|
|
|
LT Ivanne L. Cheatham |
|
LCDR Brandon L. Taylor |
|
W.W. Hastings Indian Hospital, Tahlequah
Oklahoma |
|
|
|
|
|
Waist Circumference |
|
Men > 40 Inches |
|
Women > 35 Inches |
|
Fasting Plasma Glucose 110-126mg/dl |
|
Triglycerides > 150 mg/dl |
|
HDL -C |
|
Men <40 mg/dl |
|
Women < 35 mg/dl |
|
High Blood Pressure > 130/85 mm Hg |
|
|
|
|
Pharmacy Department |
|
Medical Department |
|
Nursing Department |
|
Dietary Department |
|
Physical Therapy Department |
|
Hospital Administration |
|
Tribal Representation |
|
|
|
|
|
HDL-C |
|
< 30mg/dl in Men |
|
< 40mg/dl in Women |
|
SBP > 160 |
|
(Treated or Untreated) |
|
TG > 200mg/dl |
|
Waist Circumference |
|
Fasting Plasma Glucose |
|
|
|
|
|
|
1 of the 3 Qualifying Criteria Must Include |
|
Waist Circumference |
|
men > 45 inches |
|
women > 40 inches |
|
Fasting Plasma Glucose |
|
110-126mg/dl |
|
w/o
previous diagnosis of diabetes |
|
|
|
|
|
Patient Referral Notice |
|
Inclusion Criteria |
|
Ambulatory Care Record: Patient Care Component (PCC) |
|
Current Drug Therapy |
|
Recent Laboratory Data |
|
Vitals |
|
|
|
|
15 Month Program |
|
8:00 AM to 4:00 PM |
|
60 Minute Initial Visit |
|
20 - 30 Minute Follow-Up Visit |
|
Group Education and Problem Solving Session |
|
Maintenance Program |
|
|
|
|
|
Physical Activity Readiness Questionnaire
(PAR-Q) Form |
|
Dietary Lifestyle Questionnaire |
|
Food Frequency Questionnaire |
|
PCC |
|
Initial & Follow-Up |
|
Metabolic Syndrome Flow Sheet |
|
Handouts |
|
Access Program |
|
|
|
|
|
|
|
|
ICD-9 Code 277.7 |
|
Established Patients |
|
Evaluation & Management Billing Code (99211) |
|
modifier 15 |
|
“Incident to” Non-Physician |
|
PCC System |
|
Pharmacy Superbill System |
|
|
|
|
Current National Guidelines and Recommendations
on the Various Disease States |
|
Metabolic Syndrome Clinic Protocol |
|
Written, Verbal and Practical Means |
|
|
|
|
|
|
W.W. Hastings Indian Hospital |
|
Tahlequah, Oklahoma |
|
|
|
LT Ivanne L. Cheatham |
|
ivanne.cheatham@mail.ihs.gov |
|
|
|
LCDR Brandon L. Taylor |
|
brandon.taylor@mail.ihs.gov |
|
|
|
Duke University, Medical Center |
|
Durham, North Carolina |
|
|
|
Ralph La Forge |
|
rlaforge@nc.rr.com |
|
Notes