1 / 27

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

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

blake
Download Presentation

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

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  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

More Related