Priorities Among Effective Clinical Preventive Services

Maciosek, Michael V.; Coffield, Ashley B.; Edwards, Nichol M.; Flottemesch, Thomas J.; Goodman, Michael J.; Solberg, Leif I.

doi:10.1016/j.amepre.2006.03.012

Cited by 554 publications

(368 citation statements)

References 17 publications

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“…The aspirin concentration in the LGcombo was calculated according to a cross-species scaling factor of 10, based on a human dosage for the prevention of myocardial events of 163 mg/day, assuming an 80 kg adult. This amount is at the upper range of the dosages currently recommended by the American Diabetes Association and the American Heart Association of 75-163 mg daily for primary prevention of cardiovascular disease in men aged 45-79 years (Maciosek et al 2006). It appears unlikely that higher dosages of these supplement combinations would have a positive effect on lifespan.…”

Section: Rationale For the Dosagesmentioning

confidence: 99%

Lifespan effects of simple and complex nutraceutical combinations fed isocalorically to mice

Spindler

Mote

Flegal

2013

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Present data suggest that the consumption of individual dietary supplements does not enhance the health or longevity of healthy rodents or humans. It might be argued that more complex combinations of such agents might extend lifespan or health-span by more closely mimicking the complexity of micronutrients in fruits and vegetables, which appear to extend health-span and longevity. To test this hypothesis we treated long-lived, male, F1 mice with published and commercial combinations of dietary supplements and natural product extracts, and determined their effects on lifespan and health-span. Nutraceutical, vitamin or mineral combinations reported to extend the lifespan or health-span of healthy or enfeebled rodents were tested, as were combinations of botanicals and nutraceuticals implicated in enhanced longevity by a longitudinal study of human aging. A cross-section of commercial nutraceutical combinations sold as potential health enhancers also were tested, including Bone Restore®, Juvenon®, Life Extension Mix®, Ortho Core®, Ortho Mind®, Super K w k2®, and Ultra K2®. A more complex mixture of vitamins, minerals, botanical extracts and other nutraceuticals was compounded and tested. No significant increase in murine lifespan was found for any supplement mixture. Our diverse supplement mixture significantly decreased lifespan. Thus, our results do not support the hypothesis that simple or complex combinations of nutraceuticals, including antioxidants, are effective in delaying the onset or progress of the major causes of death in mice. The results are consistent with epidemiological studies suggesting that dietary supplements are not beneficial and even may be harmful for otherwise healthy individuals.

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Section: Rationale For the Dosagesmentioning

confidence: 99%

Lifespan effects of simple and complex nutraceutical combinations fed isocalorically to mice

Spindler

Mote

Flegal

2013

AGE

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“…[1][2][3] While together screening and brief intervention are considered a top prevention priority for U.S. adults, 4,5 they have proven challenging to implement in routine care. [5][6][7][8] The U.S. Veterans Health Administration (VA) has achieved high rates of documented alcohol screening, both overall 9,10 and relative to other healthcare systems.…”

Section: Introductionmentioning

confidence: 99%

Factors Underlying Quality Problems with Alcohol Screening Prompted by a Clinical Reminder in Primary Care: A Multi-site Qualitative Study

et al. 2015

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“…22 Services were sorted in descending order of burden estimates and in ascending order of costeffectiveness ratios. The 28 included services are not divisible into 5 equally sized groups; therefore, for each metric we identified groups of 5 and 6 services that maximized the percentage difference between estimates of the lowest estimate in the higher scoring category and the highest estimate in the lower scoring category.…”

Section: Service Scoringmentioning

confidence: 99%

“…2 A growing evidence base has expanded knowledge about effective preventive services. At the same time, the Patient Protection and Affordable Care Act (ACA) and the pursuit of the Triple Aim 3 seek to expand access to and the efficiency of primary care.…”

Section: Introductionmentioning

confidence: 99%

“…Estimation methods have been previously reported. 16 Here we highlight new methods as well as methods that are key to interpreting results.Using simulation models, the clinically preventable burden and cost-effectiveness were computed by comparing scenarios with no utilization of a service with a scenario in which the service was offered to 100% of the target population. The current burden of cervical cancer is low compared with what it would be without cervical cancer screening, as is the current burden of vaccine-preventable childhood infectious diseases.…”

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confidence: 99%

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Updated Priorities Among Effective Clinical Preventive Services

et al. 2017

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PURPOSEThe Patient Protection and Affordable Care Act's provisions for firstdollar coverage of evidence-based preventive services have reduced an important barrier to receipt of preventive care. Safety-net providers, however, still serve a substantial uninsured population, and clinician and patient time remain limited in all primary care settings. As a consequence, decision makers continue to set priorities to help focus their efforts. This report updates estimates of relative health impact and cost-effectiveness for evidence-based preventive services. METHODSWe assessed the potential impact of 28 evidence-based clinical preventive services in terms of their cost-effectiveness and clinically preventable burden, as measured by quality-adjusted life years (QALYs) saved. Each service received 1 to 5 points on each of the 2 measures-cost-effectiveness and clinically preventable burden-for a total score ranging from 2 to 10. New microsimulation models were used to provide updated estimates of 12 of these services. Priorities for improving delivery rates were established by comparing the ranking with what is known of current delivery rates nationally. RESULTSThe 3 highest-ranking services, each with a total score of 10, are immunizing children, counseling to prevent tobacco initiation among youth, and tobacco-use screening and brief intervention to encourage cessation among adults. Greatest population health improvement could be obtained from increasing utilization of clinical preventive services that address tobacco use, obesityrelated behaviors, and alcohol misuse, as well as colorectal cancer screening and influenza vaccinations.CONCLUSIONS This study identifies high-priority preventive services and should help decision makers select which services to emphasize in quality-improvement initiatives. 2017;15:14-22. https://doi.org/10.1370/afm.2017. Ann Fam Med INTRODUCTIONT he landscape for prevention in primary care has changed dramatically since the Committee on Clinical Preventive Service Priorities published the first ranking of clinical preventive services in 2001, 1 and the National Commission on Prevention Priorities (NCPP) last updated the list in 2006. 2 A growing evidence base has expanded knowledge about effective preventive services. At the same time, the Patient Protection and Affordable Care Act (ACA) and the pursuit of the Triple Aim 3 seek to expand access to and the efficiency of primary care.Changes in primary care have potential to improve utilization of preventive services. Patient-centered medical homes (PCMHs) have been associated with increased use of preventive services, though it is not clear whether health and financial outcomes are affected. [4][5][6] Accountable Care Organizations (ACOs), when combined with PCMHs, may empower primary care and incentivize change, 7 and ACO shared-savings contracts may encourage hospital systems and specialty providers to become vested stakeholders in evidence-based prevention. Preventive care quality measures and incentives in ACO contracts might ass...

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Priorities Among Effective Clinical Preventive Services

Cited by 554 publications

References 17 publications

Lifespan effects of simple and complex nutraceutical combinations fed isocalorically to mice

Lifespan effects of simple and complex nutraceutical combinations fed isocalorically to mice

Factors Underlying Quality Problems with Alcohol Screening Prompted by a Clinical Reminder in Primary Care: A Multi-site Qualitative Study

Updated Priorities Among Effective Clinical Preventive Services

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