Evidence, Guidelines and Benchmarks -- for Clinical and Community-Based Preventive Services

1. Evidence, Guidelines and Benchmarks-- for Clinical and Community-Based Preventive Services AAPHPPreventive Services ToolKit AAPHP PSTK Evidence

2. Teaching Objectives • Describe and use “evidence base” • Locate and use “evidence base” resources. • Identify and use guideline resources • Identify and use baseline-reference resources • Identify and use benchmarks AAPHP PSTK Evidence

3. Definitions • Science • Evidence • Evidence-based preventive service • Expert opinion • Baseline • Benchmark AAPHP PSTK Evidence

4. What Use of an “Evidence-based” Approach Can and Cannot Do • Can • Assure desired benefits if properly implemented • Avoid waste of resources • Facilitate evaluation • Enhance performance and reputation • Cannot • Optimize interventions • Address unique local needs and constraints • Address policy issues where the needed studies have not been done AAPHP PSTK Evidence

5. Documents and Web Sites • Guide to Clinical Preventive Services http://www.preventiveservices.ahrq.gov • Guide to Community Preventive Services http://www.thecommunityguide.org • CDC Advisory Committees and MMWR Recommendations http://www.cdc.gov/mmwr/ AAPHP PSTK Evidence

6. Guide to Clinical Preventive Services • Overseen by panel of experts • Launched in 1984 • Issues recommendations • Interventions include • Screening • Counseling • Preventive medications • Immunization handled by ACIP • Recommendations are rated A, B, C, D or I • For more info seewww.preventiveservices.ahrq.gov AAPHP PSTK Evidence

7. Clinical Guide Recommendations • 5 Infectious diseases • 7 Lipid, Metabolic and CV diseases • 11 Cancers • 8 Mental Health/Behavioral conditions • 7 Other risk factors and other conditions AAPHP PSTK Evidence

8. Recommendation - Obesity in Adults • Screen all adult patients for obesity (B) • Intensive interventions to obese adults (B) • Evidence is insufficient to recommend for or against the use of moderate- or low-intensity interventions (I) • Evidence is insufficient to recommend for or against the use of interventions of any intensity for overweight adults (I) AAPHP PSTK Evidence

9. Guide to Community Preventive Services • Task Force on Community Preventive Services • Community interventions • Health system change • Group education • Policy change • Environmental change AAPHP PSTK Evidence

10. Smoking Bans and Restrictions • Strong evidence smoking bans and restrictions to reduce environmental tobacco smoke • Bans and restrictions reduce amount smoked. • Bans more effective than restrictions AAPHP PSTK Evidence

11. CDC/MMWR Guidelines Diabeteshttp://www.cdc.gov/nccdphp/publications/aag/ddt.htm Obesityhttp://www.cdc.gov/nccdphp/dnpa/obesity/ Heart Disease and Strokehttp://www.cdc.gov/nccdphp/publications/aag/cvh.htm Asthmahttp://www.cdc.gov/asthma/NACP.htm Cancerhttp://www.cdc.gov/nccdphp/publications/aag/dcpc.htm Physical Inactivity and Poor Nutritionhttp://www.cdc.gov/nccdphp/dnpa/ Tobacco Use\Youth Risk Takinghttp://www.cdc.gov/nccdphp/publications/aag/osh.htm AAPHP PSTK Evidence

12. CDC/MMWR - Immunization • Gold standard for clinical practice • Frequently updated • Science plus opinion of public and private sector experts • Schedule can be viewed at http://www.cdc.gov/nip/menus/vaccines.htm#Schedules AAPHP PSTK Evidence

13. Baselines, Benchmarks, and Implementation Guides • Healthy People 2010 http://www.health.gov/healthypeople • Health, United States, 2005 http://www.cdc.gov/nchs/hus.htm • MMWR Surveillance Reportshttp://www.cdc.gov/mmwr/ • CDC web site http://www.cdc.gov • WONDER database http://www.wonder.cdc.gov/ • Put Prevention Into Practice (PPIP) http://www.ahrq.gov/clinic/ppipix.htm • STEPS to a Healthier US http://www.healthierus.gov/steps/ AAPHP PSTK Evidence

14. Healthy People 2010 • Healthy People series started in 1979 by DHHS. • Based more on expert opinion than on scientific evidence • One or more advisory committees for each focus area • Updated for each new decade • Now includes • 28 focus areas • 467 specific objectives • 10 leading health indicators AAPHP PSTK Evidence

15. Healthy People 2010 Objectives • Sample Objectives • 3-13. Increase the proportion of adults aged 50 years and older who have received a fecal occult blood colorectal cancer screening test in the preceding 2 years (Baseline 35%, 2010 target 50%) • 15-19. Increase the use of automobile safety belts (Baseline 69%, 2010 target 92%) AAPHP PSTK Evidence

