – Have risk factors of the disease been explained to the parents?
- CAH – physical development, genitalia, acute illness
Key Points in the Process Immediate notification PCP/Specialist
involvement Family Involvement Confirmatory/Addi-
tional testing as needed Report results to CM Genetic testing for family
Diagnosis obtained Doctor/Family Education Treatment is delivered as
soon as possible Lifetime care for some
disorders
Questions?