Transcript Document

Phase II
Voting on Topic Areas and
Finalizing Target-Setting Methods
Secretary’s Advisory Committee on Health Promotion
and Disease Prevention Objectives for 2020
Committee Chair: Jonathan Fielding, MD, MPH, MA, MBA
Director, Los Angeles County Department of Public Health &
Health Officer, Los Angeles County
April 20, 2009
Update on HHS Activities
Rear Admiral Penelope Slade-Sawyer, PT, MSW
Director, Office of Disease Prevention and Health Promotion,
U.S. Department of Health and Human Services
Update on HHS Activities
 Phase I Status
 Work of Federal Workgroup Coordinators,
Federal Interagency Workgroup
 HHS timeline for development of the
objectives and public engagement
Desired Outcomes for the Meeting
 Vote on Recommendations for Topic Areas
Selection
 Finalize Recommendations for Target-Setting
 Provide feedback to Subcommittees on next
steps.
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Key Dates for Deliverables
 Topic Area categories: March, 2009
(To be finalized during this meeting)
 Target-setting Methodology: April, 2009
(To be finalized during the May 15 meeting)
 Final inclusion criteria for evidence-based
resources: May, 2009
 Implementation strategies: June-July, 2009
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Ad Hoc Group on Topic Areas
Subcommittee Chair: Patrick Remington, MD, MPH
University of Wisconsin Population Health Institute
Dr. Jonathan Fielding
Discussion and Vote for Approval of
Recommendations
Review: Functions of Topic Areas
 Organizational functions:
• Identify and group objectives of related content
• Highlight like or closely related subjects
 Managerial functions:
• Are assigned to a federal “lead agency” that is responsible for
tracking, monitoring, and reporting on objectives within the topic
 Communication functions:
• Can be organized in a user-friendly way to help locate content
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Differences between HP 2020 Topic Areas
and HP 2010 Focus Areas
 Organizational functions:
• HP 2020 Topic areas are not mutually exclusive.
 Managerial functions:
• Multiple topic areas, with objectives of like content, may be
assigned to a single working group of federal staff.
 Communication functions:
• Objectives may fall under multiple topic areas.
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How Topic Areas Relate to the HP2020 Framework
 Topic area categories should not be developed in an ad
hoc manner, but should be consistent with the framework.
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Three broad framework categories: Interventions, determinants, outcomes.
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Users would enter through these categories to begin locating content
 Once users enter a category, topic areas would appear.
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Topic areas would be the same, regardless of which category the user chooses.
 Each topic area would have a logic model that shows how
objectives within that topic relate to each other.
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The user’s choice of entry category would determine the point in the logic model
that would come up when the user selects the topic.
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Example of a Search: “Cancer”
1. The user enters “interventions” and selects “cancer”
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A collection of objectives would be provided, e.g., (HP2010) objective 3-10:
“Increase the proportion of physicians and dentists who counsel their at-risk patients about
tobacco use cessation, physical activity, and cancer screening.”
2. The user enters “Outcomes” and selects “cancer”
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A collection of objectives would be provided, e.g., (HP2010) objective 3-3:
“Reduce the breast cancer death rate.”
3. The user enters “Determinants” and selects “cancer”
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A collection of objectives would be provided, e.g., (HP2010) objective 19-6:
“Increase the proportion of persons aged 2 years and older who consume at least three servings of
vegetables, with at least one-third being dark green or orange vegetables.”
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How can objectives be assigned to
positions within Topic Area models?

Federal staff members who are preparing objectives for their assigned Healthy
People 2020 topic area could “tag” each objective to show how it should be
positioned within the topic area logic model.
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Labels would indicate where each objective falls in the topic area logic model.
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The “tags” would reflect relevant elements for that area.
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Interventions: Programs, policies, information
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Determinants: Social factors, economic factors, environmental factors, innate individual traits
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Outcomes: Behavioral outcomes, specific risk factors, diseases, mental disorders, disability, injury,
and quality of life.
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Organizing Information within HP2020
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Example: Web of Risk Factors, Determinants, CHD
Determinants
Outcomes
Interventions
Evidence-based Policies, Programs
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Proposed List of Specific Topic Area Categories
1. Interventions (Programs; Policies; Information)
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
Emergency Preparedness
Food Safety and foodborne illness
Health Communication
Health IT
Health Promotion
High Quality Health Care
Immunizations
Medical Product Safety
Nutrition
Occupational Safety and Health
Oral Health
Physical Activity and Fitness
Public Health Infrastructure
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Proposed List of Specific Topic Area Categories
2. Determinants (Social, economic, &
environmental factors; innate individual traits.
1.
2.
3.
4.
Access to Health Care
Built Environment
Natural Environment
Lifestages
—
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—
—
—
5.
6.
Prenatal
Preschool
Primary School
Adolescent Health
Adult
Healthy Aging
Health Equity/Disparities
Social and Economic Environments
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Proposed List of Specific Topic Area Categories
3. Outcomes (Behavioral outcomes; risk factors; diseases, mental
disorders, disability, injury; QoL)
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
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24.
