Methods to Prioritize Systematic Reviews: The Guide to Community Preventive Services Shawna L. Mercer, M.Sc., Ph.D. Direct...
Presentation Structure <ul><li>What is the Guide to Community Preventive Services (Community Guide)?  </li></ul><ul><li>Wh...
The Community Guide is: <ul><li>Systematic reviews  of the available evidence </li></ul><ul><ul><li>On effectiveness of po...
The  Clinical Guide  and  Community Guide  Are Complementary
The Clinical and Community Guides Are Complementary  Individual level Clinical settings Delivered by healthcare providers ...
Community Guide (CG) Topics Settings Social Environment The Environment Worksites Schools Specific Conditions Risk Behavio...
Community Guide Outputs <ul><li>>200 systematic review findings completed </li></ul><ul><li>“Family of Products” </li></ul...
Brief History of the Community Guide  <ul><li>1986:   </li></ul><ul><ul><li>First release of Clinical Guide </li></ul></ul...
Task Force on Community Preventive Services (Task Force) <ul><li>Nonfederal, independent, rotating </li></ul><ul><li>Inter...
Community Guide: Intended Uses <ul><li>To inform decision making around: </li></ul><ul><ul><li>Practice </li></ul></ul><ul...
Community Guide’s Approach to Developing and Disseminating Evidence Based Recommendations  <ul><li>By actively engaging in...
So Whose Participation Do We Seek in our Systematic Reviews? <ul><li>Who is to be affected by the research results?  Who a...
Participants in the Community Guide <ul><li>Official Liaisons   </li></ul><ul><ul><li>>25 federal agency and organizationa...
Official Federal Agency Liaisons  <ul><li>Agency for Healthcare Research and Quality </li></ul><ul><li>National Institutes...
Official Organizational Liaisons  <ul><li>American Academy of Family Physicians </li></ul><ul><li>American Academy of Nurs...
Official Organizational Liaisons (cont’d) <ul><li>Association of State and Territorial Health Officials </li></ul><ul><li>...
Participants in the Community Guide <ul><li>Stakeholders, partners   </li></ul><ul><ul><li>For specific topics, reviews </...
Participants in Individual Reviews <ul><li>Coordination Team </li></ul><ul><ul><li>Coordinating scientist (Community Guide...
Prioritization of  Community Guide Work
Priority List - 1998 <ul><li>Task Force Considered a Range of Factors </li></ul><ul><ul><li>Burden </li></ul></ul><ul><ul>...
Priority List - 1998 <ul><li>Decision:  </li></ul><ul><ul><li>Organize the Community Guide  by topics  rather than by indi...
Note on Task Force Deliberations <ul><li>Task Force meetings are public; attended by: </li></ul><ul><ul><li>Official Liais...
The Guide Process:  From Topic to Intervention Review(s) Topic is  Selected Task  Force
The Guide Process: The Team Topic is  Selected Staff  Recruits Teams  Task  Force Coordination Team Consultation Team
The Guide Process:  Team Decisions Topic is  Selected Staff  Recruits Teams  Task  Force Coordination Team Consultation Te...
The Guide Process:  Task Force Input Topic is  Selected Staff  Recruits Teams  Task  Force Coordination Team Consultation ...
Prioritization 2006ff: Our Ultimate Goal is a Work List… <ul><li>Reflect Task Force priorities for future work </li></ul><...
We Remain Open to Funded Review Opportunities   Priority Work List Funded Review
We Have to Update Existing Reviews   Priority Work List Funded Review <ul><li>Updates Priority List </li></ul><ul><li>VPD ...
The Task Force Retains a Place for Special Projects   Priority Work List Funded Review <ul><li>Updates Priority List </li>...
We Also Need a Priority List of New and Continued Public Health Topics   <ul><li>Priority Work List </li></ul><ul><li>e.g....
Step 1: Stakeholder Survey <ul><li>Request for additional topics, interventions and supporting documentation </li></ul><ul...
Responses from Stakeholders  <ul><li>Varied in breadth, type of topic, intervention proposed  </li></ul><ul><ul><li>Land u...
Step 2: Compile List of Candidate Topics <ul><li>Combined topics from original prioritization in 1998 with new recommendat...
