Standards Required for the Development of CDC Evidence-Based Guidelines.

CDC is the nation's premier health promotion, prevention, and preparedness agency. As such, CDC is an important source of public health and clinical guidelines. If CDC guidelines are to be trusted by partners and the public, they must be clear, valid, and reliable. Methods and processes used in CDC guideline development should follow universally accepted standards. This report describes the standards required by CDC for the development of evidence-based guidelines. These standards cover topics such as guideline scoping, soliciting external input, summarizing evidence, and crafting recommendations. Following these standards can help minimize bias and enhance the quality and consistency of CDC guidelines.

Measuring success: the case for calculating the return on investment of environmental public health tracking.

The Centers for Disease Control and Prevention's Environmental Public Health Tracking (EPHT) Program has funded multiple partners to develop a nationwide surveillance system that focuses on the environment and its impact on human health. To show that investing in a nationwide EPHT Network is a sound practice, the program must demonstrate that monetized improvements to the public's health due to tracking outweigh the costs. In the process of developing capacity for the EPHT Network, programs have had a positive impact on the public health. Results from successful programs can be used to estimate financial measures of the EPHT performance, such as net present value, return on investment, and payback period. The estimation of such measures for the EPHT requires an understanding of the economic elements for analysis in the context of surveillance systems. A quantitative assessment must take into account elements that are difficult to measure and value. By performing a return on investment, a financial measure of program performance, the expected costs and potential benefits of individual projects need to be assessed and compared with the current cost burden of the health condition.

Measuring the public's health.

Allocation of public health resources should be based, where feasible, on objective assessments of health status, burden of disease, injury, and disability, their preventability, and related costs. In this article, we first analyze traditional measures of the public's health that address the burden of disease and disability and associated costs. Second, we discuss activities that are essential to protecting the public's health but whose impact is difficult to measure. Third, we propose general characteristics of useful measures of the public's health. We contend that expanding the repertoire of measures of the public's health is a critical step in targeting attention and resources to improve health, stemming mounting health care costs, and slowing declining quality of life that threatens the nation's future.

A cost-benefit analysis of three older adult fall prevention interventions.

INTRODUCTION: One out of three persons aged 65 and older falls annually and 20% to 30% of falls result in injury. The purpose of this cost-benefit analysis was to identify community-based fall interventions that were feasible, effective, and provided a positive return on investment (ROI). METHODS: A third-party payer perspective was used to determine the costs and benefits of three effective fall interventions. Intervention effectiveness was based on randomized controlled trial results. National data were used to estimate the average annual benefits from averting the direct medical costs of a fall. The net benefit and ROI were estimated for each of the interventions. RESULTS: For the Otago Exercise Program delivered to persons aged 65 and older, the net benefit was $121.85 per participant and the ROI was 36% for each dollar invested. For Otago delivered to persons aged 80 and older, the net benefit was $429.18 and the ROI was 127%. Tai chi: Moving for Better Balance had a net benefit of $529.86 and an ROI of 509% and Stepping On had a net benefit of $134.37 and an ROI of 64%. CONCLUSIONS: All three fall interventions provided positive net benefits. The ROIs showed that the benefits not only covered the implementation costs but also exceeded the expected direct program delivery costs. These results can help health care funders and other community organizations select appropriate and effective fall interventions that also can provide positive returns on investment.

Methods for conducting systematic reviews of the evidence of effectiveness and economic efficiency of interventions to promote healthy social environments.

The social and physical surroundings in which people live affect their health. Knowing what basic conditions and opportunities in communities advance or impede improvement of community health can inform public health practice and policy. This article describes the methods for conducting systematic literature reviews of three community interventions to promote healthy social environments: early childhood development programs, programs to promote affordable family housing in safe neighborhoods, and interventions to increase the cultural and linguistic competence of healthcare systems. Existing methods, established for conducting systematic reviews for the Guide to Community Preventive Services, were applied to these interventions to promote healthy social environments.

The effectiveness of early childhood development programs. A systematic review.

Early childhood development is influenced by characteristics of the child, the family, and the broader social environment. Physical health, cognition, language, and social and emotional development underpin school readiness. Publicly funded, center-based, comprehensive early childhood development programs are a community resource that promotes the well-being of young children. Programs such as Head Start are designed to close the gap in readiness to learn between poor children and their more economically advantaged peers. Systematic reviews of the scientific literature demonstrate effectiveness of these programs in preventing developmental delay, as assessed by reductions in retention in grade and placement in special education.

Reviews of evidence on interventions to prevent dental caries, oral and pharyngeal cancers, and sports-related craniofacial injuries.

