Panel Ranks High-Value, Cost-Effective Preventive Services

A recent report about the National Commission on Prevention Priorities' project, "Priorities for America's Health: Capitalizing on Life-Saving, Cost-Effective Preventive Services," found that for some services and some population groups, receiving evidence-based clinical preventive services is unlikely.

The report and associated materials appear on the Web site for Partnership for Prevention and include articles from the July issue of the American Journal of Preventive Medicine.

Noting that receipt of evidence-based clinical preventive services "remains discouragingly low for some services and among some population groups," the commission started by prioritizing preventive services that the U.S. Preventive Services Task Force and the CDC's Advisory Committee on Immunization Practices have identified as effective. On a scale from 1 to 5, the commission gave each service a grade for its health impact and a grade for cost-effectiveness. The combined grades ranged from 2 to 10, with the top three items scoring 10. (See chart for top 10 items.)

"The authors identify which of the highest-value clinical preventive services have the lowest utilization rates nationally, including tobacco-use screening and brief intervention, colorectal cancer screening, pneumococcal immunization, and Chlamydia screening," FP David Satcher, M.D., Ph.D., who chaired the commission and is a former U.S. surgeon general, says in his commentary on the Web site. "For these interventions in particular, health care leaders, employers, policy-makers and researchers should closely monitor utilization trends, identify the specific barriers that are impeding greater utilization, and direct resources to overcoming these impediments." Satcher directs the National Center for Primary Care at the Morehouse School of Medicine, Atlanta.

Steven Woolf, M.D., M.P.H., professor of family medicine, preventive medicine and community health at Virginia Commonwealth University, Fairfax, Va., and Kurt Stange, M.D., Ph.D., professor of family medicine, epidemiology and biostatistics, and oncology and sociology at Case Western Reserve University, Cleveland, served on the 24-member commission and wrote the commentary "A Sense of Priorities for the Healthcare Commons."

"Diseases develop, extant illnesses worsen, and people die prematurely when health care fails to deliver the most effective services," say Woolf and Stange. The commission's rankings "have greatest relevance in the primary care setting," they say. "The rankings provide a rational backdrop for the daily primary care task of matching multiple opportunities with patients' needs and values."

Among advisers to the commission were Herbert Young, M.D., M.A., director of the AAFP Scientific Activities Division. The CDC and the Agency for Healthcare Research and Quality sponsored the project.