Module Components

• Overview

Topics

• Care Coordination and Case Management
• Screening and Referral

Nurs 467 - Public Health Nursing

Module 8: Case Management, Screening, and Referral

Screening and Referral

Screening

Screening is a secondary prevention activity used to detect illness for the purpose of early diagnosis. Screening identifies individuals with unrecognized health risk factors or asymptomatic disease conditions in populations.

Criteria for Selecting Screening Tests

There are a number of options for screening tests. Knowing which is appropriate for your purpose is important to the public health nurse. The criteria used in choosing an appropriate test are validity and reliability.

Validity is the ability of a test to distinguish between those who have the disease versus those who do not have the disease. Validity is measured by sensitivity and specificity.

• Sensitivity: the ability of a screening test to identify correctly those with the disease (true positives)
• Specificity: the ability of a screening test to identify those without disease who correctly test negative.

Reliability is the ability of the test to provide accurate results over time regardless of who administers the test and when or where the test is administered.

Examples of screening tests include:

• Phenylketonuria (PKU)
• Denver II Development Screening (DDST)
• Scoliosis
• Blood pressure

Review the following video for an example of a newborn screening program

http://www.infanthearing.org/videos/featured/Tennessee-Hearing-Screening.php

Access these links for examples of screening and referral programs in Maryland:

State of Maryland, Breast and Cervical Cancer Screening Program

New Requirements for Lead Testing in Maryland

Referral

Referral is the process of sending or directing someone for treatment, aid, information, or a decision. Making referrals is an essential component of the screening process.

When establishing referral guidelines, providers must use outcome based clinical evidence (Clinical Guidelines).

A referral always consists of communications among three individuals: the client, the person making the referral, and the person or persons to whom the client has been referred. When providing screening services, the organization must have a procedure for referring clients.

Developing a Referral System

• Develop a list of services and providers in the community (review/update periodically)
• Develop and implement a referral protocol
• Train staff to make referrals
• Develop and implement a follow-up system

Procedures for Making a Referral

• Assess client receptivity
• Implement procedure for initiating referral
• Determine criteria for eligibility
• Investigate payment mechanisms
• Evaluate the effectiveness of the referral from both the patient and provider perspectives.

See the following examples of screening and referral forms.

• Vision Screening
• Maryland Early Intervention/Education Referral and Feedback Form

The U.S. Preventive Services Task Force

The U.S. Preventive Services Task Force (USPSTF) is an independent volunteer panel of national experts in disease prevention and evidence-based medicine. The Task Force works to improve the health of all Americans by making evidence-based recommendations about clinical preventive services.(Source: Ahrq.gov)

The Guide to Clinical and Preventive Services (Community Guide)

The guide is a collection of evidence-based findings designed as a resource to help improve the health of communities.

Access the link to review some of the recommended screenings.

https://www.thecommunityguide.org/search/?query=recommended%20screenings&dpage=1