Phase II: Implementation, Evidence-based Actions, and Process for Choosing National Priorities

Transcription

1 Phase II: Implementation, Evidence-based Actions, and Process for Choosing National Priorities Secretary s Advisory Committee on National Health Promotion & Disease Prevention Objectives for 2020 Committee Chair: Jonathan Fielding, MD, MPH, MA, MBA Director, Los Angeles County Department of Public Health & Health Officer, Los Angeles County July 10, 2009

2 Welcome Howard Koh, M.D., M.P.H. Assistant Secretary for Health Office of Public Health and Science U.S. Department of Health and Human Services

3 Update on HHS Activities Carter Blakey Office of Disease Prevention and Health Promotion, U.S. Department of Health and Human Services

4 Update on HHS Activities Objective Development Public Engagement Public meetings Kansas City, October 22 Philadelphia, November 7 Seattle, TBA Public Comment Web site, healthypeople.gov Healthy People Consortium

5 Desired Outcomes for the Meeting Discuss potential recommendations for: Implementation strategies Use of evidence in selecting interventions A process for selecting national priority objectives Data and information technology 5

6 Implementation Strategies: Short- and Long-Term Recommendations Committee Vice-Chair: Subcommittee Co-Chair: Shiriki Kumanyika, PhD, MPH Univ. Pennsylvania School of Medicine Eva Moya, LMSW, PhD (c) U.S.-Mexico Border Health Association

7 Members of the Subcommittee on Implementation External Members ASTHO*: Julia Pekarsky Internal Members NACCHO Lou Brewer Abby King America s Health Plans (AHIP), James Glauber Business Coalition on Health, Andrew Webber Adewale Troutman, Co-Chair Shiriki Kumanyika * Association of State and Territorial Health Agencies National Association of County and City Health Officials 7

8 Efforts of the Subcommittee on Implementation Met by teleconference five times since March Charged with addressing the questions: How do we move from the framework to action? How can we ensure accountability? What are users needs for tools, aids, and guidance? What examples can be put in place? 8

9 Implementation Issues Discussed Action-orientation Address past criticisms that Healthy People did not tell users how to accomplish objectives What s needed is not only information (though that is important), but also an infrastructure for accountability Accountability Public Health Accreditation Board What if they adopted the Healthy People priority objectives? State Healthy People Coordinators Traditionally, role has been undefined & is up to states An enthusiastic, engaged group that has done a good job, with few resources. Visibility varies. 9

10 Implementation Issues Discussed Incentives Public recognition for action (e.g., awards, media) Memoranda of understanding Monetary incentives for effective implementation Tools, resources, guidance Compiled sample resources and reports What is most useful? Case studies Success stories Templates to guide planning 10

11 Immediate Recommendations for Implementing Healthy People 2020 Subcommittee Charge Immediate Recommendations Action-orientation 1. Foster continuity, build on current activities/strengths, especially relating to social determinants of health 2. Jump start and support innovation for social determinants approach Accountability 3. Build accountability and incentives into Federal health programs 4. Facilitate evaluation Tools & Guidance 5. Provide more detail about how to implement at the state and local levels through a toolkit 6. Help users to prioritize and focus their efforts 7. Assess and meet technical assistance needs Note: Numbering in this list does not imply prioritized actions. 11

12 Longer-Term Recommendations Subcommittee Charge Longer-Term Recommendations Action-orientation 1. Interactive website that will make Healthy People a living document 2. Make participation in the HP Consortium meaningful Accountability 3. Make HP2020 a cornerstone of national prevention efforts 4. Create a clear, empowered role for state HP Coordinators 5. Adopt a health in all policies approach & ensure that HP is included in the strategic plans of other federal agencies Tools & Guidance 6. Offer an assessment tool on the Website to crosswalk HP objectives with existing state & local programs 7. Leverage resources through partnerships and networks Examples 8. Models of Excellence, with core components: A State Coordinator is in place Effective strategies are used to make advancements Note: Numbering in this list does not imply prioritized actions. 12

13 A Health in All Policies Approach Health in All Policies (HiAP) addresses the effects on health across all policies such as agriculture, education, the environment, fiscal policies, housing, and transport. It seeks to improve health and at the same time contribute to the well-being and the wealth of the nations through structures, mechanisms and actions planned and managed mainly by sectors other than health. Thus HiAP is not confined to the health sector and to the public health community, but is a complementary strategy with a high potential towards improving a population s health, with health determinants as the bridge between policies and health outcomes. Source: Staht T, Wismar M, et al., Health in All Policies: Prospects and Potentials, Finnish Ministry of Social Affairs and Health, Health Department, Finland; Available online at: 13

14 Discussion of Committee Recommendations for Healthy People 2020 Implementation Strategies Have the issues raised in the Committee s charge been addressed adequately? Action-orientation Accountability Tools, aids, and guidance Examples Are changes/ revisions needed? Process for making any needed changes. Is the Committee ready to vote on recommendations? Timeline for voting 14

15 Evidence-based Strategies Committee Chair: Jonathan Fielding, MD, MPH, MA, MBA Los Angeles County Department of Public Health & Health Officer, Los Angeles County

16 Ad Hoc Group: Criteria for Evidence-based Strategies Internal and external participants (Dr. Teutsch, Dr. Calonge, Dr. Orleans, Dr. McGinnis) Charged with addressing the questions: How should decisions be made about linking HP objectives with evidence-based interventions? What should be done when there is insufficient evidence to identify effective interventions? What guidance can be provided to users about what really needs to be done? 16

