Presentation is loading. Please wait.

Presentation is loading. Please wait.

Promoting Million Hearts® Goals Using The Community Preventive Services Task Force Recommendations A Focus on Risk Factors for Cardiovascular Disease A.

Similar presentations


Presentation on theme: "Promoting Million Hearts® Goals Using The Community Preventive Services Task Force Recommendations A Focus on Risk Factors for Cardiovascular Disease A."— Presentation transcript:

1 Promoting Million Hearts® Goals Using The Community Preventive Services Task Force Recommendations A Focus on Risk Factors for Cardiovascular Disease A CONVERSATION WITH: John M. Clymer, Member, U.S. Community Preventive Services Task Force Philip Huang, MD, MPH, Medical Director, Austin-Travis County Health and Human Services August 28 th, 2014

2 Community Preventive Services Task Force Findings on Effectiveness of Interventions: 1) To Prevent Cardiovascular Disease 2) To Reduce Tobacco Use

3 CONTEXT FOR EVIDENCE-BASED PUBLIC HEALTH 3

4 Benefits of Basing Guidelines on Systematic Research Synthesis  Reliability Move us beyond anecdote and selective use of scientific evidence  Transparency Reduce bias Make assumptions and procedures clear  Synthesis Streamline enormous amounts of data Reconcile or explain variable results 4

5 Benefits of Basing Guidelines on Systematic Research Synthesis  Reliability Move us beyond anecdote and selective use of scientific evidence  Transparency Reduce bias Make assumptions and procedures clear  Synthesis Streamline enormous amounts of data Reconcile or explain variable results 5

6 Systematic Reviews and Developing Recommendations Systematic Review Meta-analysis Narrative Review Evaluations of individual programs Individual Studies Findings Evaluation of evaluations Recommend Recommend against Insufficient

7 What Do Public Health Interventions Look Like?  Programs, services, and policies Often implemented opportunistically to address perceived needs, considering available resources Seldom permit random allocation to intervention and control conditions  Usually more “complex” than clinical interventions Multiple facets that vary across locations Often adapted to meet local needs and resources Rarely implemented in isolation—several potential confounding factors to consider Results may depend on context  Potential for substantial health impact at a modest cost 7

8 OBJECTIVES AND GUIDING PRINCIPLES OF THE COMMUNITY GUIDE 8

9 The Community Guide * 9  Product of an independent US Task Force: Community Preventive Services Task Force  A focus on population- based interventions in: Communities Health care systems  Evidence-based recommendations and conclusions regarding use *www.thecommunityguide.org

10 Topics for Community Guide Reviews (as of 2013) Reviews Organized by Environment Health EquitySocial Environment Reviews by Risk BehaviorReviews by Specific Condition Alcohol abuse/misuseCancer Tobacco useMental health Poor nutritionVaccine-preventable disease Physical inactivityViolence Unhealthy sexual behaviorsMotor vehicle injuries Cardiovascular disease preventionDiabetes Oral health Reviews Organized by SettingReviews Organized by Life Stage Worksite health promotionAdolescent health Special Projects Health communicationsPandemic influenza 10

11 2013 Community Preventive Services Task Force  Jonathan C. Fielding, MD, MPH, MBALos Angeles County Dep. Of Public Health  Barbara K. Rimer, DrPHUniversity of North Carolina  Bruce N. Calonge, MD, MPHColorado Trust  Marshall Chin, MD, MPH, FACPUniversity of Chicago  John M. ClymerAlliance to Make US Healthiest  Karen Glanz, PhD, MPHUniversity of Pennsylvania  Ron Goetzel, PhDEmory University  Larry Green, DrPHUC San Francisco  David Grossman, MD, MPHGroup Health Cooperative  Robert L. Johnson, MDUMD-New Jersey Medical School  Shiriki Kumanyika, PhD, MPHUniversity of Pennsylvania  C. Tracy Orleans, PhDRobert Wood Johnson  Nico P. Pronk, PhDHealthPartners  Gilbert Ramirez, DrPHWest Virginia University  Patrick Remington, MD, MPHUniversity of Wisconsin 11

12 Overarching Goals of the Community Guide Develop evidence-based guidance on interventions to improve population health that is of maximum utility for decision-makers: Provide evidence-based recommendations Assess economic efficiency Highlight important evidence gaps 12

13 Issues Considered in Community Guide Reviews Population or Group Intended Outcomes (Behavior, Health) Reduced Morbidity and Mortality Intervention (policy or program) Is the evidence applicable to “my population”? Considerations for Implementation Economic Efficiency BenefitsCosts Additional Benefits? Potential Harms? ? ?

