Tuesday, August 21, 2018

OCMA Blog

Autism Spectrum Disorder — The Importance of Early Identification and Behavior Intervention

By Donald Sharps, M.D.
CalOptima Behavioral Health Medical Director

 

Early identification of children with delays in development or those at risk of delays provides primary care providers with a critical opportunity to pinpoint special health care needs. 

The main path to the early identification is a developmental screening in the primary care setting. In particular, early identification of autism spectrum disorder (ASD) can help a child significantly. According to the Centers for Disease Control and Prevention (CDC), early treatment services can improve a child’s development by helping the child talk, walk and interact with others. Therefore, it is important to screen children for ASD or any other developmental problems in their early years. 


The CDC and CalOptima recommend that all children be screened for developmental delays and disabilities during regular well-child doctor visits at: 
  • 9 months
  • 18 months
  • 24 or 30 months

If a child is at high risk for developmental problems due to preterm birth, low birth weight or other reasons, additional screenings might be required.

Additionally, all children should be screened specifically for ASD during regular well-child doctor visits at:

  • 18 months
  • 24 motnhs

Further screenings might be needed if a child is at high risk for ASD (e.g., having a sibling or other family member with ASD) or if behaviors sometimes associated with ASD are present.

Identifying a child as having a special health care need is only the first step. Once developmental delays are identified then an appropriate diagnostic work-up and follow-up must occur. It is in this next step that the relationship between the primary care provider and an early behavior intervention service becomes critical.

Effective September 15, 2014, CalOptima covers behavioral health treatment for ASD. This treatment includes Applied Behavior Analysis and other behavior intervention services. The services help develop or restore, as much as possible, the daily functioning of a member with ASD.

If the developmental screening is positive for signs of developmental delays associated with ASD, you may be able to conduct the additional assessment for ASD, or you may refer the patient to a specialist for a comprehensive diagnostic evaluation. Alternatively, Medi-Cal members can call the Orange County Mental Health Plan Access Line at 1-800-723-8641 to request the evaluation or to access other mental health services.

Resources:

http://www.cdc.gov/ncbddd/autism/screening.html

http://www.cdc.gov/ncbddd/autism/facts.html

 


Community Partnerships: Bringing Health and Wellness to Where We Live and Work

By Annette Walker, Executive Vice President, Strategic Services at St. Joseph Hoag Health

Keeping people – and communities – healthy means more than treating illness and injury. It means partnering with people before they get sick and making it easy and convenient for them to exercise, get preventive care like vaccines and screenings and learn how to eat right.

But in today's fast-paced lifestyle, a lifestyle where we're eating breakfast in the car and checking emails at night on our phones, our health sometimes takes a back seat. But what's the solution? Health and wellness professionals need to meet people where they live and work.

One way we are addressing this at St. Joseph Hoag Health is through our Wellness Corners which are located in neighborhood and office settings. This is helping local employees and residents get their screenings, making them healthier than ever because health care services are available within steps of their offices and front doors.

Offering basic medical care, the Wellness Corner focus on services that help to improve our overall health and wellness and prevent chronic conditions through lifestyle management programs. Members of the local workforce and residential community can stop by to get a flu shot, review his lab test results to ensure that his cholesterol levels have gone down (due to a new healthy eating routine) and attend a seminar about the benefits of mindful meditation.

Our centers located at Four Park Plaza at Jamboree Center, the Park Place business community and The Village at Irvine Spectrum neighborhood are emerging as successful clinics that empower people to take control of their health to prevent illnesses and increase their well-being. We are planning to open additional locations throughout Orange County soon, each with the goal to make healthy living for our family, friends and neighbors more convenient, flexible and accessible.

By making access to health care and wellness programs convenient, we can help people manage their health and ward off illness. This is the health care model of the present and of the future.

Annette Walker is executive vice president, strategic services for St. Joseph Hoag Health where she is responsible for the strategy, business development, marketing and communications. She works directly with senior executives and physicians to develop, support and implement the strategic objectives and competitive positioning of the health ministry. For additional information about the Wellness Corners, click here.