Challenges Moving Forward <ul><li>What should be the organizing structure? </li></ul><ul><ul><li>Disease, condition, risk ...
Challenges Moving Forward <ul><li>Organizing Structure - Solution  </li></ul><ul><ul><li>Four key groupings of topics: </l...
Challenges Moving Forward <ul><li>Broad vs. narrow focus of topics </li></ul><ul><ul><li>Nutrition vs. breastfeeding </li>...
Product of Step 2 <ul><li>Master topic list  >100 </li></ul>Notes Source Focused Topic Overall Topic Topic Number Grouping...
Step 3: Compile Information to Enable Ranking of Topics <ul><li>Challenge:  </li></ul><ul><ul><li>Providing information fo...
a) Information Compiled for Each Topic <ul><li>Burden, prevalence  </li></ul><ul><ul><li>Mortality </li></ul></ul><ul><ul>...
b) CDC Program Directors Questionnaire <ul><li>For assigned topics, others they wish to add: </li></ul><ul><ul><li>Level o...
b) CDC Program Directors’ Questionnaire <ul><li>For assigned, added topics (cont’d): </li></ul><ul><ul><li>Their opinion r...
b) CDC Program Directors’ Questionnaire <ul><li>Response rate:  </li></ul><ul><ul><li>(100%) </li></ul></ul><ul><ul><li>Se...
Initial Re-Prioritization of Topics:  Task Force Meeting, Fall 2006 <ul><li>Goal for meeting: a rank-ordered list of topic...
Initial Plan Total List of  Considered Topics (n=111) Additional Information High Priority Tier of  Topics (n=~25) Medium ...
Mid-Course Modifications Initial Vote 111 Topics 1  …… 2  …… 3  …… 4  …… 5  …… . . . . 111 Preliminary Rank Order for all ...
Key Criteria Agreed Upon for Voting <ul><li>Overall attributable burden </li></ul><ul><li>Preventability, attributable fra...
Voting   Process; Resulting Rankings <ul><li>Topics displayed on the screen one by one  </li></ul><ul><li>Voted using Perc...
Initial Rank Order Led to (Lots and Lots of!!!) Consensus Discussion Initial Vote 1 …… 2 …… .  …… .  …… 25 or so 1  …… 2  ...
We Alerted Task Force During Consensus Discussion of… <ul><li>Situations where broad topics (and all focused topics within...
Consensus Discussion 1 …… 2 …… .  …… .  …… 25 or so 26 ish 27 …… 28 …… .  …… 50 or so 51 …… 62 …… .  …… .  ……  111 Move lo...
End of Task Force Meeting High Priority Tier of Topics 25 or so ‘ Loosely ranked’ Medium Priority Tier of Topics Low Prior...
Subsequent Steps <ul><li>Formation of Task Force Subcommittee on Prioritization to: </li></ul><ul><ul><li>Continue reviewi...
Prioritization of Interventions for Systematic Review within Topics Topic is  Selected Staff  Recruits Teams  Task  Force ...
Prioritization of Interventions for Systematic Review within a Topic <ul><li>Coordination Team: subject matter expertise  ...
For More Information <ul><li>Shawna L. Mercer, MSc, PhD  </li></ul><ul><ul><li>Community Guide Director </li></ul></ul><ul...