16. Healthy People 2010 Uses • Can be used as • Data resource • Vehicle to involve the public, media, and elected officials • Basis to form coalitions and partnerships with community-based groups • See http://www.health.gov/healthypeople AAPHP PSTK Evidence

17. Health, United States, 2005 • Annual report on trends in U.S. health statistics • executive summary • chartbook • trend tables • appendix • index • 2005 version has special section on health statistics for adults ages 55-64 • See http://www.cdc.gov/nchs/hus.htm • (for state and sub-state data, contact your state health department) AAPHP PSTK Evidence

18. Recent CDC Reports and Recommendations in MMWR • A Comprehensive Immunization Strategy to Eliminate Transmission of Hepatitis B Virus Infection in the United States (Dec. 23, 2005) • Guidelines for the Investigation of Contacts of Persons with Infectious Tuberculosis (Dec. 16, 2005) • Recommended Antimicrobial Agents for the Treatment and Postexposure Prophylaxis of Pertussis (Dec. 9, 2005) • Controlling Tuberculosis in the United States (Nov. 4, 2005) • See http://www.cdc.gov/mmwr/ AAPHP PSTK Evidence

19. CDC WONDER • Wide-ranging On-Line Data for Epidemiologic Research • It’s an easy-to-use, menu-driven system • For research, priority setting, baselines and benchmarks • Has both national and state-specific data • See http://www.wonder.cdc.gov/ AAPHP PSTK Evidence

20. Put Prevention Into Practice (PPIP) • Derived from the Guide to Clinical Preventive Services • Designed to combat barriers to preventive service • Based on research and expert opinion • Many tools & resources including • Personal and Child Health Guides • Staying Healthy at 50+ • Fact sheets: What’s New from the U.S Preventive Services Task Force • Clinician’s Handbook • A Step-by-Step Guide to Delivering Clinical Preventive Services: A Systems Approach • See http://www.ahrq.gov/clinic/ppipix.htm AAPHP PSTK Evidence

21. STEPS to a Healthier US • DHHS initiative • Addresses major risk factors • Addresses • Diabetes • Obesity • Heart disease and stroke • Asthma • Cancer • Physical inactivity and poor nutrition • Tobacco use • Youth risk-taking • Forty communities have been funded since 2003 • Community guides for several interventions to be available • Seehttp://www.healthierus.gov/steps/ AAPHP PSTK Evidence

22. Other Evidence-Based Documentsand Web Sites • Pediatric Red Bookhttp://www.aap.org/cdrom/vrb3.html • Other medical specialty practice guidelines • AHRQ National Guideline Clearinghousehttp://www.guidelines.gov • Priorities and rankings for clinical preventive services http://www.prevent.org/content/view/21/21/#priorities AAPHP PSTK Evidence

23. Resources and Web Sites for Baselines and Benchmarks • National Committee for Quality Assurance (NCQA)/Health Employer Data and Information Set (HEDIS) –http://www.ncqa.org/Programs/HEDIS/index.htm • Joint Commission on Accreditation of Healthcare Organizations (JCAHO) –http://www.jcaho.com • Centers for Medicare and Medicaid Services (CMS) –http://www.cms.hhs.gov • America’s Health Rankings -http://www.unitedhealthfoundation.org/ahr2005.html • Pay for Performance resources http://www.bridgestoexcellence.org/bte/ AAPHP PSTK Evidence

24. Partnership for Prevention Priorities in Clinical Preventive Services • Developed by Partnership for Prevention with a grant from the CDC • Based on score for “clinically preventable burden” plus “cost effectiveness” • Ranked from 0 to 10, with 10 being the highest priority • Original ref: AJPM 2001; 21(1) • www.prevent.org/content/view/21/21/#priorities • (covered in greater detail in Epi Module) AAPHP PSTK Evidence

25. Module 2 Instructors Manual with Supplemental Materials • Resource descriptions and tables of contents • How-to-use guidelines • Reference web sites (in hotlink format) • http://www.aaphp.org • Preventive Services ToolKit AAPHP PSTK Evidence

26. Bottom Line re: Evidence Base • Do not start with a literature review!!! • Wherever possible, use the resource web sites and documents • Best place to start is usually the AHRQ National Guideline Clearinghouse http://www.guidelines.gov • Instructor’s manual with Supplemental Materials to this “Module 2” at http://www.aaphp.org, under “Preventive Services ToolKit” AAPHP PSTK Evidence

27. Q and A • Open Discussion AAPHP PSTK Evidence