Strengthening Public Health Policy and Practice: Recent EvidenceBased Recommendations from the Guide

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Strengthening Public Health Policy and Practice
Recent Evidence-Based Recommendations from the
Guide to Community Preventive Services

• Shawna L. Mercer, M.Sc., Ph.D.
• Director
• Robin E. Soler, Ph.D.
• Coordinating Scientist
• The Guide to Community Preventive Services
• National Center for Health Marketing
• Centers for Disease Control and Prevention (CDC)

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The Guide to Community Preventive Services
(Community Guide)

• Is a foundational component for a health system
  that is
• high-performance
• economically efficient
• accountable
• Helps communities, public health professionals,
  policymakers, employers, and others in their
  decision making about how to achieve the greatest
  health impact and health value with their
  available resources

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The Community Guide

• Conducts state-of-the-science systematic reviews
  that
• Analyze all available evidence on what works to
• Promote health and wellness
• Prevent disease, injury, impairment
• Identify programs and policies that
• Save lives
• Increase quality of life
• Assess the economic benefit of all
  effective interventions
• Highlight critical research gaps

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The Community Guide

• These systematic review findings form the basis
  for evidence-based recommendations
• About effective programs and policies for
  communities, worksites, schools, health care
  systems, etc.
• Developed by the Task Force on Community
  Preventive Services

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Task Force on Community Preventive Services (Task
Force TFCPS)

• Nonfederal, independent, rotating
• Internationally renowned experts in public health
  research, practice, policy
• Appointed by CDC director
• Roles
• Oversee topic and intervention priority setting
• Participate on individual review teams
• Make recommendations for policy, practice,
  research, on the basis of Community Guide
  reviews, especially for the U.S.
• Not a federal advisory committee

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The Clinical and Community Guides Are
Complementary
Individual level Clinical settings Delivered by
healthcare providers Screening, Counseling,
etc.
Clinical Guide US Preventive Services Task
Force Recommendations
Group level Health system changes
Insurance/benefits coverage Access
to/provision of services Community,
population-based Informational (Group
Education, Media) Behavioral, Social
Environmental Policy Change
Community Guide Task Force on Community
Preventive Services Recommendations
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gt210 TFCPS Recommendations
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Community Guide How is it Used?

• To inform decision making around
• Practice (initiatives, programs)
• Policy making
• Research
• Funding for research and programs

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Community Guide Places Equal Weight on

• The quality of the systematic review methods and
  analysis
• The group processes
• Participation and
  collaboration

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Intended Users Participation Are we

• Prioritizing the right topics and interventions
  for review?
• Asking the right questions?
• Staying true to the important questions over the
  course of the review?
• Appropriately considering context, other issues
  of applicability to different settings,
  populations?
• Thinking proactively about interpretability,
  relevance, usefulness, use?
• Planning for and undertaking dissemination and
  translation into action from the outset?

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Participants in the Community Guide

• Official Liaisons
• gt28 federal agency and organizational
• For all reviews
• Stakeholders, partners
• For specific topics
• Roles
• Provide input into prioritization,
  recommendations
• Recommend, find participants for review teams
• Participate on review teams
• Participate in dissemination, translation
  especially to their constituents

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Participants in Individual Reviews

• Coordination Team (n10-15)
• Coordinating scientist (Community Guide)
• Fellows, abstractors (Community Guide)
• Subject matter experts and users
• From CDC, other federal agencies,
  academia, practice, policy settings
• Task Force member(s)
• Liaison(s)
• Consultation Team (n20-60)
• subject matter experts
• Community Guide Staff

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The CG Seeks to Answer Key Questions about
Interventions

• Do they work?
• How well?
• For whom?
• Under what circumstances are they
  appropriate?
• What do they cost?
• Do they provide value?
• Are there barriers to their use?
• Are there any harms?
• Are there any unanticipated outcomes?

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Community Guide Review Process

• Convene review teams
• Coordination team
• Consultation team
• Develop a conceptual framework
• Develop prioritized list of
  interventions
• Develop, refine clear research
  questions
• Search for evidence

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Community Guide Review Process

• Abstract and critically evaluate the available
  studies
• Summarize the evidence
• Calculate effect sizes
• Summarize effect sizes
• Median or mean
• Homogeneity tests
• Meta-analysis
• Meta-regression
• Task Force discussion and recommendations
• Disseminate the results
• Support translation of findings into action

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In General, a Conclusion About Effectiveness
Requires.
A Body of Evidence
A Demonstration of Effectiveness

• Number of studies
• Quality of studies
• Suitability of study design

Consistency of Effect
Sufficient Magnitude of Effect

Most studies demonstrated an effect in the
direction of the intervention
The effect demonstrated across the body of
evidence is meaningful
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Recent TFCPS Recommendations What is the
effectiveness of
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www.thecommunityguide.org
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Using the Community Guide to Examine Worksite
Influenza Vaccination Program Effectiveness

• Robin E. Soler, PhD
• matt griffith, MPH
• David Hopkins, MD
• Qiana Baker, MPH

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Rationale

• Influenza burden on public health
• Potential pandemic influenza
• HP 2010 and ACIP recommendations
• Vaccination effectiveness for improving
• Public health threats
• Worker outcomes (e.g., morbidity, medical costs)
• Employer outcomes (e.g., productivity)