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Centers for Disease Control & Prevention Community Guide

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  • Centers for Disease Control & Prevention Community Guide

    1. 1. Methods to Prioritize Systematic Reviews: The Guide to Community Preventive Services Shawna L. Mercer, M.Sc., Ph.D. Director The Guide to Community Preventive Services National Center for Health Marketing Centers for Disease Control and Prevention (CDC)
    2. 2. Presentation Structure <ul><li>What is the Guide to Community Preventive Services (Community Guide)? </li></ul><ul><li>What issues influence the way the Community Guide prioritizes its systematic reviews? </li></ul><ul><li>How does the Guide prioritize its work? </li></ul><ul><ul><li>Into topics </li></ul></ul><ul><ul><li>Into interventions within topics that are addressed in systematic reviews </li></ul></ul>
    3. 3. The Community Guide is: <ul><li>Systematic reviews of the available evidence </li></ul><ul><ul><li>On effectiveness of population-based public health interventions </li></ul></ul><ul><li>Formulated by teams of renowned researchers, public health practitioners, representatives of health organizations </li></ul><ul><li>Concise, carefully-considered recommendations for policy and practice </li></ul><ul><li>Identification of research gaps </li></ul>
    4. 4. The Clinical Guide and Community Guide Are Complementary
    5. 5. The Clinical and Community Guides Are Complementary Individual level Clinical settings Delivered by healthcare providers Screening, Counseling, etc. 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 (TFCPS Recommendations ) Clinical Guide (USPSTF Recommendations)
    6. 6. Community Guide (CG) Topics Settings Social Environment The Environment Worksites Schools Specific Conditions Risk Behaviors Vaccine-Preventable Disease Pregnancy Outcomes Violence Motor Vehicle Injuries Depression Cancer Diabetes Oral Health Obesity Tobacco Use Alcohol Abuse/Misuse Other Substance Abuse Poor Nutrition Inadequate Physical Activity Unhealthy Sexual Behaviors
    7. 7. Community Guide Outputs <ul><li>>200 systematic review findings completed </li></ul><ul><li>“Family of Products” </li></ul><ul><ul><li>Book </li></ul></ul><ul><ul><ul><li>First book published in January 2005 </li></ul></ul></ul><ul><ul><ul><ul><li>www.thecommunityguide.org, Oxford Press </li></ul></ul></ul></ul><ul><ul><li>Publications </li></ul></ul><ul><ul><li>Web site </li></ul></ul><ul><ul><li>www.thecommunityguide.org </li></ul></ul>
    8. 8. Brief History of the Community Guide <ul><li>1986: </li></ul><ul><ul><li>First release of Clinical Guide </li></ul></ul><ul><li>Late 1980s – Mid 1990s: </li></ul><ul><ul><li>Could there be a comparable guide for public health? </li></ul></ul><ul><li>1996: </li></ul><ul><ul><li>Department of Health and Human Services established the Community Guide </li></ul></ul><ul><ul><ul><li>As a resource for all of HHS, and for public health </li></ul></ul></ul><ul><ul><ul><li>Housed at CDC </li></ul></ul></ul><ul><ul><ul><li>Established a Task Force to direct its work </li></ul></ul></ul>
    9. 9. Task Force on Community Preventive Services (Task Force) <ul><li>Nonfederal, independent, rotating </li></ul><ul><li>Internationally renowned experts in public health research, practice, policy </li></ul><ul><li>Appointed by CDC director </li></ul><ul><li>Roles: </li></ul><ul><ul><li>Oversee topic and intervention priority setting </li></ul></ul><ul><ul><li>Participate on individual review teams </li></ul></ul><ul><ul><li>Make recommendations for policy, practice, research, especially for the U.S. </li></ul></ul><ul><ul><ul><li>Not a federal advisory committee </li></ul></ul></ul>
    10. 10. Community Guide: Intended Uses <ul><li>To inform decision making around: </li></ul><ul><ul><li>Practice </li></ul></ul><ul><ul><li>Policy making </li></ul></ul><ul><ul><li>Research </li></ul></ul><ul><ul><li>Research Funding </li></ul></ul>