14 Task Force Findings Options 14  Recommend Based on strong evidence Based on sufficient evidence  Recommend against Based on strong evidence Based on sufficient evidence  Insufficient evidence to recommend for or against

15 Example Logic Model: Strategies to Prevent CVD 15 CVD Risk Conditions Prevented / Reduced / Controlled Biological Behavioral Environmental Social Context Health Care Hyperlipidemia Hypertension Determinants Intermediate Health Outcomes Interventions to Prevent CVD risk conditions (and CVD) Interventions to Increase/Improve management of clients with CVD Reduced CVD Morbidity And Mortality Diabetes Interventions to Increase/ Improve control of CVD Risk Conditions Tobacco Use Obesity Physical Activity Nutrition Alcohol

16 COMMUNITY PREVENTIVE SERVICES TASK FORCE RECOMMENDATIONS FOR CARDIOVASCULAR DISEASE 16

17 Example Priorities List for Task Force Consideration: CVD Prevention 17 1.Interventions to improve hypertension control 2.CVD risk reduction interventions that bundle preventive services 3.Health system implementation/organizational variables and processes 4.Policies to reduce dietary sodium 5.Comprehensive Tobacco Control programs* 6.Community-based campaigns to increase awareness 7.Improved access to quality care for CVD 8.Setting-based CVD risk reduction interventions 9.Technology-enabled CVD risk reduction interventions *Intervention review covered by CG Tobacco team

18 Community Guide CVD Prevention Reviews 18 InterventionDescriptionTask Force Finding Team-based care (TBC) A health systems intervention that uses a team—including primary care providers, other health professionals (usually nurses and pharmacists), and patients—working together to improve blood pressure control among patients at risk for CVD Strong Evidence Increased proportion of patients with controlled BP Reduced Systolic and Diastolic BP Reducing out- of-pocket costs (ROPC) ROPC for medications to control high blood pressure and high cholesterol, when combined with additional policies or actions to improve patient– provider interaction and patient knowledge Strong Evidence Improved medication adherence Improved BP and cholesterol outcomes Clinical Decision- Support Systems (CDSS) Computer-based information systems, specifically aimed at CVD prevention, designed to assist healthcare providers in implementing clinical guidelines at the point of care Sufficient Evidence Improved screening for CVD risk factors by providers Improving practices for CVD- related preventive care, clinical tests, and treatments

19 Community Guide Tobacco Use Reduction Reviews 19 InterventionDescriptionTask Force Finding Comprehensive Tobacco Control Programs These programs are typically organized and funded at the state level in the U.S., providing a platform for effective implementation of core components such as mass-reach health communication interventions, state-wide cessation services, and partnerships with community-based coalitions and programs to pursue grassroots-level efforts to reduce tobacco use. Strong Evidence Reduced tobacco use prevalence Reduced tobacco product consumption Increased quitting Reduced secondhand smoke exposure Reduced tobacco-related morbidity and mortality Increase the Unit Price of Tobacco Products Public policies at the federal, state, or local level that increase the purchase price per unit of sale for tobacco products. The review considered excise tax through legislations or fees levied on tobacco products at the point of sale. Strong Evidence Reduced tobacco use prevalence Reduced tobacco product consumption Increased quitting Reduced initiation of tobacco use Reduced tobacco-related morbidity and mortality

20 Community Guide Tobacco Use Reduction Reviews (contd.) 20 InterventionDescriptionTask Force Finding Smoke-free Policies Public-sector regulations and private- sector rules that prohibit smoking in indoor spaces and designated indoor and outdoor public areas. Strong Evidence Reduced secondhand smoke exposure Reduced tobacco use prevalence Reduced initiation of tobacco use Increased quitting Reduced tobacco-related morbidity and mortality Mass-reach Health Communication Interventions Interventions target large audiences through various media channels (TV, radio, print, out-of-home placements, digital) to change knowledge, beliefs, attitudes, and behaviors about tobacco use. Intervention messages are typically developed through formative research and broadcasted on TV, targeting both tobacco users and the general public. Strong Evidence Reduced tobacco use prevalence Increased use of available services, e.g., quitlines Increased quitting Reduced initiation of tobacco use

21 Community Guide Tobacco Use Reduction Reviews (contd.) 21 InterventionDescriptionTask Force Finding Quitline Interventions Evidence-based behavioral counseling offered via telephone to support tobacco users who want to quit. Quitlines typically offer proactive counseling (cessation specialists schedule follow-ups) that is widely accessible, convenient to use, and generally at no cost to callers. Strong Evidence Increased quitting Reducing Out- of-Pocket Costs for Evidence- based Cessation Treatments Policy or program changes that make evidence-based treatments more affordable. Benefit changes may be communicated to tobacco users and health care providers to increase use of these benefits in quitting efforts. Strong Evidence Increased quitting Mobile Phone- based Cessation Intervention Interventions use interactive features to deliver evidence-based information, strategies, and behavioral support directly to tobacco users interested in quitting. Messages are targeted to specific populations, tailored to specific users, or automated. Sufficient Evidence Increased quitting

22 Community Guide CVD Prevention http://www.thecommunityguide.org/cvd/index.html http://www.thecommunityguide.org/cvd/index.html Community Guide Tobacco Use Reduction http://www.thecommunityguide.org/tobacco/index.html 22

23 Center for Surveillance, Epidemiology, and Laboratory Services (CSELS) Division of Epidemiology, Analysis, and Library Services (DEALS) Evidence-Based Recommendations Slides from the Community Preventive Services Task Force Provided Courtesy of Anil Thota, MBBS, MPH athota@cdc.gov Community Guide Branch Acknowledgement

24 Disclaimer The findings and opinions expressed in this presentation are those of the presenters and the Community Preventive Services Task Force. They may not represent the official positions of the Centers for Disease Control and Prevention (CDC). The Centers for Disease Control and Prevention provides administrative, research, and technical support for the Community Preventive Services Task Force. 24


Download ppt "Promoting Million Hearts® Goals Using The Community Preventive Services Task Force Recommendations A Focus on Risk Factors for Cardiovascular Disease A."

Similar presentations


Ads by Google