ACOG-Led Panel Collates Female Preventive Service Recommendations from WPSI, USPSTF, and Bright Futures

The benefits women derive from preventive health services throughout their life span are well documented in the literature.  Evidence-based preventive health care has been demonstrated to identify risk factors for disease and to promote early detection of disease and infection, allowing more effective management and prevention of further complications (Maciosek, 2010).

But to ensure that women of every age receive appropriate preventive health screenings, health care providers need established guidelines for recommended preventive services for their care. The availability of various and sometimes inconsistent guidelines can result in provider uncertainty and patient confusion.

NPs providing such services now have a comprehensive and innovative tool in the recently updated Well-Woman Chart. The tool is specifically intended for clinicians providing preventive healthcare for women, particularly in primary care settings.

Devised by an American College of Obstetricians and Gynecologists (ACOG)-led expert panel of organizations, the Well-Woman Chart is separated by patient age group, and services are broken into the categories of general health, infectious diseases, and cancer, all listed in alphabetical order for ease of use. Recommendations from the Women’s Preventive Services Initiative (WPSI) and U.S. Preventive Services Task Force (USPSTF) for preventive services for pregnant and postpartum women are also provided in the chart. The tool’s developers note that patient immunizations should be administered according to the Centers for Disease Control and Prevention’s most recent Advisory Committee of Immunization Practices (ACIP) recommendations. When recommendations overlap among the various groups, the chart uses the most inclusive recommendation.

Beyond a checklist

More than just a listing of services or a standalone chart, the Well-Woman Chart includes corresponding clinical summaries with the appropriate age and frequencies in which the preventive services should be performed, considerations for clinical practice, and any relevant risk assessments.

The 2-page PDF is downloadable in both English and Spanish and includes an interactive online version (https://www.womenspreventivehealth.org/wellwomanchart/#interactive).

But not all at once

Its developers emphasize that the services listed in the Well-Woman Chart should not be viewed as what is expected to be performed at every well-woman visit by every health care provider. Rather, a series of such visits may be necessary to provide all of the chart’s recommended services depending upon your patient’s age, health status, reproductive health needs, pregnancy status, and risk factors.

The cost question

The most comprehensive care listing can’t help patients with access issues. As such, creators of the tool have ensured that all recommendations listed on the Well-Woman Chart include clinical preventive services that most private insurance plans and many Medicaid state programs cover without patient cost-sharing as required by the Affordable Care Act.  They counsel providers to refer their patients who have cost questions to the federal coverage requirements information for preventive services available at healthcare.gov and to their individual insurance carriers.

For those providers with billing queries, ACOG offers coding resources available at https://www.acog.org/store/products/coding-resources. In addition, specific coding questions can also be submitted via ACOG’s Coding Ticket Database https://www.acog.org/practice-management/coding/ask-a-coding-question. Registration is required for access to the portal, but the resource is free and offered to ACOG members and non-members alike.

Combining clinical forces

The Health Resources and Services Administration (HRSA)-supported Women’s Preventive Services Guidelines were originally established in 2011 based on recommendations from a Department of Health and Human Services’ commissioned study by the Institute of Medicine (IOM), now known as the National Academy of Medicine (NAM).

Since the establishment of the Guidelines, advancements in science have left gaps subsequently identified in clinical practice. To address these, in 2016, HRSA awarded a 5-year cooperative agreement to ACOG to launch the WPSI. The organization convened a coalition of clinical, academic, and consumer-focused health professional organizations with the shared goal of conducting a scientifically rigorous review to develop recommendations for updated Guidelines. The development process of the WPSI is based on adaptation of the 8 criteria for evidence-based clinical practice guidelines as articulated in the 2011 report, Clinical Practice Guidelines We Can Trust from the NAM.

The WPSI is overseen by an Advisory Panel comprised of representatives from ACOG and 3 other major professional organizations representing the majority of women’s health care providers, including the National Association of Nurse Practitioners in Women’s Health (NPWH), the American Academy of Family Physicians (AAFP), and the American College of Physicians (ACP).

Start here

While intended as a “tool and a starting point for providing well-woman care and implementing the WPSI-recommended well-woman preventive visits,” ACOG notes that the chart should be adapted as necessary to meet a woman’s needs. It further counsels that, should the new tool’s recommendations conflict with providers’ association guidelines, they should defer to their clinical institutional authority. The Well-Woman Chart will be updated annually.

Click here to download this 2-page tool “The Well-Woman Chart” or go to https://www.womenspreventivehealth.org/wp-content/uploads/WPSI_WWC_11x17_2021Update.pdf

The contents of this feature are not provided or reviewed by NPWH.