evidence, guidelines and benchmarks -- for clinical and community-based preventive services
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Evidence, Guidelines and Benchmarks -- for Clinical and Community-Based Preventive Services. AAPHP Preventive Services ToolKit. Teaching Objectives. Describe and use “evidence base” Locate and use “evidence base” resources. Identify and use guideline resources - PowerPoint PPT PresentationTRANSCRIPT
10/10/06 AAPHP PSTK Evidence Module 2, Slide 1
Evidence, Guidelines and Benchmarks
-- for Clinical and Community-Based Preventive Services
AAPHPPreventive Services ToolKit
10/10/06 AAPHP PSTK Evidence Module 2, Slide 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
10/10/06 AAPHP PSTK Evidence Module 2, Slide 3
Definitions
Science Evidence Evidence-based preventive service Expert opinion Baseline Benchmark
10/10/06 AAPHP PSTK Evidence Module 2, Slide 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
10/10/06 AAPHP PSTK Evidence Module 2, Slide 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/
10/10/06 AAPHP PSTK Evidence Module 2, Slide 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 see www.preventiveservices.ahrq.gov
10/10/06 AAPHP PSTK Evidence Module 2, Slide 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
10/10/06 AAPHP PSTK Evidence Module 2, Slide 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)
10/10/06 AAPHP PSTK Evidence Module 2, Slide 9
Guide to Community Preventive Services
Task Force on Community Preventive Services
Community interventions
Health system change
Group education
Policy change
Environmental change
10/10/06 AAPHP PSTK Evidence Module 2, Slide 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
10/10/06 AAPHP PSTK Evidence Module 2, Slide 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
10/10/06 AAPHP PSTK Evidence Module 2, Slide 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
10/10/06 AAPHP PSTK Evidence Module 2, Slide 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 Reports http://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/
10/10/06 AAPHP PSTK Evidence Module 2, Slide 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
10/10/06 AAPHP PSTK Evidence Module 2, Slide 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%)
10/10/06 AAPHP PSTK Evidence Module 2, Slide 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
10/10/06 AAPHP PSTK Evidence Module 2, Slide 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)
10/10/06 AAPHP PSTK Evidence Module 2, Slide 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/
10/10/06 AAPHP PSTK Evidence Module 2, Slide 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/
10/10/06 AAPHP PSTK Evidence Module 2, Slide 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
10/10/06 AAPHP PSTK Evidence Module 2, Slide 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
See http://www.healthierus.gov/steps/
10/10/06 AAPHP PSTK Evidence Module 2, Slide 22
Other Evidence-Based Documentsand Web Sites
Pediatric Red Bookhttp://www.aap.org/cdrom/vrb3.html
Other medical specialty practice guidelines
AHRQ National Guideline Clearinghouse http://www.guidelines.gov
Priorities and rankings for clinical preventive services http://www.prevent.org/content/view/21/21/#priorities
10/10/06 AAPHP PSTK Evidence Module 2, Slide 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 resourceshttp://www.bridgestoexcellence.org/bte/
10/10/06 AAPHP PSTK Evidence Module 2, Slide 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)
10/10/06 AAPHP PSTK Evidence Module 2, Slide 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
10/10/06 AAPHP PSTK Evidence Module 2, Slide 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”
10/10/06 AAPHP PSTK Evidence Module 2, Slide 27
Q and A
Open Discussion