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(Carolyn Clancy) So,just a little bit of background on AHRQ and what
our role is in helping to advance these objectives.
Our mission is to improve the quality, safety, efficiency, and effectiveness of
health care for all Americans and we do that by supporting research
that helps people make more informed decisions, for example, about cancer
screening. It improves the quality of those services.
We also work to translate that knowledge into guidelines, tools, and
so forth that
people can use to improve safety and quality.
Most of our work is done through grants and contracts. Next.
Now, many of you are familiar with the U.S. Preventive Services Task Force.
This is an independent group of national experts in prevention and evidence-based
medicine.
I believe it is close to thirty years old.
It was originally started by the Office of the Assistant Secretary for Health,
moved to AHRQ in 1995;
It's an independent group of national experts in prevention and evidence-based
medicine,
and they develop recommendations on clinical preventive services, such as
screening,
counseling services, and the use of preventive medicine.
By law,
AHRQ convenes the Task Force and providse scientific and administrative
support of its operations.
Next slide.
So, the Task Force itself
systematically
reviews evidence for clinical preventive services
implemented in a primary care setting.
By and large, the Task Force is addressing
whether this is recommended
for people walking in, not with a specific complaint or specific risk
factor, but just all comers.
These recommendations are intended to help primary care clinicians and
patients decide together
whether a preventive service is right for that individual's needs.
Iif you want to learn more, they have their own website, a very big mouthful
uspreventiveservicestaskforce...all one word....org.
I believe it's case insensitive, but they are easy to find.
Next.
Now, the Task Force's recommendations are important to many of the objectives
in Healthy People 2020
relevant to our review today.
They've made several recommendations for screening, counseling, and preventive
medications to reduce cancer rates or
to help identify cancer earlier.
Two of their recommendations are listed on this slide, screening for cervical
cancer and counseling young people to reduce their exposure to UV radiation.
Just a brief note about the cervical cancer recommendation...
significant, because the Task Force, which has an ongoing commitment to update
their recommendations at least every five years, sometimes more
frequently as new evidence emerges,
actually did this in very close collaboration
with both partners within HHS
and
partners in the broader healthcare community, the American Cancer Society,
the American College of ObGyn,
and so forth. This was the cervical cancer and at the bottom of the slide are just two
of the Healthy People objectives supported by these
recommendations. Next slide.
So, as Dr. Khoury mentioned, the Task Force's recommendation on genetic
counseling for women with an increased risk, or BRCA1 or BRCA2,
served as the foundation for the objective G-1,
and their recommendation is seen on this slide and,
notably, is currently being updated and it's being updated...
and this is a little salute to the Task Force and my colleagues who support their
work...
very consistent with the Task Force's new approach to
transparency at all phases of the process. So, from the very moment that
they decided to do an update,
they convened stakeholders and got their input really at time zero. They
got input on the key questions that would be
addressed by the systematic review that we support.
Then, the draft recommendation is out for public comment, and so forth.
I don't believe it's out yet, but it will be. That's
the new process.
And I have to say that groups were very, very helpful with this recommendation.
Next. So, as a result of the Affordable
Care Act, let me just say,
everyone is
extremely interested in the Preventive Services Task Force,
because the
A and B recommendations from the Task Force along with recommendations of three
other groups
ultimately guide Medicare, Medicaid, and private insurance companies to
increase access
to clinical preventive services and to ensure that they are affordable,
by which I mean, no co-payment for these recommended services.
So, you can see that whatever reading it gets,
gets a lot of attention. It particularly gets a lot of attention
because the American public has very strong and generally
extremely enthusiastic feelings about all preventive
services.
We know from Medicare, for example, for preventive
services to be
covered used to
literally require an act of Congress, sort of one at a time. Just
because you're covered doesn't mean that people take advantage of the service.
So, we have funded a variety of research activities to help implement the
recommendations in other settings. So, for example,
in our work...and we've been collaborating quite a bit with Dr.
Koh's office on this...
on improving care for people with multiple chronic conditions. Multiple
studies have found that, if you've got multiple chronic conditions,
often effective evidence-based screening
kind of gets left off the agenda, partly because there are other issues to address
and so forth.
So our Center for Advancing Equity in Clinical Preventive Services at
Northwestern University is developing and testing interventions to address
that very gap and working very closely with FQHCs
in the Chicago area.
Next slide.
Now, tools for implementation...if it's just a recommendation in a journal article or on
a shelf somewhere, it doesn't help very much.
We still support the development of a clinical guide. It turns out
clinicians like to have something to put in that proverbial white
coat pocket, so we do that.
We also have something I think is much snappier, which is an electronic
preventive services selector,
which you can do online or you can download a free app to your iPhone
or other smartphone, and so forth. For awhile, it was the leading free app for
the iPhone.
I definitely have to say something about myhealthfinder,
where there's some terrific information for consumers
about these recommendations,
and there are also consumer fact sheets, and so forth.
We work very closely and the Task Force, especially, works very closely with
communications professionals
to make sure that they're addressing the key issues of concern
to the public. Next slide.
Finally, I just want to highlight a unique tool,
originally developed by AHRQ, but now implemented by the CDC.
We developed a computer-based clinical decision support tool to
facilitate shared decisionmaking between clinicians and women at risk of
breast or ovarian cancer.
The tool was developed to support the Task Force's recommendation
on genetic counseling.
CDC's
Division for Cancer Prevention and Control picked up the concept and
implemented it as BodyTalk.
So, thank you to my colleagues from the CDC.
It has two interfaces:
one is a patient portion of the tool,
which was designed with the idea in mind that patients would actually think about
this ahead of time before
for their visit, allowing them to be fully informed about the conversation
that's going to happen;
the clinician interface allows that clinician to review the patient's history
and provides resources for referring these high-risk women to the
appropriate specialist.
And the tool is really,I think, a very nice illustration of the kind
of conversation that
really needs to happen between patients and clinicians to make sure
that patients get the most appropriate
clinical preventive services for themselves
and to make progress in increasing evidence-based screening in reducing
cancer death rates.