    11. 11. Community Guide’s Approach to Developing and Disseminating Evidence Based Recommendations <ul><li>By actively engaging in conducting and disseminating the systematic review those who are expected to be the users and beneficiaries of the research, it is more likely the findings and recommendations will be relevant to their needs </li></ul>
    12. 12. So Whose Participation Do We Seek in our Systematic Reviews? <ul><li>Who is to be affected by the research results? Who are the intended users? </li></ul><ul><ul><li>Health departments </li></ul></ul><ul><ul><li>Practitioners </li></ul></ul><ul><ul><li>Policy makers </li></ul></ul><ul><ul><li>Professional organizations </li></ul></ul><ul><ul><li>Nongovernmental organizations </li></ul></ul><ul><ul><li>Employers </li></ul></ul><ul><ul><li>Representatives of minority or special populations </li></ul></ul><ul><ul><li>Researchers </li></ul></ul><ul><ul><li>Research funders </li></ul></ul>
    13. 13. Participants in the Community Guide <ul><li>Official Liaisons </li></ul><ul><ul><li>>25 federal agency and organizational </li></ul></ul><ul><ul><li>Provide input into prioritization, reviews, recommendations </li></ul></ul><ul><ul><li>Recommend, find participants for review teams </li></ul></ul><ul><ul><li>Participate on review teams </li></ul></ul><ul><ul><li>Participate in dissemination, translation especially to their constituents </li></ul></ul>
    14. 14. Official Federal Agency Liaisons <ul><li>Agency for Healthcare Research and Quality </li></ul><ul><li>National Institutes of Health </li></ul><ul><li>Office of Disease Prevention and Health Promotion </li></ul><ul><li>Department of Veterans Affairs </li></ul><ul><li>Health Resources and Services Administration </li></ul><ul><li>Substance Abuse and Mental Health Services Administration Indian Health Service </li></ul><ul><li>United States Navy Medicine </li></ul><ul><li>United States Air Force </li></ul><ul><li>United States Army </li></ul>
    15. 15. Official Organizational Liaisons <ul><li>American Academy of Family Physicians </li></ul><ul><li>American Academy of Nurse Practitioners </li></ul><ul><li>American Academy of Pediatrics Bright Futures Education Center Advisory Committee </li></ul><ul><li>American Academy of Physician Assistants </li></ul><ul><li>America’s Health Insurance Plans </li></ul><ul><li>American Public Health Association </li></ul><ul><li>American College of Preventive Medicine </li></ul><ul><li>Association of Schools of Public Health </li></ul><ul><li>Association for Prevention Teaching and Research </li></ul><ul><li>Institute of Medicine </li></ul>
    16. 16. Official Organizational Liaisons (cont’d) <ul><li>Association of State and Territorial Health Officials </li></ul><ul><li>National Association of County and City Health Officials </li></ul><ul><li>National Association of Local Boards of Health </li></ul><ul><li>Directors of Health Promotion and Education </li></ul><ul><li>Public Health Foundation </li></ul><ul><li>Society for Public Health Education </li></ul><ul><li>Center for the Advancement of Health </li></ul>
    17. 17. Participants in the Community Guide <ul><li>Stakeholders, partners </li></ul><ul><ul><li>For specific topics, reviews </li></ul></ul><ul><ul><li>Participate on review teams </li></ul></ul><ul><ul><li>Provide input to Task Force on topic prioritization, formation of recommendations </li></ul></ul><ul><ul><li>Participate in dissemination, translation </li></ul></ul>
    18. 18. Participants in Individual Reviews <ul><li>Coordination Team </li></ul><ul><ul><li>Coordinating scientist (Community Guide) </li></ul></ul><ul><ul><li>Fellows, abstractors (Community Guide) </li></ul></ul><ul><ul><li>Subject matter experts </li></ul></ul><ul><ul><ul><li>From CDC, other federal agencies, academia, practice, policy settings </li></ul></ul></ul><ul><ul><li>Task Force member(s ) </li></ul></ul><ul><ul><li>[Liaison(s)] </li></ul></ul><ul><li>Consultation Team </li></ul><ul><ul><li>Subject matter experts </li></ul></ul><ul><li>Community Guide Staff </li></ul>
    19. 19. Prioritization of Community Guide Work
