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Sharon McDonnell MD MPH

Skill building: Determining priorities and decision making: Using the best evidence and mindful community process. Sharon McDonnell MD MPH. Objectives. Discuss issues- what = success in the process of decision-making in short and long term?

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Sharon McDonnell MD MPH

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  1. Skill building: Determining priorities and decision making:Using the best evidence and mindful community process Sharon McDonnell MD MPH

  2. Objectives • Discuss issues- what = success in the process of decision-making in short and long term? • Review processes and programs set up to facilitate community prioritization such as MAPP, APEX, Assessment initiative. • Evidence based epidemiological approach using PAR analysis • What is PAR, how calculated, data needed? • Comparing different problems and approaches to decide “best” decision

  3. Decision-making and priority setting • Discuss issues- what = success in the process of decision-making in short and long term?

  4. Decision-making and priority setting • Formal processes and programs designed to facilitate community prioritization: • MAPP - includes a data collection and comparison process • APEX, • Assessment initiative. • Other myriad methods emphasizing one or more of following elements • Community participation & Process • Political support and engagement of institutions • Evidence-based • Outcomes • Sustainability

  5. Priority setting • Emphasizing different weights of “so what test” • Magnitude • Severity • feasibility • Acceptability • Political support • Economics/cost • others

  6. Evidence based Public healthPopulation attributable risk (PAR) • To improve evidence for magnitude and effect • To improve evidence about effectiveness

  7. Population Attributable Risk If we ask ourselves what proportion of disease in the population is a result of a specific exposure or risk? Pe (relative Riska– 1) -------------------------- 1 + Pe (relative Riska– 1) Where Pe = proportion of the population that is exposed Relative Riska = the Relative Risk of the specific condition

  8. Population Attributable Risk for death from CVD selected cardiovascular Risk Factors

  9. Population Attributable Risk II for death from CVD selected cardiovascular Risk Factors

  10. Inadequate social connection or social isolation increases all cause mortality (2-2.8 times) • Inadequate health literacy increases all cause mortality nearly twofold. • ADD in Alameda tables and syme re various data sets on social isolation • How social isolation defined

  11. Smoking and lung cancer slide with determinants • Terms- determinant, risk, influencing factor etc • Culture - how to measure and watch? • Make a commercial targeted to ill health • The opposite of a risk factor is not a health factor

  12. See word file table for preferred table

  13. Thacker paper Community guide

  14. Efficacy and effectiveness • Efficacy –refers to the impact of an intervention in a clinical trial, differing from 'effectiveness' which • Immunization in the laboratory or clinical trial • Effectiveness – refers to the impact in real world situations. • immunization in real world

  15. Influences on Efficacy • Efficacy: • Inherent to drug/intervention • Interacting with human(s) • In a context

  16. Influences on effectiveness • Effectiveness: • Human resources and training • Recruitment, qualifications, didactic and applied training, continuing education • Infrastructure • Supplies and equipment, salary, transportation, supervision • Community support • Access and demand

  17. Good Health (p=0.87) exercise Infarction or other CHD (p= 0.09) Death from CHD (p = 0.03) Population 35 y/o men (20 yrs) Good Health (p = 0.74) Infarction or other CHD (p = 0.12) No exercise Death from CHD (p = 0.06) Hyptothetical population used to apply probabilities of various events

  18. Good Health Immunization Side effects Measles Population US Good Health Side effects No immunization Measles Efficacy of measles immunization = 98% (administered twice) Effectiveness of measles immunization = something much smaller than efficacy

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