Arthritis, Osteoporosis and Chronic Back Conditions
Blood Diseases
Cancer
Chronic Kidney Disease
Communicable Diseases
Depression & Suicide
Diabetes
Digestive Diseases
Disability and Secondary Conditions
Global Health
Hearing
Heart Disease and Stroke
HIV
Mental Health and Mental Disorders
Overweight
Quality of Life
Reproductive Health
Respiratory Diseases
Sexually Transmitted Diseases
Substance Abuse
Tobacco Use
Unintentional Injury
Violence
Vision
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Criteria to Refine the List of Topic Areas
 The topic area is an “organizing principle”
• Groups of objectives can be organized within that category
 Federal leadership has been identified for the
topic area
• Has expertise to adequately monitor and address the issue over
the course of the decade
 The topic area allows sufficient focus and action
• Minimum number of objectives to ensure focus
• Manageable number of objectives to facilitate action
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Standards for the Content of Topic Areas
 A logic model to clarify how objectives are related
 Coherence of content; clarity of emphasis within/
differences among topic areas
 Each topic area should:
• Reflect a body of available literature that can be accessed to promote
health, prevent disease or injury
• Reflect our understanding of the pathophysiology and multiple
underlying determinants of health;
• Relate to a schema or conceptual model that links to the framework;
• Have accountable groups with complementary expertise to adequately
address the issue;
• Permit sufficient focus to ensure feasibility and accountability.
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Introductory Material for Each Topic Area
 Introductory material for each Topic Area must highlight
issues related to the concepts of:
• An ecological approach to health promotion
• Health equity;
• Life stages.
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Topic Area Recommendations
 Discussion
• Clarification of terms;
• Clarification of concepts;
— Many outcomes are also determinants. Should this be addressed to enhance usability?
— How does the Committee conceive of “Topic Area logic models”?
— How does the Committee conceive of conceptual models that show the relationships of
objectives across Topic areas?
— How detailed should these models be, assuming that there may be more than 500
objectives in Healthy People 2020?
• Changes to proposed approaches/ strategies.
 Committee vote to approve
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Target-Setting Recommendations
Finalizing Draft Recommendations
Subcommittee Chair: Patrick Remington, MD, MPH
University of Wisconsin Population Health Institute
Dr. Jonathan Fielding
Discussion and Next Steps for Finalizing
Recommendations
Definitions of Key Terms
 SMART Objectives:
• National, specific, measurable, and realistic statements of
intended outcomes over a stated period of time (by 2020)
 Target:
• The level of progress or performance expected for an objective.
 Target-setting:
• Methods used to set the value for a target.
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Methods used for Healthy People 2010
 Better than the best.
 Percent improvement.
 “Total coverage” or “Total elimination” (for targets like
100 percent, 0 percent, all States, etc.).
 Consistent with __________________(another national
program, for example, national education goals).
 Retain year 2000 target (the Healthy People 2000 target
has been retained).
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Why these Methods were Inadequate
 Not adequately specific
 Left too much room for inconsistency
 “Better than the best” approaches:
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Provided little guidance was provided for how much better the rate should be;
Are unrealistic, especially when applied to the most affected subpopulations;
Often designated a “best,” reference population based on problematic data;
Have not been notably effective in contributing to the elimination or even the
narrowing of health disparities.
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What processes and data should be used?
 Targets should:
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Be rooted in and build on past experience (i.e., HP 2000 and HP 2010)
Be set with a focus on objectives that have existing data to track progress to
2010, so that a trend can be projected to 2020
Be set using a variety of target-setting methods, with clear explanation of the
rationale for selecting a particular method
 Guidelines for target-setting should be provided, but exceptions
should be permitted when necessary.
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Guidelines (--not the targets themselves) should be put out for public comment
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A Single Target or Multiple Targets?
 Recommendation: set a single population target for each objective
that would represent an improvement for most of the population, but
might not be better than the “best” subpopulation.
 A single target would be easy to communicate about, but:
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If based on the status of a reference population, it could be virtually unachievable
for some subgroups.
If based on a population average, some groups may already have met the target.
 Consider setting a “disparities” target to reduce variation in the
population, in addition to the general target for the population.
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The disparities target would lessen as disparity between the subpopulation with
the highest health status and those with the lowest health status diminishes
A challenge in setting a disparities target would be identifying a means of clearly
communicating about it to the users of Healthy People 2020.
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Aspirational or Realistic Targets?
 Healthy People 2020 should set realistic targets based on:
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A projection of where the objective would be by the target date (e.g., 2020) “if
nothing changed” (i.e., a projection based on trend data.)
Knowledge of what is potentially achievable given the health issue
Current or emerging knowledge of interventions, programs, and policies that
might result in improvement.
 Targets should represent "a reach,” and should be more than a
continuation of the status quo.
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Targets should be based on the projected positive trend, plus implementation of
“aspirational interventions” (i.e., implement the things that we know will work.)
The setting of Healthy People 2020 objectives and targets should ultimately
result in the implementation of effective interventions, programs and policies.
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Should targets incorporate knowledge of
effective interventions?
 Targets should incorporate knowledge of past, current, and future, in
terms of the effects of interventions.
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In many areas, adequate interventions have not been identified.
The possibilities of what "could become available" should be highlighted.
 When describing methods used to make projections and setting
targets, an explanation should be provided of how information about
effective interventions was incorporated.
 The best available knowledge about effective interventions should
be linked to targets as one avenue for assisting users to work
towards improved health for the nation.
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Target-setting: Discussion and Next Steps
 Unresolved issues:
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Should there be a disparities target?
What guidance/ tools should be provided for states, regions, and localities?
Should there be a smaller number of objectives that have a data-driven, sciencebased, SMART targets (such as a “core indicator” set)?
 Guidance and processes for completing this work.
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Other Subcommittee Efforts
 Implementation
 Data & IT
 Priorities
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Summary and Next Steps
 Remaining work on target-setting
 Next steps for subcommittees
 Next Committee meeting dates
• Friday, May 15th: 1:00 PM- 3:00 PM (ET)
• Should a meeting be scheduled for July/ August?
 Other issues
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