    20. 20. Priority List - 1998 <ul><li>Task Force Considered a Range of Factors </li></ul><ul><ul><li>Burden </li></ul></ul><ul><ul><li>Preventability </li></ul></ul><ul><ul><li>Related initiatives </li></ul></ul><ul><ul><li>Usefulness of the ‘package’ </li></ul></ul>
    21. 21. Priority List - 1998 <ul><li>Decision: </li></ul><ul><ul><li>Organize the Community Guide by topics rather than by individual interventions </li></ul></ul><ul><ul><li>Output: systematic reviews on sets of related interventions </li></ul></ul><ul><li>Rationale: </li></ul><ul><ul><li>Economies of scale from developing extensive expertise, partnerships, support within a topic </li></ul></ul><ul><ul><li>Practitioners, policymakers often interested in choosing from a menu of effective interventions within a topical area, to best meet their context and situation </li></ul></ul><ul><li>But, also permitted specific interventions, funded reviews </li></ul><ul><ul><li>Proposed, requested by partners </li></ul></ul><ul><ul><li>To meet immediate needs </li></ul></ul>
    22. 22. Note on Task Force Deliberations <ul><li>Task Force meetings are public; attended by: </li></ul><ul><ul><li>Official Liaisons </li></ul></ul><ul><ul><li>Community Guide staff </li></ul></ul><ul><ul><li>Other CDC staff </li></ul></ul><ul><ul><li>Other stakeholders, interested parties </li></ul></ul>
    23. 23. The Guide Process: From Topic to Intervention Review(s) Topic is Selected Task Force
    24. 24. The Guide Process: The Team Topic is Selected Staff Recruits Teams Task Force Coordination Team Consultation Team
    25. 25. The Guide Process: Team Decisions Topic is Selected Staff Recruits Teams Task Force Coordination Team Consultation Team Team Decides Breadth vs Depth Team Develops Conceptual Approach Team Develops Priority List of Interventions
    26. 26. The Guide Process: Task Force Input Topic is Selected Staff Recruits Teams Task Force Coordination Team Consultation Team Team Decides Breadth vs Depth Team Develops Conceptual Approach Team Develops Priority List of Interventions Team Presents To Task Force
    27. 27. Prioritization 2006ff: Our Ultimate Goal is a Work List… <ul><li>Reflect Task Force priorities for future work </li></ul><ul><ul><li>With input from Liaisons, other partners, stakeholders </li></ul></ul><ul><li>Identify issues to work on next: </li></ul><ul><ul><li>As staff and resources become available </li></ul></ul><ul><ul><li>As stakeholders express interest in participating, supporting the review </li></ul></ul><ul><li>Identify issues that might be developed with additional funding or resources </li></ul>
    28. 28. We Remain Open to Funded Review Opportunities Priority Work List Funded Review
    29. 29. We Have to Update Existing Reviews Priority Work List Funded Review <ul><li>Updates Priority List </li></ul><ul><li>VPD </li></ul><ul><li>PA </li></ul><ul><li>Tobacco </li></ul><ul><li>Diabetes </li></ul><ul><li>… . </li></ul>
    30. 30. The Task Force Retains a Place for Special Projects Priority Work List Funded Review <ul><li>Updates Priority List </li></ul><ul><li>VPD </li></ul><ul><li>PA </li></ul><ul><li>Tobacco </li></ul><ul><li>Diabetes </li></ul><ul><li>… . </li></ul><ul><li>Specials Priority List </li></ul><ul><li>Cross-cutter </li></ul><ul><li>Big Intervention </li></ul><ul><li>Dissemination </li></ul><ul><li>… .. </li></ul><ul><li>… .. </li></ul>
    31. 31. We Also Need a Priority List of New and Continued Public Health Topics <ul><li>Priority Work List </li></ul><ul><li>e.g., </li></ul><ul><li>New Topic: </li></ul><ul><li>Expanded Topic </li></ul><ul><li>Update: VPD </li></ul><ul><li>Funded Review </li></ul><ul><li>Specials: Taxes </li></ul><ul><li>… . </li></ul><ul><li>… . </li></ul>Funded Review <ul><li>Topics Priority List </li></ul><ul><li>New </li></ul><ul><li>Expanded </li></ul><ul><li>Updates Priority List </li></ul><ul><li>VPD </li></ul><ul><li>PA </li></ul><ul><li>Tobacco </li></ul><ul><li>Diabetes </li></ul><ul><li>… . </li></ul><ul><li>Specials Priority List </li></ul><ul><li>e.g., </li></ul><ul><li>Cross-cutter </li></ul><ul><li>Big Intervention </li></ul><ul><li>Dissemination </li></ul><ul><li>… .. </li></ul><ul><li>… .. </li></ul>
