Original Articles
Developing the guide to community preventive services—overview and rationale1

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Abstract

Contents: When the Guide to Community Preventive Services: Systematic Reviews and Evidence-Based Recommendations (the Guide) is published in 2001, it will represent a significant national effort in encouraging evidence-based public health practice in defined populations (e.g., communities or members of specific managed care plans). The Guide will make recommendations regarding public health interventions to reduce illness, disability, premature death, and environmental hazards that impair community health and quality of life. The Guide is being developed under the guidance of the Task Force on Community Preventive Services (the Task Force)—a 15-member, nonfederal, independent panel of experts.

Subject matter experts, methodologists, and scientific staff are supporting the Task Force in using explicit rules to conduct systematic literature reviews of evidence of effectiveness, economic efficiency, and feasibility on which to base recommendations for community action. Contributors to the Guide are building on the experience of others to confront methodologic challenges unique to the assessment of complex multicomponent intervention studies with nonexperimental or nonrandomized designs and diverse measures of outcome and effectiveness.

Persons who plan, fund, and implement population-based services and policies to improve health at the state and local levels are invited to scrutinize the work in progress and to communicate with contributors. When the Guide is complete, readers are encouraged to consider critically the value and relevance of its contents, the implementation of interventions the Task Force recommends, the abandonment of interventions the Task Force does not recommend, and the need for rigorous evaluation of the benefits and harms of promising interventions of unknown effectiveness.

Introduction

The Guide to Community Preventive Services: Systematic Reviews and Evidence-Based Recommendations (the Guide), being prepared by the Task Force on Community Preventive Services (the Task Force), will provide public health practitioners and decision makers with recommendations regarding population-based interventions to promote health and to prevent disease, injury, disability, and premature death in communities. The Guide aims to promote evidence-based public health practice in the United States. For this reason, it has been described as the public health companion to the Guide to Clinical Preventive Services, which aims to promote evidence-based prevention for individuals.1 Although the primary focus for the Guide is on interventions that have been evaluated in industrialized nations, audiences in developing nations also might consider the information relevant to their needs.

The Task Force expects that the Guide will be useful to practitioners (public health and clinical) and decision makers for three reasons. First, most practitioners and decision makers value scientific knowledge as a foundation for health-related decision making. Second, the scientific literature regarding a particular health problem often is large, inconsistent, uneven in quality, and sometimes inaccessible to many busy practitioners who could put research findings into practice. Third, a panel of experts with the time, experience, objectivity, and opportunity to help interpret the content and quality of the literature is seldom available to practitioners for consultation on demand. Thus, an evidence-based guide can help overcome these obstacles to making the best use of what is known regarding a public health problem and its potential solutions. This article describes the Guide’s audience and purpose, content and conceptual approach, methods and standards for developing evidence-based topics (chapters), and plans for disseminating and implementing its recommendations for public health action. Several important definitions adopted by the Task Force are given below:

Community: A group of individuals who share one or more characteristics.

Community preventive service: An intervention (activity) that prevents disease or injury or promotes health in a group of persons.

Determinant: Causal factor hypothesized to affect health outcomes; can include (1) demographic and population (host) factors; (2) environmental factors such as disease vectors or transmission agents (e.g., food or water); (3) social, economic, educational, health care, cultural, or other systems; or (4) preventive interventions.

Effectiveness: Improvement in health or behavioral outcome produced by an intervention in a community setting.

Evidence-based method: A strategy for explicitly linking public health or clinical practice recommendations to the underlying scientific evidence that demonstrates effectiveness.

Health outcome: Measure of health or loss of health, including (1) mortality—rates of death, years of potential life lost, quality adjusted life years gained, disability adjusted life years lost; (2) morbidity—disease or injury rates, infertility rates, disability, chronic pain, functional status, psychiatric disorders, and so forth; and (3) pregnancy and birth rates. Biologic markers and behaviors are considered intermediate outcomes. Health outcomes frequently are used to define both harmful and beneficial health effects of specific population-based prevention interventions.

Intermediate outcome: Variable that occurs in the causal pathway between a determinant and the final health outcome. Examples include: (1) levels of risk behaviors; (2) rates of access to, usage of, and coverage of preventive services; (3) physiologic measures (e.g., blood pressure or cholesterol); and (4) levels of environmental exposures. In certain circumstances, one health outcome leads to another health outcome; the original health outcome, therefore, becomes an intermediate outcome. Diabetes, for example, can lead to cardiovascular disease or a sexually transmitted infection can lead to infertility.

Public Health Practitioners: Persons responsible for providing public health services, regardless of the organization in which they work. This definition includes a variety of occupational categories commonly employed in public health agencies, managed care plans, community health centers, and academic institutions. Persons who occasionally contribute to public health activities in the course of fulfilling other responsibilities are not included under this term.28

Section snippets

The guide’s audience and purpose

The Task Force has identified as its primary target audience persons involved in planning, funding, and implementing population-based services and policies to improve health at the state and local levels.2 Such persons could be those responsible for developing policy or implementing programs in a variety of organizational contexts (e.g., health departments, managed care plans, legislatures, academic centers, and community coalitions). In health departments, legislatures, and academic centers,

Content of the guide

The scope and organization of the Guide is described in detail and justified elsewhere.5 Briefly, however, the Task Force envisioned a Guide that would (1) encompass Healthy People 20006 and 2010 priority areas7; (2) have a broad scope of problem areas and related interventions; (3) address risk behaviors with the largest collective impact on health; and (4) address major causes of ill health across the life span (i.e., children, adults, and older adults). To put evaluated interventions and

Methods and standards used in developing the guide

Since the first edition of the Guide to Clinical Preventive Services was published in 1989 addressing individual clinical services, many professional groups including public health practitioners, managed care executives, health care policy makers, and payers have expressed a need for evidence-based recommendations to help them select and implement population-based preventive health services in varying topics of interest.12, 19

Guide chapter development includes the following substantive tasks:20

Plans for disseminating and implementing recommendations

The Task Force envisions disseminating the Guide using three related approaches—(1) publishing and distributing the primary document as a scientific report, along with a series of related interim products in a variety of formats; interim products might include each chapter-specific systematic review and recommendations as separate publications in print and on the Internet3, 4, 25; (2) facilitating the use of the Guide as a basis for developing other types of products (e.g., how-to manuals); and

Summary

When the first volume of the Guide is published in 2001, it will represent the first installment of a significant national effort in encouraging evidence-based public health practice in communities, including populations of beneficiaries enrolled in managed care plans. The Guide will make recommendations regarding public health interventions that (1) change risk behaviors; (2) reduce diseases, injuries, and impairments that account for a large portion of the burden of illness, disability, and

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  • Cited by (0)

    1

    The names and affiliations of the Task Force members are listed on page v of this supplement and at http://www.thecommunityguide.org.

    2

    Dr. Pappaioanou is currently with the Office of Global Health, Centers for Disease Control, Atlanta, Georgia.

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