Rising Number of Measles Cases Creates Numerous Patient Safety Issues

As more measles cases are diagnosed, physicians should implement effective screening protocols, infection control techniques, and patient education to reduce liability risks and promote patient safety. Since initial presenting symptoms of measles are similar to those of upper respiratory infections, measles may be misdiagnosed before a patient presents with the familiar red rash.


Exposure to measles in a medical office or facility is a serious patient safety issue because of the potential for complications from the disease, including death. The disease is airborne and extremely contagious. An infected individual is considered contagious from four days before to four days after the rash appears. The rash usually appears 14 days after a person is exposed; however, the incubation period ranges from 7 to 21 days.

Your practice can reduce liability risks and promote patient safety by:

  • Developing screening protocol for patients calling in with symptoms of upper respiratory infections and measles. Staff should query the individual regarding exposure to known measles cases, travel abroad, and immunization status.
  • Documenting all discussions with patients and parents of minors regarding measles, including the risks and benefits of inoculation. When patients/parents decline measles immunization, consider using an informed refusal form: www.thedoctors.com/ecm/groups/public/@tdc/@web/@kc/@patientsafety/documents/form/con_id_001221.pdf. Patients who contract measles and claim that their physician never discussed inoculation represent a potentially significant liability.
  • Providing serologic testing for immunity, when necessary, and documenting all related discussions with patients who are unsure of their immunity status against measles.
  • Ensuring that immunization tracking is up to date and well documented in the medical record.
  • Complying with state laws for the provision of vaccines to healthcare workers. For more information, go to www2a.cdc.gov/nip/statevaccapp/statevaccsapp/default.asp.
  • Advising those who may have come in contact with an infected individual to contact their physician immediately.
  • Ensuring that office staff members are trained to use personal protective equipment and proper isolation techniques.

Follow these tips if you or your staff suspects a patient has measles symptoms:

  • Minimize the risk of exposure to others by admitting the patient through a separate entrance and isolating him or her in an exam room. If possible, schedule the patient at the end of the day. The exam room should not be used until the following day since the virus can live on surfaces for up to two hours. Keep the exam room door closed.
  • Place a surgical mask on the patient and ensure that all office staff members wear protective equipment.
  • Follow standard disinfection and sterilization procedures for exam rooms.
  • Report suspected cases to the local health department.
  • Consider making post-exposure prophylaxis available to those who have been exposed. Post-exposure vaccination can be effective in preventing measles in some individuals. As an alternative, Immunoglobulin, if administered within six days, can offer some protection.

Contributed by The Doctors Company. For more patient safety articles and practice tips, visit www.thedoctors.com/patientsafety


Mental Health Services Access Hotline for Patients and Physicians

The Orange County Mental Health Plan has a hotline available to help Orange County patients locate mental health services. This includes outpatient mental health services provided by mental health professionals and psychiatric inpatient services. Physicians can also utilize the number to locate services for patients. 

Click here for more information.

Orange County Mental Health Plan:

1-800-723-8641


Measles Outbreak Update February 2015

Measles Outbreak Update
February 17, 2015


Measles cases have continued to occur in Orange County with 35 cases confirmed this year. In California, as of February 13, 2015, 113 cases have been confirmed since December 2014; 20% of those with known hospitalization status have been hospitalized. Of those with known vaccination status, the majority are unvaccinated, with most of these because of personal belief exemptions.

Orange County Cases
Of the 35 Orange County cases, 14 are children, 13 of whom were not vaccinated.
Thirteen of our cases spent time at the Disneyland Parks since mid-December, 2014. Sixteen cases had no known source, signaling ongoing transmission in the community. The most recent cases were contacts to previously known cases.

Vaccination is Key to Prevention
Although some of the confirmed cases occurred in people with a history of vaccination, their illness is generally milder and typically not as infectious. Vaccination is critical to prevent the ongoing spread of disease.