    32. 32. Step 1: Stakeholder Survey <ul><li>Request for additional topics, interventions and supporting documentation </li></ul><ul><li>Letter sent to 200 stakeholders in May 2006 </li></ul><ul><ul><li>Directors, key scientific staff of CDC programs (62) </li></ul></ul><ul><ul><li>Official Liaisons </li></ul></ul><ul><ul><li>Present, past Task Force members </li></ul></ul><ul><ul><li>Other partners and stakeholders: </li></ul></ul><ul><li>Pharmaceutical firms </li></ul><ul><li>Foundations </li></ul><ul><li>Cochrane collaboration </li></ul><ul><li>Worksite health organizations </li></ul><ul><li>Organizations representing health disparities groups </li></ul><ul><li>Nongovernmental, professional health, business organizations </li></ul><ul><li>Managed care organizations </li></ul><ul><li>Some international health-related agencies </li></ul><ul><li>Schools of public health, medicine </li></ul><ul><li>Federal, state, local, health-related agencies </li></ul>
    33. 33. Responses from Stakeholders <ul><li>Varied in breadth, type of topic, intervention proposed </li></ul><ul><ul><li>Land use planning </li></ul></ul><ul><ul><li>Disaster response </li></ul></ul><ul><ul><li>Interventions to increase the dietary intake of magnesium </li></ul></ul><ul><ul><li>Interventions to improve the health of older adults </li></ul></ul><ul><ul><li>E-Health Communications interventions </li></ul></ul><ul><li>Varied in level of detail provided </li></ul>
    34. 34. Step 2: Compile List of Candidate Topics <ul><li>Combined topics from original prioritization in 1998 with new recommendations </li></ul><ul><li>Grouped like interventions into topics, highlighting recommended interventions </li></ul><ul><li>List of >100 candidate topics </li></ul>
    35. 35. Challenges Moving Forward <ul><li>What should be the organizing structure? </li></ul><ul><ul><li>Disease, condition, risk factor? </li></ul></ul><ul><ul><li>Gender, life stage? </li></ul></ul><ul><ul><ul><li>Women, older adults </li></ul></ul></ul><ul><ul><li>Health protection, health systems issues? </li></ul></ul><ul><ul><li>Poverty, health disparities? </li></ul></ul><ul><li>Considerations: </li></ul><ul><ul><li>Move to life stage, health protection, social issues </li></ul></ul><ul><ul><ul><li>CDC goals, Healthy People 2020 plans, WHO UN Millenium Development Goals </li></ul></ul></ul><ul><ul><li>Current stakeholder needs, public health funding </li></ul></ul>
    36. 36. Challenges Moving Forward <ul><li>Organizing Structure - Solution </li></ul><ul><ul><li>Four key groupings of topics: </li></ul></ul><ul><ul><ul><li>Changing risk behaviors </li></ul></ul></ul><ul><ul><ul><li>Reducing specific diseases, injuries, and impairments </li></ul></ul></ul><ul><ul><ul><li>Addressing social, environmental, and ecosystem challenges </li></ul></ul></ul><ul><ul><ul><li>Life stages, health protection, and population health </li></ul></ul></ul><ul><ul><li>Cross-referenced wherever appropriate </li></ul></ul>
    37. 37. Challenges Moving Forward <ul><li>Broad vs. narrow focus of topics </li></ul><ul><ul><li>Nutrition vs. breastfeeding </li></ul></ul><ul><ul><li>Infectious diseases vs. tuberculosis </li></ul></ul><ul><li>Solution: </li></ul><ul><ul><li>Kept overall topics and focused topics separate </li></ul></ul><ul><ul><li>Focused topics co-located with overall topics in tables, other documentation produced </li></ul></ul><ul><ul><li>Ability to select overall topics, focused topics, or both was retained through all voting, qualitative discussion, grouping, and ranking </li></ul></ul>
    38. 38. Product of Step 2 <ul><li>Master topic list >100 </li></ul>Notes Source Focused Topic Overall Topic Topic Number Grouping: Addressing social, environmental, and ecosystem challenges New; DNPAO,NCIPC Stakeholders Land use planning and policy 71 New; DNPAO,NCIPC Stakeholders, Guide staff Built environment 70 . . .
