Am 8.40 diaz


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  • We were asked to recommend what should be considered in the development of comprehensive national guidelines
  • The committee could not consider costs as a factor The applicability was to be for clinical settings, community-based prevention was defined as beyond the study scope
  • Throughout the study process the committee repeatedly questioned whether the disease or condition was of significance to women and especially whether it was more common or more serious in women than in men or whether women experienced different outcomes or benefited from different interventions than men
  • Am 8.40 diaz

    1. 1. Preventive Womens Health Services & Health Care Reform: Closing the Gaps The Charge to the Institute of Medicine Angela Diaz, MD, MPHJean C. and James W. Crystal Professor of Pediatrics and Preventive Medicine Mount Sinai School of Medicine Women’s Health 2012 Congress March 18, 2012
    2. 2. The Charge to the Institute of Medicine (IOM)Convene a Committee of experts• To review women’s health preventive services and identify critical gaps, as identified in the ACA by the: US Preventive Services Task Force American Academy of Pediatrics Bright Futures Recommendations for Adolescents Center for Disease Control & Prevention’s Advisory Committee on Immunization Practices• To recommend what should be considered in the development of comprehensive national guidelines
    3. 3. IOM PSW CommitteeLinda Rosenstock, M.D., M.P.H., ChairUCLA School of Public Health  eidi Nelson, M.D., M.P.H., FACPAlfred O. Berg, M.D., M.P.H. regon Health and Science UniversityUniversity of WashingtonClaire D. Brindis, Dr.P.H.University of California, San Francisco oberta B. Ness, M.D., M.P.H.Angela Diaz, M.D., M.P.H. niversity of Texas School of Public HealthMount Sinai Medical Center, NYFrancisco Garcia, M.D., M.P.H. agda Peck, Sc.D.University of ArizonaKimberly Gregory, M.D., M.P.H. niversity of Nebraska Medical CenterCedars-Sinai Medical Center, Los AngelesPaula A. Johnson, M.D., M.P.H. . Albert Reece, M.D., Ph.D., M.B.A.Brigham and Womens Hospital, Boston niversity of Maryland (Baltimore)Anthony Lo Sasso, Ph.D.University of Illinois at Chicago lina Salganicoff, Ph.D.Jeanette H. Magnus, M.D., Ph.D.Tulane University
    4. 4. Statement of Task• What is the scope of preventive services for women not included in those graded A and B by the United States Preventive Services Task Force (USPSTF)?• What additional screenings and preventive services have been shown to be effective for women?• What services and screenings are needed to fill gaps in recommended preventive services for women?• What models could HHS and its agencies use to coordinate regular updates of the comprehensive guidelines for preventive services and screenings for women and adolescent girls?
    5. 5. Committee ProcessThe committee held three open meetings in Washington, DC,which featured presentations from experts in the followingareas:  Women’s health  Evidence-based medicine  Preconception care  Quality of care  Adolescent health  Health insurance  Reproductive health  Guidelines development  Mental health  Oral health  Occupational healthThe Committee reviewed written testimony submitted byinterest groups, professional associations, and individualsThe Committee met five times in closed session fordeliberation
    6. 6. ApproachThe Committee defined preventive health services asmeasures shown to improve well-being and / ordecrease the likelihood or delay the onset of a targeteddisease or conditionThe Committee developed four overarching questions: Are there high-quality systematic evidence reviews to show that the service is effective in women? Are quality peer-reviewed studies available that demonstrate effectiveness in women? Has the measure been identified as a federal priority? Are there existing federal, state, or international practices, professional guidelines, or federal
    7. 7. ApproachThe committee followed the following in its analysis:• The condition to be prevented affects a broad population• The condition to be prevented has a large potential impact on health and well-being• The quality and strength of evidence is supportive
    8. 8. The Report from the Committee on Preventive Services for Women
    9. 9. Committee RecommendationsRecommendation 1Screening for gestational diabetes in pregnant women between24 and 28 weeks of gestation and at the first prenatal visit forpregnant women identified to be at high risk for diabetesRecommendation 2The addition of high-risk human papillomavirus (HPV) DNAtesting to cytology testing in women with normal cytologyresults. Screening should begin at 30 years of age and shouldoccur no more frequently than every 3 years
    10. 10. Committee RecommendationsRecommendation 3Annual counseling on sexually transmitted infections forsexually active womenRecommendation 4Counseling and screening for HIV infection on an annual basisfor sexually active womenRecommendation 5The full range of FDA-approved contraceptive methods,sterilization procedures, and patient education and counselingfor women with reproductive capacity
    11. 11. Committee RecommendationsRecommendation 6Comprehensive lactation support and counseling and costs ofrenting breastfeeding equipment. A trained provider shouldprovide counseling services to all pregnant women and to thosein the postpartum period to ensure the successful initiation andduration of breastfeeding
    12. 12. Committee RecommendationsRecommendation 7Screening and counseling for interpersonal and domesticviolence. Screening and counseling involve elicitation ofinformation from women and adolescents about current andpast violence and abuse in a culturally sensitive and supportivemanner to address current health concerns about safety andother current or future health problems
    13. 13. Committee RecommendationsRecommendation 8At least one well-woman preventive care visit annually foradult women to obtain the recommended preventive services,including preconception and prenatal care