  • Although the overall risk of getting measles in Orange County remains low, residents who have not received any measles-containing vaccine and do not have any other evidence of immunity should get a dose of MMR vaccine.
  • Two doses of measles-containing vaccine (MMR vaccine) are more than 99% effective in preventing measles. The first dose is routinely given at 12-15 months of age, with the second dose usually at age 4-6 years. The second dose may be given any time ≥28 days after the first dose.
  • All healthcare workers (HCW), including those born before 1957, should have two documented doses of MMR or serologic evidence of measles immunity. HCW who are exposed to a case of measles may be excluded from work until they provide evidence of immunity.
  • If exposed to measles, all, children and school/child care staff without documented immunity will be removed from work/school/child care from day 7 after the first exposure to day 21 after the last exposure.

Report any suspect case of measles to the Orange County Health Care Agency immediately at 714-834-8180 (714-628-7008 after hours).

For more information on measles, see www.ochealthinfo.com/measles. Information on vaccination recommendations by age group is available in the previous advisory dated 1/26/2015 and guidance on clinical presentation, infection control, reporting, and testing is in the 1/21/2015 advisory.

click here to download this measles outbreak update.


Measles Outbreak Update

Measles has now been confirmed in 22 Orange County (OC) residents, signaling ongoing transmission in the community and at the Disneyland Parks. Thirteen of these cases spent time at the Disneyland Parks since mid-December, 2014. In California, as of today, 59 cases of measles have been confirmed since the end of December; 42 of these had an exposure in December at Disneyland or California Adventure Park. Additional cases have been identified that were at the park while infectious in January, including within the last week. Nine of the OC cases have no Disney or other known measles exposure. Additional cases are expected in Orange County.
 

Of the 22 Orange County cases, five are children, of whom four were not vaccinated and two were hospitalized. Although some of the confirmed cases occurred in people with a history of vaccination, their illness is generally milder and typically not as infectious. Vaccination is critical to prevent the ongoing spread of disease.

  • Although the overall risk of getting measles in Orange County remains low, residents who have not received any measles-containing vaccine should get a dose of MMR vaccine.
  • Two doses of measles-containing vaccine (MMR vaccine) are more than 99% effective in preventing measles. The first dose is routinely given at 12-15 months of age, with the second dose usually at age 4-6 years. The second dose may be given any time ≥28 days after the first dose.
  • All healthcare workers (HCW) should have two documented doses of MMR or serologic evidence of measles immunity. HCW who are exposed to a case of measles may be excluded from work until they provide evidence of immunity.
  • If exposed to measles, all, children and school/child care staff without documented immunity will be removed from work/school/child care from day 7 after the first exposure to day 21 after the last exposure.

Measles is highly contagious and people can be exposed by just being in the same room as a measles case during their infectious period (4 days before onset of rash until 4 days after). Several of the cases have potentially exposed patients in healthcare facilities, resulting in large contact investigations and persons needing immune globulin administration, post-exposure vaccination, or serologic testing for immunity.

  • Any patient suspected of having measles should be masked immediately and promptly moved to a negative pressure room when available. Providers seeing patients in an office or clinic setting should consider options such as arranging to see suspect measles cases after all other patients have left the office, or assessing patients outside of the building to avoid having a potentially infectious patient enter the office.
  • Notify Orange County Public Health Epidemiology immediately at 714-834-8180 (or 714-628-7008 after hours) about any suspect cases. Do not wait for laboratory confirmation before reporting a suspect case. Do NOT refer patients to Public Health without first discussing with one of our staff.
  • DO NOT send potentially infectious suspect measles patients to a reference laboratory for specimen collection.

For more information on measles, see www.ochealthinfo.com/measles.


2015 Young Physicians Patient Safety Award

The Doctors Company Foundation is now accepting essays for the 2015 Young Physicians Patient Safety Award. The annual award recognizes six third- and fourth-year students attending U.S. medical schools who write winning essays about the most instructional patient safety event they have experienced in a clinical rotation. Winners each receive a $5,000 award from The Doctors Company Foundation,which co-sponsors the contest with the Lucian Leape Institute of the National Patient Safety Foundation.
 

For more information on the award and how to apply, please visit www.tdcfoundation.com/2015ypawards. Essays are due by Monday, February 2, 2015 (5:00 PM PST).


