1. 10/10/06AAPHP PSTK EvidenceModule 2, Slide 1 Evidence, Guidelines and Benchmarks -- for Clinical and Community-Based Preventive Services AAPHP Preventive Services ToolKit

2. 10/10/06AAPHP PSTK EvidenceModule 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

3. 10/10/06AAPHP PSTK EvidenceModule 2, Slide 3 Definitions  Science  Evidence  Evidence-based preventive service  Expert opinion  Baseline  Benchmark

4. 10/10/06AAPHP PSTK EvidenceModule 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

5. 10/10/06AAPHP PSTK EvidenceModule 2, Slide 5 Documents and Web Sites  Guide to Clinical Preventive Services http://www.preventiveservices.ahrq.gov http://www.preventiveservices.ahrq.gov  Guide to Community Preventive Services http://www.thecommunityguide.org http://www.thecommunityguide.org  CDC Advisory Committees and MMWR Recommendations http://www.cdc.gov/mmwr/ http://www.cdc.gov/mmwr/

6. 10/10/06AAPHP PSTK EvidenceModule 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 www.preventiveservices.ahrq.gov

7. 10/10/06AAPHP PSTK EvidenceModule 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

8. 10/10/06AAPHP PSTK EvidenceModule 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)

9. 10/10/06AAPHP PSTK EvidenceModule 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. 10/10/06AAPHP PSTK EvidenceModule 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

11. 10/10/06AAPHP PSTK EvidenceModule 2, Slide 11 CDC/MMWR Guidelines Diabetes http://www.cdc.gov/nccdphp/publications/aag/ddt.htm http://www.cdc.gov/nccdphp/publications/aag/ddt.htm Obesity http://www.cdc.gov/nccdphp/dnpa/obesity/ http://www.cdc.gov/nccdphp/dnpa/obesity/ Heart Disease and Stroke http://www.cdc.gov/nccdphp/publications/aag/cvh.htm http://www.cdc.gov/nccdphp/publications/aag/cvh.htm Asthma http://www.cdc.gov/asthma/NACP.htm http://www.cdc.gov/asthma/NACP.htm Cancer http://www.cdc.gov/nccdphp/publications/aag/dcpc.htm http://www.cdc.gov/nccdphp/publications/aag/dcpc.htm Physical Inactivity and Poor Nutrition http://www.cdc.gov/nccdphp/dnpa/ http://www.cdc.gov/nccdphp/dnpa/ Tobacco Use\Youth Risk Taking http://www.cdc.gov/nccdphp/publications/aag/osh.htm http://www.cdc.gov/nccdphp/publications/aag/osh.htm

12. 10/10/06AAPHP PSTK EvidenceModule 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 http://www.cdc.gov/nip/menus/vaccines.htm#Schedules

13. 10/10/06AAPHP PSTK EvidenceModule 2, Slide 13 Baselines, Benchmarks, and Implementation Guides  Healthy People 2010 http://www.health.gov/healthypeople http://www.health.gov/healthypeople  Health, United States, 2005 http://www.cdc.gov/nchs/hus.htm http://www.cdc.gov/nchs/hus.htm  MMWR Surveillance Reports http://www.cdc.gov/mmwr/ http://www.cdc.gov/mmwr/  CDC web site http://www.cdc.gov http://www.cdc.gov  WONDER database http://www.wonder.cdc.gov/ 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/ http://www.healthierus.gov/steps/

14. 10/10/06AAPHP PSTK EvidenceModule 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

15. 10/10/06AAPHP PSTK EvidenceModule 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%)

16. 10/10/06AAPHP PSTK EvidenceModule 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/healthypeoplehttp://www.health.gov/healthypeople

17. 10/10/06AAPHP PSTK EvidenceModule 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 http://www.cdc.gov/nchs/hus.htm  (for state and sub-state data, contact your state health department)

18. 10/10/06AAPHP PSTK EvidenceModule 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/ http://www.cdc.gov/mmwr/

19. 10/10/06AAPHP PSTK EvidenceModule 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/ http://www.wonder.cdc.gov/

20. 10/10/06AAPHP PSTK EvidenceModule 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 http://www.ahrq.gov/clinic/ppipix.htm

21. 10/10/06AAPHP PSTK EvidenceModule 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/ http://www.healthierus.gov/steps/

22. 10/10/06AAPHP PSTK EvidenceModule 2, Slide 22 Other Evidence-Based Documents and Web Sites  Pediatric Red Book http://www.aap.org/cdrom/vrb3.html http://www.aap.org/cdrom/vrb3.html  Other medical specialty practice guidelines  AHRQ National Guideline Clearinghouse http://www.guidelines.gov http://www.guidelines.gov  Priorities and rankings for clinical preventive services http://www.prevent.org/content/view/21/21/#priorities http://www.prevent.org/content/view/21/21/#priorities

23. 10/10/06AAPHP PSTK EvidenceModule 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 http://www.ncqa.org/Programs/HEDIS/index.htm  Joint Commission on Accreditation of Healthcare Organizations (JCAHO) – http://www.jcaho.com http://www.jcaho.com  Centers for Medicare and Medicaid Services (CMS) – http://www.cms.hhs.govhttp://www.cms.hhs.gov  America’s Health Rankings - http://www.unitedhealthfoundation.org/ahr2005.html http://www.unitedhealthfoundation.org/ahr2005.html  Pay for Performance resources http://www.bridgestoexcellence.org/bte/

24. 10/10/06AAPHP PSTK EvidenceModule 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 www.prevent.org/content/view/21/21/#priorities  (covered in greater detail in Epi Module)

25. 10/10/06AAPHP PSTK EvidenceModule 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 http://www.aaphp.org Preventive Services ToolKit

26. 10/10/06AAPHP PSTK EvidenceModule 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 http://www.guidelines.gov  Instructor’s manual with Supplemental Materials to this “Module 2” at http://www.aaphp.org, under “Preventive Services ToolKit” http://www.aaphp.org

27. 10/10/06AAPHP PSTK EvidenceModule 2, Slide 27  Q and A  Open Discussion