Priorities among recommended clinical preventive services.

BACKGROUND: Many recommended clinical preventive services are delivered at low rates. Decision-makers who wish to improve delivery rates, but face competing demands for finite resources, need information on the relative value of these services. This article describes the results of a systematic assessment of the value of clinical preventive services recommended for average-risk patients by the U.S. Preventive Services Task Force. METHODS: The assessment of services' value for the U.S. population was based on two dimensions: burden of disease prevented by each service and cost effectiveness. Methods were developed for measuring these criteria consistently across different types of services. A companion article describes the methods in greater detail. Each service received 1 to 5 points on each of the two dimensions, for total scores ranging from 2 to 10. Priority opportunities for improving delivery rates were determined by comparing the ranking of services with what is known of current delivery rates nationally. RESULTS: The highest ranked services (scores of 7+) with the lowest delivery rates (< or =50% nationally) are providing tobacco cessation counseling to adults, screening older adults for undetected vision impairments, offering adolescents an anti-tobacco message or advice to quit, counseling adolescents on alcohol and drug abstinence, screening adults for colorectal cancer, screening young women for chlamydial infection, screening adults for problem drinking, and vaccinating older adults against pneumococcal disease. CONCLUSIONS: Decision-makers can use the results to set their own priorities for increasing delivery of clinical preventive services. The methods provide a basis for future priority-setting efforts.

Methods for priority setting among clinical preventive services.

Methods used to compare the value of clinical preventive services based on two criteria-clinically preventable burden (CPB) and cost effectiveness (CE)-are described. A companion article provides rankings of clinical preventive services and discusses its uses for decision-makers; this article focuses on the methods, challenges faced, and solutions. The authors considered all types of data essential to measuring CPB and CE for services recommended by the U.S. Preventive Services Task Force and developed methods essential to ensuring valid comparisons of different services' relative value.

Role of state health agencies in responding to AIDS.

State health agencies have assumed a leadership role in responding to the major public health issues raised by the AIDS epidemic. Directors of State health agencies (State health officers) have asserted their influence at the national level as well as at the State level. The Association of State and Territorial Health Officials (ASTHO), and especially ASTHO'S AIDS Committee, has served as the primary vehicle through which State health officers communicate their views to the Federal Government and vice versa. To date, ASTHO has held four national conferences on AIDS. Each one has brought together Federal, State, and local officials, advocacy groups, and other public health experts, and each has resulted in practical recommendations to public health departments on how to implement their AIDS programs most effectively. Although State health agencies have responded differently to the epidemic, many have adopted innovative, and sometimes unpopular, approaches. State health agencies' responses to the AIDS epidemic are governed partly by environmental factors, including the views of political leaders in the State, the strength of concerned advocacy groups, and the number of AIDS cases in the State. Despite their different approaches, State health officers have agreed that education is the most important tool in their programs to prevent human immunodeficiency virus (HIV) infections. The rapidly changing AIDS epidemic has required State health agencies to be flexible in their approaches to controlling the epidemic. State health officers' evolving views about HIV testing and partner notification are two examples of how new information about the epidemic has affected States' HIV control programs.