National Commission on Prevention Priorities updates clinical preventive services ranking

Using cost-effectiveness and relative health impact as criteria, the National Commission on Prevention Priorities has released a new ranking of evidence-based preventive services.

The report, published in Annals of Family Medicine, is the first update since 2006 and can help medical professionals find their focus and set priorities when treating patients.

“Our analysis includes only a fraction of services among which priorities for clinic time and resources must be made. It is useful to consider these rankings in a broader context,” Michael V. Maciosek, PhD, of HealthPartners Institute in Minneapolis, and colleagues wrote. “Relative differences exist in the benefits that can be achieved through more consistent use of these services; all of these services, however, have proven value in prevention and should be prioritized over services with less or no evidence.”

Researchers used information from groups such as the U.S. Preventive Services Task Force and the Advisory Committee on Immunization Practices to come up with their list.

According to the report, the top ten priorities for improving the use of clinical preventive services, based on the health impact of the service and cost-effectiveness are:

childhood immunization series;
tobacco use, brief prevention counseling, youth;
tobacco use, brief prevention counseling, adults;
alcohol misuse screening and brief intervention;
aspirin chemoprevention for those at higher risk of CVD;
cervical cancer screening;
colorectal cancer screening;
chlamydia and gonorrhea screening;
cholesterol screening; and
hypertension screening.

Researchers noted there has been little fluctuation in scores since the first National Commission on Prevention Priorities (NCPP) ranking came out in 2001 and also indicated the latest analysis did not include all of the services available, effective community preventive services and evidence-based preventive services for higher-risk groups.

Maciosek and colleagues encouraged health systems, medical organizations and clinicians to evaluate the preventive service use rates in the communities they work in to identify areas that can be improved.

“This study identifies high-priority preventive services and should help decision makers select which services to emphasize in quality-improvement initiatives,” researchers wrote.

In a related editorial, David Satcher, MD, PhD, former U.S. Surgeon General and founder of the Satcher Health Leadership Institute in Atlanta, wrote preventive interventions should be on every physicians’ to-do list.

“Cost-saving and cost-neutral preventive service delivery makes good sense in a resource-constrained or time-constrained environment. Smart preventive service delivery makes sense in an accountable care environment,” he wrote, noting the changing health and health care landscape also stress the need for using the NCPP guidelines.

George Isham, MD, MS, HealthPartners Institute in Minneapolis, and colleagues, furthered Satcher’s remarks in a separate editorial by noting the rankings can help clinicians, patients and other medical professionals set priorities.

“Office visits are already too brief, and the portion of physician visits allocated to prevention is shorter still,” he wrote. “[Primary care physicians and patient-centered medical homes] should wisely choose which services to provide first and which to provide at subsequent office visits…. Providing information directly to consumers enables them to demand evidence supported care from their clinicians.”

In a third editorial, authored by Patrick J. O’Connor, MD, MA, MPH, also of HealthPartners, and colleagues, sought to explain why clinical support systems and electronic health records should be used to help set those priorities.

“[These] save time, satisfy clinicians, empower patients, have high use rates, and improve care are now up and running in several large health care systems,” he wrote. – by Janel Miller

References:

Isham G, et al. Ann Fam Med. 2017:doi:10.1370/afm.2023.

Maciosek M, et al. Ann Fam Med. 2017:doi:10.1370/afm.2017.

O’Connor P, et al. Ann Fam Med. 2017:doi:10.1370/afm.2027.

Satcher D, et al. Ann Fam Med. 2017:doi:10.1370/afm.2026.

Disclosures: The researchers report no relevant financial disclosures.