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.
Coffield
A B
AB
Partnership for Prevention, Washington, DC 20036, USA. accoffield@prevent.org
Maciosek
M V
MV
McGinnis
J M
JM
Harris
J R
JR
Caldwell
M B
MB
Teutsch
S M
SM
Atkins
D
D
Richland
J H
JH
Haddix
A
A
D000328:Adult; D000368:Aged; D000465:Algorithms; D002648:Child; D017046:Cost Savings; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D003659:Decision Making, Organizational; D003663:Decision Trees; D003695:Delivery of Health Care / Q000458:organization & administration*; D019983:Guideline Adherence / Q000592:standards*; D015276:Health Care Rationing / Q000458:organization & administration; D006292:Health Priorities; D006801:Humans; D008403:Mass Screening / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data; D020380:Needs Assessment; D017410:Practice Guidelines as Topic / Q000592:standards*; D011314:Preventive Health Services / Q000191:economics / Q000592:standards* / Q000706:statistics & numerical data; D011322:Primary Prevention / Q000191:economics / Q000592:standards*; D019057:Quality-Adjusted Life Years; D012307:Risk Factors; D014481:United States / Q000453:epidemiology