    39. 39. Step 3: Compile Information to Enable Ranking of Topics <ul><li>Challenge: </li></ul><ul><ul><li>Providing information for comparison across diseases, risk factors, systems, life stage issues </li></ul></ul><ul><li>Format: </li></ul><ul><ul><li>For each topic (overall and focused) </li></ul></ul><ul><ul><ul><li>Compiled key information in consultation with subject matter experts internal and external to CDC </li></ul></ul></ul><ul><ul><ul><li>Sent questionnaire to Program Directors at CDC on topics related to their areas of focus </li></ul></ul></ul><ul><ul><li>For expanded topics, also included: </li></ul></ul><ul><ul><ul><li>List of completed intervention reviews </li></ul></ul></ul><ul><ul><ul><li>List of expanded review options identified by the Coordinating Team </li></ul></ul></ul>
    40. 40. a) Information Compiled for Each Topic <ul><li>Burden, prevalence </li></ul><ul><ul><li>Mortality </li></ul></ul><ul><ul><li>Morbidity </li></ul></ul><ul><ul><li>Subpopulations with higher burden </li></ul></ul><ul><ul><li>Costs </li></ul></ul><ul><ul><li>Other measures </li></ul></ul><ul><li>Potential partners for reviews </li></ul><ul><li>Related Healthy People 2010 objectives </li></ul><ul><li>Related reviews by USPSTF </li></ul><ul><li>IOM reports </li></ul><ul><li>Other reports, reviews, recommendations </li></ul><ul><li>Other notes (e.g., potential overlap) </li></ul>
    41. 41. b) CDC Program Directors Questionnaire <ul><li>For assigned topics, others they wish to add: </li></ul><ul><ul><li>Level of interest in this topic by: </li></ul></ul><ul><ul><ul><li>CDC </li></ul></ul></ul><ul><ul><ul><li>Public health field </li></ul></ul></ul><ul><ul><li>Level of priority of the topic by: </li></ul></ul><ul><ul><ul><li>CDC </li></ul></ul></ul><ul><ul><ul><li>Other federal entities </li></ul></ul></ul><ul><ul><li>How much influence/leverage could CG recommendations have on: </li></ul></ul><ul><ul><ul><li>CDC? </li></ul></ul></ul><ul><ul><ul><li>Public health field? </li></ul></ul></ul>
    42. 42. b) CDC Program Directors’ Questionnaire <ul><li>For assigned, added topics (cont’d): </li></ul><ul><ul><li>Their opinion re potential to reduce the public health burden (preventability) for the topic </li></ul></ul><ul><li>Additional question: </li></ul><ul><ul><li>Knowing the Community Guide can’t conduct reviews on every topic, what are the 3-5 most important topics they should address? </li></ul></ul>
    43. 43. b) CDC Program Directors’ Questionnaire <ul><li>Response rate: </li></ul><ul><ul><li>(100%) </li></ul></ul><ul><ul><li>Several cross-cutting programs declined to rate due to ongoing prioritization exercises </li></ul></ul><ul><li>Summary of responses: </li></ul><ul><ul><li>For each topic: </li></ul></ul><ul><ul><ul><li>Number of CDC programs that rated </li></ul></ul></ul><ul><ul><ul><li>Names of CDC programs that rated </li></ul></ul></ul><ul><ul><ul><li>For each question (e.g., level of interest within CDC) </li></ul></ul></ul><ul><ul><ul><ul><li>Mean, standard deviation </li></ul></ul></ul></ul><ul><li>For new topics identified by Questionnaire: </li></ul><ul><ul><li>Compiled information on burden, partners, etc. </li></ul></ul>
    44. 44. Initial Re-Prioritization of Topics: Task Force Meeting, Fall 2006 <ul><li>Goal for meeting: a rank-ordered list of topics </li></ul><ul><ul><li>Ranking completed by Task Force (TF) </li></ul></ul><ul><ul><li>With input from and discussion with all other attendees </li></ul></ul>
    45. 45. Initial Plan Total List of Considered Topics (n=111) Additional Information High Priority Tier of Topics (n=~25) Medium Priority Tier of Topics (n=~50) Low Priority Tier of Topics (rest) Initial Vote Consensus Discussion Rank Vote Within High Priority Tier Final Consensus
    46. 46. Mid-Course Modifications Initial Vote 111 Topics 1 …… 2 …… 3 …… 4 …… 5 …… . . . . 111 Preliminary Rank Order for all 111 topics Agree on criteria for voting