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Worksite Coordination Team

• Task Force Members
• Nico Pronk, Vice-President, HealthPartners
• Ron Goetzel, Director, Institute for Health and
  Productivity Studies
• CDC
• Lisa Koonin, Branch Chief, Office of Public and
  Private Partnerships
• Leigh Ramsey Buchanan, Coordinating Scientist,
  Division of Nutrition and Physical Activity and
  Obesity
• Abby Rosenthal, Health Education Specialist,
  Office on Smoking and Health
• Deborah Bauer, Partnership and Dissemination
  Coordinator, Community Guide
• Academic and Private Sectors
• Dee Edington, Professor, University of Michigan
• Curtis Florence, Assistant Professor, Emory
  University
• Deborah MacLean, Operations Manager, Coca-Cola
• Dennis Richling, VP and Medical Director,
  CorSolutions
• Andrew Walker, Private Consultant

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Influenza Consultation Team

• Public Sector
• Faruque Ahmed, Medical Epidemiologist, CDC
  Immunization Services
• Deborah Banton, Public Health Nursing Director,
  San Juan Basin Health Department (CO)
• Pamela Butler, Health Commissioner, Wood County
  Health District (OH)
• Renee Funk, Medical Epidemiologist, NIOSH
• Gina Mootrey, Medical Officer, CDC Immunization
  Services
• Kristin Nichol, Chief of Medicine, Minneapolis VA
  Medical Center/Professor of Medicine, U of
  Minnesota
• Private Sector
• Theresa Frost, Health Education Specialist,
  Pitney Bowes, Inc.
• Sara Kashima, Health Information Coordinator,
  Chevron Corporation
• Advocacy
• Charlie Key, Treasurer-Secretary, Georgia AFL-CIO
• Diane Peterson, Associate Director, Immunization
  Action Coalition

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Decisions Along the Way

• Begin with on-site (at the workplace) programs
• Conduct separate reviews for healthcare and
  non-healthcare settings
• Different contexts
• Different motivations
• Different implications
• Compare all potential intervention methods

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Interventions for Healthcare Workers A Sample
Review
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Intervention Definition

• Free, on-site programs to increase influenza
  vaccination coverage among working populations in
  healthcare settings. On-site programs are those
  interventions that provide access to vaccinations
  for workers at the worksite for free and are
  announced through formal worksite mechanisms,
  such as newsletters, e-mails, or paycheck
  inserts. These programs may include additional
  components, such as health education and mobile
  carts.

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Influenza Vaccination in Healthcare Settings

• ACIP recommends vaccination of all healthcare
  workers to
• Protect staff and their patients,
• Reduce disease burden and health-care costs

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Body of Evidence
(n46)
Qualifying studies 43 studies
Excluded 3 limited studies
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Summary of Findings
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Influenza Vaccination CoverageModerate
Suitability (Time-Series) Studies
100 90 80 70 60 50 40 30 20 10 0
Median one-year change 34.0 pct pts
Nace 07 (226)

Olson 91 (452)
Lopes 08 (19,997)
Sartor 04 (2,373)
n of studies 4
(Post-)
(Pre-)
p lt.05
Intervention Year
Shortage year
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Applicability

• Workers in
• Long term care (n7 studies)
• Hospitals (n31 studies)
• Pediatric hospitals (n4 studies)
• Position
• May be less effective for nurses than physicians
• 11.0 pct pts vs. 18.5 pct pts
• Persons with direct and indirect patient care
  responsibilities
• Medium and large healthcare settings
• US, Europe, Asia, South America, Australia
• Limited information on gender, age, ethnicity

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Task Force Finding Interventions with on-site,
free, actively promoted vaccinations for
healthcare workers

• The Task Force on Community Preventive Services
  recommends interventions with on-site, free, and
  actively promoted influenza vaccinations to
  increase influenza vaccination coverage among
  workers in healthcare worksites. This
  recommendation is based on strong evidence that
  this intervention increases influenza vaccination
  coverage among workers in healthcare worksites
  and on sufficient evidence that this intervention
  reduces influenza cases among workers and
  patients when implemented alone or as part of a
  multi-component intervention.

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Task Force Finding Interventions with actively
promoted, off-site vaccinations for healthcare
workers

• The Task Force on Community Preventive Services
  finds insufficient evidence to determine the
  effectiveness of interventions with actively
  promoted, off-site influenza vaccinations to
  increase vaccination coverage among workers of
  healthcare worksites. This finding is based on a
  broad systematic search of the literature that
  identified only two relevant studies.

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Task Force Findings for Non-Healthcare Worker
Reviews
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Task Force Finding Interventions with on-site,
reduced cost, actively promoted vaccinations for
non-healthcare workers

• The Task Force on Community Preventive Services
  recommends interventions with on-site, reduced
  cost, and actively promoted influenza
  vaccinations to increase influenza vaccination
  coverage among workers in worksites. This
  recommendation is based on sufficient evidence
  that this intervention increases influenza
  vaccination coverage among workers in worksites,
  whether implemented alone or as part of a
  multi-component intervention.

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Task Force Finding Interventions with actively
promoted, off-site vaccinations for
non-healthcare workers

• The Task Force on Community Preventive Services
  finds insufficient evidence to determine the
  effectiveness of interventions with actively
  promoted, off-site influenza vaccinations to
  increase influenza vaccination coverage among
  workers in worksites. This finding is based on a
  broad systematic search of the literature that
  identified only one relevant study, which had a
  small effect estimate.

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• For More Information
• Shawna L. Mercer, MSc, PhD
• SMercer_at_cdc.gov
• Robin E. Soler, PhD
• RSoler_at_cdc.gov

The findings and conclusions in this presentation
are those of the presenters and do not
necessarily represent the views of CDC.