Theme articlePriorities Among Effective Clinical Preventive Services: Results of a Systematic Review and Analysis
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.
Section snippets
Methods
Although more-comprehensive discussions of the methods used are available,9, 13 the key aspects needed to interpret the results are summarized here briefly. In 2002, Partnership for Prevention, a national nonprofit organization, asked David Satcher to chair a National Commission on Prevention Priorities (NCPP) to guide an update to the 2001 ranking of clinical preventive services. The NCPP—a 24-member panel of decision makers from health insurance plans, an employer group, academia, clinical
Results
Table 1 summarizes the QALYs saved in each quintile-defined group for CPB, and the cost per QALYs saved in each group for cost effectiveness. Scores are listed in Table 2 for all services meeting the study’s inclusion criteria.
Eleven services received scores of ≥7. Three of these received scores of 10 and are cost saving: discussing aspirin use with high-risk adults, immunizing children, and tobacco-use screening and brief intervention. Other services receiving scores of ≥7 were two adult
Discussion
This study offers a tool to help decision makers at multiple levels choose where to improve utilization rates by indicating which services are most consequential and cost effective for the population or individuals. Thoughtful decisions based on a careful review of each score and the underlying data should lead to larger improvements in population health and more efficient allocation of resources in contrast with decisions based on incomplete data, noncomparable data, or no data at all. Details
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