    47. 47. Key Criteria Agreed Upon for Voting <ul><li>Overall attributable burden </li></ul><ul><li>Preventability, attributable fraction </li></ul><ul><li>Leverage: </li></ul><ul><ul><li>Is evidence-based guidance currently available? </li></ul></ul><ul><ul><li>Avoid duplication </li></ul></ul><ul><li>Ability to cover a reasonable portion of the topic </li></ul><ul><li>Overlap, synergy with the Clinical Guide </li></ul><ul><li>NOT </li></ul><ul><li>Funding or fundability </li></ul>
    48. 48. Voting Process; Resulting Rankings <ul><li>Topics displayed on the screen one by one </li></ul><ul><li>Voted using Perception Analyzer keypad: </li></ul><ul><ul><li>1=High priority </li></ul></ul><ul><ul><li>2=Medium priority </li></ul></ul><ul><ul><li>3=Low priority </li></ul></ul><ul><li>Screen advanced once all TF members voted </li></ul><ul><li>Discussion during voting only for clarification </li></ul><ul><li>Produced ranking of 111 topics: </li></ul><ul><ul><li>By mean of Task Force members’ votes </li></ul></ul><ul><ul><li>Also provided frequency of high, medium, low priority votes </li></ul></ul>
    49. 49. Initial Rank Order Led to (Lots and Lots of!!!) Consensus Discussion Initial Vote 1 …… 2 …… . …… . …… 25 or so 1 …… 2 …… 3 …… 4 …… 5 …… . . . . 111 26 ish 27 …… 28 …… . …… 50 or so 51 …… 62 …… . …… . …… 111
    50. 50. We Alerted Task Force During Consensus Discussion of… <ul><li>Situations where broad topics (and all focused topics within it) dropped down in the voting process because of split votes across the focused topics. </li></ul><ul><li>Topics with overlap dropping down due to split voting </li></ul><ul><ul><li>E.g., “Reducing medication errors is important to consider for a review” </li></ul></ul><ul><ul><ul><li>Task Force member A votes for Topic #59 Drug and Biologics Safety </li></ul></ul></ul><ul><ul><ul><li>Task Force member B votes for Topic #80 Medical Care Safety </li></ul></ul></ul>
    51. 51. Consensus Discussion 1 …… 2 …… . …… . …… 25 or so 26 ish 27 …… 28 …… . …… 50 or so 51 …… 62 …… . …… . …… 111 Move lower ranked Topics Up Move higher ranked Topics Down Consider to exclude from further discussion? Consider if wish to group focused topics, exclude too broad topics
    52. 52. End of Task Force Meeting High Priority Tier of Topics 25 or so ‘ Loosely ranked’ Medium Priority Tier of Topics Low Priority Tier of Topics
    53. 53. Subsequent Steps <ul><li>Formation of Task Force Subcommittee on Prioritization to: </li></ul><ul><ul><li>Continue reviewing prioritization issues and processes </li></ul></ul><ul><ul><li>Prioritize and assess processes for updating existing reviews </li></ul></ul>
    54. 54. Prioritization of Interventions for Systematic Review within Topics Topic is Selected Staff Recruits Teams Task Force Coordination Team Consultation Team Team Decides Breadth vs Depth Team Develops Conceptual Approach Team Develops Priority List of Interventions Team Presents To Task Force
    55. 55. Prioritization of Interventions for Systematic Review within a Topic <ul><li>Coordination Team: subject matter expertise </li></ul><ul><li>They consider: </li></ul><ul><ul><li>Degree of interest in the interventions by the field </li></ul></ul><ul><ul><li>Interventions where effectiveness entirely uncertain </li></ul></ul><ul><ul><li>Potentially effective interventions that are underutilized </li></ul></ul><ul><ul><li>Potentially ineffective interventions that are overutilized </li></ul></ul><ul><li>Team ranks interventions using a formal Delphi process </li></ul><ul><ul><li>All team members receive equal vote </li></ul></ul>
    56. 56. For More Information <ul><li>Shawna L. Mercer, MSc, PhD </li></ul><ul><ul><li>Community Guide Director </li></ul></ul><ul><ul><li>[email_address] </li></ul></ul>The findings and conclusions in this presentation are those of the presenter and do not necessarily represent the views of CDC.

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