This report presents the results of systematic reviews of effectiveness, applicability, other positive and negative effects, economic evaluations, and barriers to use of selected population-based interventions intended to prevent or control dental caries, oral and pharyngeal cancers, and sports-related craniofacial injuries. The related systematic reviews are linked by a common conceptual approach. These reviews form the basis of recommendations by the Task Force on Community Preventive Services (the Task Force) about the use of these selected interventions. The Task Force recommendations are presented in this supplement.

Increasing diabetes self-management education in community settings. A systematic review.

This report presents the results of a systematic review of the effectiveness and economic efficiency of self-management education interventions for people with diabetes and forms the basis for recommendations by the Task Force on Community Preventive Services. Data on glycemic control provide sufficient evidence that self-management education is effective in community gathering places for adults with type 2 diabetes and in the home for adolescents with type 1 diabetes. Evidence is insufficient to assess the effectiveness of self-management education interventions at the worksite or in summer camps for either type 1 or type 2 diabetes or in the home for type 2 diabetes. Evidence is also insufficient to assess the effectiveness of educating coworkers and school personnel about diabetes.

The effectiveness of disease and case management for people with diabetes. A systematic review.

This report presents the results of a systematic review of the effectiveness and economic efficiency of disease management and case management for people with diabetes and forms the basis for recommendations by the Task Force on Community Preventive Services on the use of these two interventions. Evidence supports the effectiveness of disease management on glycemic control; on screening for diabetic retinopathy, foot lesions and peripheral neuropathy, and proteinuria; and on the monitoring of lipid concentrations. This evidence is applicable to adults with diabetes in managed care organizations and community clinics in the United States and Europe. Case management is effective in improving both glycemic control and provider monitoring of glycemic control. This evidence is applicable primarily in the U.S. managed care setting for adults with type 2 diabetes. Case management is effective both when delivered in conjunction with disease management and when delivered with one or more additional educational, reminder, or support interventions.

Conceptual framework of public health surveillance and action and its application in health sector reform.

BACKGROUND: Because both public health surveillance and action are crucial, the authors initiated meetings at regional and national levels to assess and reform surveillance and action systems. These meetings emphasized improved epidemic preparedness, epidemic response, and highlighted standardized assessment and reform. METHODS: To standardize assessments, the authors designed a conceptual framework for surveillance and action that categorized the framework into eight core and four support activities, measured with indicators. RESULTS: In application, country-level reformers measure both the presence and performance of the six core activities comprising public health surveillance (detection, registration, reporting, confirmation, analyses, and feedback) and acute (epidemic-type) and planned (management-type) responses composing the two core activities of public health action. Four support activities - communications, supervision, training, and resource provision - enable these eight core processes. National, multiple systems can then be concurrently assessed at each level for effectiveness, technical efficiency, and cost. CONCLUSIONS: This approach permits a cost analysis, highlights areas amenable to integration, and provides focused intervention. The final public health model becomes a district-focused, action-oriented integration of core and support activities with enhanced effectiveness, technical efficiency, and cost savings. This reform approach leads to sustained capacity development by an empowerment strategy defined as facilitated, process-oriented action steps transforming staff and the system.

Public goods and externalities: a research agenda for public health economics.

Among the many roles a government plays in our daily lives, protecting the public's health is one of the most conspicuous. The government provides goods and services such as registration of births and deaths, public health surveillance of disease and injury, outbreak investigations, research and education, health insurance for the poor and elderly, enforcement of laws and regulations, evaluation of health promotion programs, and assurance of a competent healthy workforce. In the past, economics in public health has almost exclusively focused on efficiency of programs through the use of cost-effectiveness or net present value measures clustered under the rubric of "economic evaluation." Efficiency measures are useful at the programmatic level. However, lack of full employment and market failures including public goods and the impact of consumers and producers actions not reflected in the markets (externalities) not only compromise efficiency but also generate health inequities. We propose an expansion of the scope of existing health economics research in an area characterized as public health economics--the study of the economic role of government in public health, particularly, but not exclusively, in supplying public goods and addressing externalities.

Economics of prevention: the public health research agenda.

Public health policy makers often focus their attention on the economic evaluation methods (eg, cost-benefit and cost-effectiveness analyses) because of their interest in the economic returns from investment in prevention programs. This article presents a case for the broader applicability of economic theories and methods in development of public health prevention research issues. Public financing, delivery, and regulatory policies are often advocated and used to correct the imperfections in the market for preventive health services. A proper understanding of the incentives and constraints faced by individual agents in the market, however, can improve the effectiveness of these policies in achieving the prevention targets. In developing a research agenda, economics can play a more substantial role beyond the traditional economic evaluation research.