Allied Anesthesia Offers Surgery Survival Tips for Parents in the New Year

Contact: 
Paul Yost 714-619-5383
pyost@alliedanesthesia.com
http://www.alliedanesthesia.com/


FOR IMMEDIATE RELEASE

Orange, Calif. (Jan. 20, 2015) –Many people see the New Year as a time to reflect, restore and revitalize.

But, for children who are scheduled to have surgery in the New Year, it’s a time for fear and anxiety.

Allied Anesthesia doctors, who provide anesthesia and pain management services at Children’s Hospital of Orange County (CHOC) and other hospitals around the Southland, are committed to ensuring that every pediatric patient they encounter is as comfortable and unafraid as possible, no matter how difficult and dangerous the procedure. 

With that in mind, they have compiled some tips for parents to help make their child’s experience less mysterious and miserable and more positive and productive.

  1. Whether the child is undergoing a minor outpatient procedure or major surgery, it's important for parents to remain calm and reassuring. Children take their cues from their parents. If their parents are worried and anxious, they will be worried and anxious as well. 
  2. It’s best if children and parents have an idea what to expect. There are many age-appropriate books on the market featuring familiar characters such as “A Visit to the Sesame Street Hospital” and “Curious George Goes to the Hospital.”  Sit down with your child and read it together.
  3. Many children are afraid of being alone either before or after the procedure. Hospitals are much more family friendly today than they were in the past.  Parents should assure their children that they will stay with them up until time for the operation and be there waiting for them when they move into recovery.  
  4. Younger children might enjoy playing “doctor” with a doll or stuffed animal.  Parents can purchase a kit with toy instruments and show them how to take the doll’s temperature or listen to its heartbeat. Older children might benefit from a pre-operative tour of the hospital where they will meet members of the hospital staff and become familiar with the rooms, equipment and procedures. 
  5. When talking about medical procedures, avoid using alarming language such as “the doctor will cut you open” or “you’ll be put to sleep,” which young children might equate to what happens when their pets get sick.
  6. Instead of focusing on what the doctor is going to do, focus on the outcome such as “after your knee surgery, you will be able to play baseball again.”

Above all, be honest and reassuring. 

About Allied Anesthesia: With over 100 highly qualified physician anesthesiologists on staff, Allied Anesthesia provides adult and pediatric anesthesia services to St. Joseph Hospital of Orange, CHOC Children’s Hospital, St. Jude Medical Center in Fullerton, San Antonio Community Hospital in Upland, St. Mary’s Hospital in Apple Valley and many other Southern California health care facilities. In 2014, Allied Anesthesia joined with Fullerton Anesthesia Associates and Upland Anesthesia Medical Group to consolidate best practices in more than six hospitals and more than a dozen ambulatory surgery centers. The expanded medical practice is dedicated to offering the highest comprehensive quality of care and the most cost-effective procedures in all facilities they serve. All Allied physician anesthesiologists are board certified in Anesthesiology and they staff and manage the most efficient operating rooms in Southern California. Allied is a member of the California Society of Anesthesiologists, the American Society of Anesthesiologists, and the Anesthesia Quality Institute.  

For more information, visit:  http://www.alliedanesthesia.com

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NOTICE to OCMA Physicians of Excellence Recipients

Congratulations to the recipients of the 2015 Orange County Medical Association Physician of Excellence award!
  
We would like to clarify that the full list of Physicians of Excellence will be published in one of the Orange County Register publications in early spring 2015. OCMA's new partnership with the Orange County Register elevates the stature of the program, broadens the recognition of the physician recipients as well as extends the reach of those who will read the list in Orange County.   
  
Today we learned that Orange Coast Magazine published a January 2015 issue of "top doctors" - this is not a list of OCMA's Physicians of Excellence. This publication is no longer affiliated whatsoever with OCMA. OCMA ended the relationship with Orange Coast Magazine in April 2014. Though we had a productive relationship for many years, OCMA's Board of Directors decided to partner with the Orange County Register beginning in 2015. 
  

Hopefully this clears up any potential confusion.  In addition, more information on the reception for all recipients in April 2015 will be forthcoming soon. We are excited about the new partnership and we look forward to celebrating the many achievements of all the distinguished recipients.


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