17 How can Healthy People offer Guidance on What Needs to be Done? Use the resources that have amassed best available evidence and have developed valid methodologies Interventions can be graded within levels of evidence, but Compared to clinical settings, patterns of service delivery in community settings are more variable due to adaptations to fit community circumstances. Effectiveness of the same intervention may vary across communities. Therefore, it is more difficult to develop standardized grades for community- based services. 17

18 What Are Evidence-based Strategies? What is meant by the term evidence-based? How can current practices that are widely accepted but not yet supported by evidence of effectiveness be formally evaluated? How should findings of Health Impact Assessments be included in evidence reviews? 18

19 When Evidence Is Not Available How should actions be chosen when there is no evidence? Two alternate viewpoints: 1. We should recognize interventions that are accepted, but may be supported by weaker forms of evidence versus 2. We should prioritize the things that we know will work over those that are unproven. 19

20 Hierarchies of Evidence Use a hierarchy of evidence to organize different levels of evidence Community Guide, Clinical Guide at the top; Systematic analysis of all available studies by parties free of conflicts of interest in peer-reviewed journals would be listed next; Other types of evidence and related methods should be included (e.g., HIAs) 20

21 How Should Evidence be Considered? Various approaches exist for weighing evidence Examples include: US Preventive Services Task Force Recommendation Grid: Letter Grade of Recommendation or Statement of Insufficient Evidence Assessing Certainty and Magnitude of Net Benefit Guide to Community Preventive Services Review cycle of evidence-based intervention strategies and Evidence typology for classification of policy and environmental intervention strategies Transtria LLC, Washington University Institute for Public Health, The Robert Wood Johnson Foundation 21

22 Key Messages on Selecting Strategies Proposed critical information to be communicated to the FIW to help them select appropriate strategies Interventions from Clinical and Community Guides, Cochrane Reviews, and other analyses Other available, validate/ proven techniques, including intersectoral evaluations (HIAs) Priorities to consider while using Healthy People Policies that affect the physical and social environment may be better than programs targeting individuals, given political support Explore ways to produce rapid syntheses of what is being learned from evaluations of all types to help stakeholders feel that they are part of a learning organization, and to capture the wisdom of crowds. Use Web 2.0 applications to learn about what stakeholders want to know. 22

23 Preliminary Recommendations: Criteria for Evidence-based Strategies Criteria for selecting evidence-based practices should be put within the context of priority-setting, because this is where people will be making systematic decisions. The issue should be framed in a positive way. Evidence has been helpful in the clinical setting; We need more evidence of what works at the community level too. Next steps and timeline for finalizing evidence guidance 23

24 Identifying National Priorities Subcommittee Chair: Subcommittee Co-Chair: David Meltzer, MD, PhD University of Chicago Abby King, PhD Stanford University

25 The Need for National Priorities Why create a set of national priorities? They provide valuable information for broad numbers of people and government agencies They enable cross-agency collaboration Key characteristics of national priority objectives They should be supported by a compelling rationale They should be relevant to agencies with a broad range of mandates 25

26 National Priorities vs. LHIs Differentiating between national priorities and leading health indicators (LHIs) HP 2010 LHIs were originally created to provide a broad picture of our nation s health Over the decade, there was confusion that LHIs, because they were a small and manageable set, could be viewed as priorities. LHIs are not priorities. LHIs and priorities must be separately and clearly defined to ensure that they are not used synonymously or interchangeably. 26

27 National Priorities, Defined Priority issues are of national urgency. They are important enough that every level of government should monitor and undertake efforts to improve them. 27

28 Identifying National Priorities: What is the Committee s Role? This Committee will not set national priorities Because it is not a broad-based, representative group, the Advisory Committee is not the correct body to develop a set of national priorities. However, we can recommend a process whereby national priorities can be identified. The audience for these recommendations is DHHS and other participating federal agencies. (Priorities will likely be identified by the FIW). 28

29 Developing Recommendations for a Process to Identify National Priorities Proposed during Subcommittee meetings: A single, suggested set of criteria for making these choices (rather than a menu of possible processes) Should combine quantitative and qualitative approaches (a hybrid, based on the work of Lomas) Must be practical, not overly academic Should convene public health experts and top experts from other fields (e.g., housing, transportation, agriculture) to find priorities that each of them can use. 29

30 Priorities Subcommittee Next Steps Are additional meetings needed? What decisions need to be made? What should be the process for finalizing this group s recommendations? 30

31 Subcommittee on Data and IT: Recommendations Subcommittee Chair: Ronald Manderscheid, PhD SRA International

32 Data and IT Subcommittee: Guiding Questions HHS Data for HP2020 Measures: What actions should be recommended to improve the coverage and quality of HHS epidemiology, services, and services cost data, as relevant to HP2020, so that they are better able to meet the data needs of HP2020? Federal Data on Social and Physical Determinants of Health: What actions should be recommended so that key federal data sources on the social and physical determinants of health are available to meet the data needs of HP2020? Phased Development of HP2020 IT: What high level actions should be recommended so that HP2020 is on a course to make effective use of new developments on EHRs/PHRs, esp. with respect to: an online national public health epidemiological data system an online HP2020 community of users 32

33 Data and IT Subcommittee: Process and Recommendations Have met by teleconference eight times since March Began by organizing data systems into three types: epidemiological data, services data, and encounter data Reviewed HHS data sources systematically, and explored non-hhs data sources Drafting recommendations regarding immediate and long-term needs for HHS and non-hhs data sources. 33

34 Data and IT Subcommittee: Next Steps Draft high-level recommendations around the IT needs of Healthy People Specifically, these will address: Building public health IT infrastructure; Enhancing the capacity to share data. Next steps and timeline 34

35 Next Steps for the Secretary s Advisory Committee Future Meetings August 14th, 1:00 3:00 P.M. (ET) September 17-18, Washington DC (pending an extension of the Committee s charter) 35