Priorities Among Effective Clinical Preventive Services

Background

Decision makers at multiple levels need information about which clinical preventive services matter the most so that they can prioritize their actions. This study was designed to produce comparable estimates of relative health impact and cost effectiveness for services considered effective by the U.S. Preventive Services Task Force and Advisory Committee on Immunization Practices.

Methods

The National Commission on Prevention Priorities (NCPP) guided this update to a 2001 ranking of clinical preventive services. The NCPP used new preventive service recommendations up to December 2004, improved methods, and more complete and recent data and evidence. Each service received 1 to 5 points on each of two measures—clinically preventable burden and cost effectiveness—for a total score ranging from 2 to 10. Priorities for improving delivery rates were established by comparing the ranking with what is known of current delivery rates nationally.

Results

The three highest-ranking services each with a total score of 10 are discussing aspirin use with high-risk adults, immunizing children, and tobacco-use screening and brief intervention. High-ranking services (scores of 6 and above) with data indicating low current utilization rates (around 50% or lower) include: tobacco-use screening and brief intervention, screening adults aged 50 and older for colorectal cancer, immunizing adults aged 65 and older against pneumococcal disease, and screening young women for Chlamydia.

Conclusion

This study identifies the most valuable clinical preventive services that can be offered in medical practice and should help decision-makers select which services to emphasize.

Introduction

Receipt of evidence-based clinical preventive services among the population of the United States has improved over the past 10 years, yet it remains discouragingly low for some services and among some population groups. For example, the majority of people at risk for colorectal cancer are not being screened.1, 2 In 2005, 78% of Hispanic adults and 63% of black adults aged over 65 years reported never having received the pneumococcal immunization compared to 38% of white adults aged over 65.³

An important reason for the less-than-ideal delivery of preventive care is limited clinician time coupled with the difficulty of integrating many preventive service recommendations among many competing demands.4, 5, 6 Clinicians must decide which preventive services to offer, and decision makers must decide which services should be the focus of practice improvement efforts and other policies and programs. Clinicians, health insurance plans, care delivery leaders, employers, and consumers all need information about which preventive services produce the greatest returns on investment, to be able to target them for improved utilization rates.

This article updates a 2001 ranking of clinical preventive services based on comparable measures of their relative value to the U.S. population.7, 8 An update was necessary because of new recommendations from the U.S. Preventive Services Task Force (USPSTF) and more recent data on the burden of disease, service effectiveness, use of services, and costs of delivery. A description of the methods as well as the findings for three important services may be found in companion articles.9, 10, 11, 12 Additional resources are available online: a detailed methods report,¹³ all of the service-specific data and calculations used to derive the estimates, and tables with many of the component values on which the rankings were based (prevent.org/ncpp).

The overall goal of the analysis was to develop a ranking of services with fair to good evidence of effectiveness, excluding services with insufficient evidence or evidence of ineffectiveness. The ranking was designed to assist decision makers at multiple levels: Clinicians and their patients can use the ranking to identify which among these recommended services to emphasize, and care delivery leaders should find the ranking valuable as they make choices about the design of prevention programs. The ranking should also enlighten discussions about health insurance coverage for preventive services and encourage the evaluation of benefit packages. Employers, public health agencies, and others may use the ranking as a starting point in encouraging more appropriate consumer demand for high-quality, high-value healthcare services. The findings and methods can also be adapted to assess prevention quality, ascertain priorities for specific population subgroups, or identify research and data needs.