RESUMO
BACKGROUND: Many recommended clinical preventive services are delivered at low rates. Decision-makers who wish to improve delivery rates, but face competing demands for finite resources, need information on the relative value of these services. This article describes the results of a systematic assessment of the value of clinical preventive services recommended for average-risk patients by the U.S. Preventive Services Task Force. METHODS: The assessment of services' value for the U.S. population was based on two dimensions: burden of disease prevented by each service and cost effectiveness. Methods were developed for measuring these criteria consistently across different types of services. A companion article describes the methods in greater detail. Each service received 1 to 5 points on each of the two dimensions, for total scores ranging from 2 to 10. Priority opportunities for improving delivery rates were determined by comparing the ranking of services with what is known of current delivery rates nationally. RESULTS: The highest ranked services (scores of 7+) with the lowest delivery rates (< or =50% nationally) are providing tobacco cessation counseling to adults, screening older adults for undetected vision impairments, offering adolescents an anti-tobacco message or advice to quit, counseling adolescents on alcohol and drug abstinence, screening adults for colorectal cancer, screening young women for chlamydial infection, screening adults for problem drinking, and vaccinating older adults against pneumococcal disease. CONCLUSIONS: Decision-makers can use the results to set their own priorities for increasing delivery of clinical preventive services. The methods provide a basis for future priority-setting efforts.
Assuntos
Atenção à Saúde/organização & administração , Fidelidade a Diretrizes/normas , Prioridades em Saúde , Guias de Prática Clínica como Assunto/normas , Serviços Preventivos de Saúde/normas , Prevenção Primária/normas , Adulto , Idoso , Algoritmos , Criança , Redução de Custos , Efeitos Psicossociais da Doença , Análise Custo-Benefício , Tomada de Decisões Gerenciais , Árvores de Decisões , Alocação de Recursos para a Atenção à Saúde/organização & administração , Humanos , Programas de Rastreamento/economia , Programas de Rastreamento/normas , Programas de Rastreamento/estatística & dados numéricos , Avaliação das Necessidades , Serviços Preventivos de Saúde/economia , Serviços Preventivos de Saúde/estatística & dados numéricos , Prevenção Primária/economia , Anos de Vida Ajustados por Qualidade de Vida , Fatores de Risco , Estados Unidos/epidemiologiaRESUMO
Methods used to compare the value of clinical preventive services based on two criteria-clinically preventable burden (CPB) and cost effectiveness (CE)-are described. A companion article provides rankings of clinical preventive services and discusses its uses for decision-makers; this article focuses on the methods, challenges faced, and solutions. The authors considered all types of data essential to measuring CPB and CE for services recommended by the U.S. Preventive Services Task Force and developed methods essential to ensuring valid comparisons of different services' relative value.