Filling Prevention Research Gaps from the USPSTF I Statements JENNIFER VILLANI, PHD, MPH NIH OFFICE OF DISEASE PREVENTION

Transcription

1 Filling Prevention Research Gaps from the USPSTF I Statements JENNIFER VILLANI, PHD, MPH NIH OFFICE OF DISEASE PREVENTION

2 Agenda NIH Office of Disease Prevention (ODP) US Preventive Services Task Force (USPSTF) Our partnership related to I Statements 2

3 NIH ODP Strategic Plan Priority II: Identify prevention research areas for investment or expanded effort by the NIH Objective 1: Work with stakeholders to identify needs in prevention research NIH Institutes & Centers AHRQ/USPSTF CDC/CPSTF DHHS/Healthy People Cochrane Collaboration National Academy of Medicine 3

4 US Preventive Services Task Force Independent, volunteer panel of national experts in prevention and evidence-based medicine USPSTF makes evidence-based recommendations about clinical preventive services in primary care, such as screenings, counseling, and preventive medications USPSTF assigns a letter grade (A, B, C, D, or I) based on the strength of the evidence and balance of benefits/harms of a preventive service 4

5 USPSTF Grade Definitions NO COST SHARING 5

6 What is an I Statement? The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of the service. Evidence is lacking, of poor quality, or conflicting, and the balance of benefits and harms cannot be determined. 6

7 Examples of Current I Statements Screening for suicide risk in primary care Screening for vitamin D deficiency in asymptomatic adults Use of electronic nicotine delivery systems (ENDS) for tobacco cessation in adults Older adults Screening for cognitive impairment Screening for abuse and neglect Screening for hearing loss in asymptomatic adults Screening for breast cancer in women ages 75+ Adolescents Screening and behavioral counseling in primary care to reduce alcohol misuse Pregnant women: Screening for iron deficiency anemia Routine iron supplementation Pharmacotherapy for tobacco cessation Screening for gestational diabetes mellitus early in pregnancy Men: Screening for osteoporosis Screening for chlamydia and gonorrhea Young children Screening for autism spectrum disorder Screening for iron deficiency anemia Screening for speech and language delay and disorders Screening for dental caries by primary care clinician 7

8 Coordination Activities NIH coordinates with AHRQ/USPSTF to ensure that: USPSTF evidence reports and recommendations are informed by the most recent NIH-supported research Recommendations are clearly explained to the public NIH ICs are aware of I Statements ODP is the NIH liaison to the USPSTF: Work with NIH ICs to facilitate NIH scientific review and input Monitor progress on active topics and I Statements 8

9 Goal Generate sufficient evidence to move I Statements to a letter grade Recent examples: Screening for Type 2 Diabetes in Adults (I B) Behavioral Counseling for Sexually Transmitted Infections (I B) 9

10 Methodology Searched the 95 published recommendations of the USPSTF for I Statements Identified 47 I Statements covering a broad range of preventive services 10

11 Methodology Distilled the specific research needs for each I Statement Example: Oral Cancer Screening (released November 2013) Research Needs: RCTs of high risk patients Screening accuracy of PCPs, dentists, etc. Targeted studies of men, African Americans Screening based on HPV status 11

12 Methodology Disseminated these research needs to: 1) NIH ICs To ascertain IC involvement in activities that address these gaps To promote opportunities in prevention research for additional investment 2) Researchers To stimulate new research to address knowledge gaps 12

13 13

14 14

15 Initial Findings Research gaps included the need for: Randomized, controlled trials Studies of the benefits and harms Studies measuring the effect on health outcomes Studies assessing implementation in busy clinical practice settings Populations most impacted by I Statements include: Infants, children, and adolescents (34%) General adult population (34%) Women (21%) Older adults (15%) Most NIH ICs are funding research that addresses gaps from I Statements 15

16 Conclusion By generating evidence to fill I Statement research gaps, researchers can contribute to USPSTF efforts to make recommendations that are based on the most current, highest-quality evidence Widespread implementation of these recommendations in clinical practice can ultimately lead to improved population health 16

17 Team Members Carrie Klabunde, PhD Elizabeth Neilson, PhD, MPH, MSN Deborah Langer, MPH Amy C. Lossie, PhD Denise Stredrick, PhD David M. Murray, PhD Not pictured: Christine Jones, MS 17

18 Questions? Jennifer Villani, PhD, MPH 18