Description | Data to be Collected |
---|---|
All relevant chronic disease prevention and screening test results and values | cholesterol, fasting blood sugar, glycated hemoglobin, stool for blood, sigmoidoscopy, colonoscopy, pap, and mammogram |
All relevant cancer surveillance results and values depending on personal history of cancer | breast - mammography, bone density; colorectal – colonoscopy, carcinoembryonic; antigen test, computerized axial tomography; prostate - prostate specific antigen test |
Physical and vital information | blood pressure, weight, height, and body mass index For patients randomized to the intervention group, the PP will take the BP, weight and height measurements during the visit with the patient. For patients randomized to wait-list control, these will be collected from their medical record (electronic or paper) at baseline and 12-month data collection time points. |
Referrals made or actions to be taken by the patient, PP, or primary care team in order to follow up on identified CCDPS items | Description of referrals and actions taken |