Introduction
The number of preventive care guidelines is rapidly increasing. It is unknown whether
the number of guideline-recommended preventive services is associated with utilization.
Methods
The authors used Poisson regression of 390,778 person-years of electronic medical
records data from 2008 to 2015, in 80,773 individuals aged 50–75 years. Analyses considered
eligibility for 11 preventive services most closely associated with guidelines: tobacco
cessation; control of obesity, hypertension, lipids, or blood glucose; influenza vaccination;
and screening for breast, cervical, or colorectal cancers, abdominal aortic aneurysm,
or osteoporosis. The outcome was the rate of preventive care utilization over the
following year. Results were adjusted for demographics and stratified by the number
of disease risk factors (smoking, obesity, hypertension, hyperlipidemia, diabetes).
Data were collected in 2016 and analyzed in 2017.
Results
Preventive care utilization was lower when the number of guideline-recommended preventive
services was higher. The adjusted rate of preventive care utilization decreased from
38.67 per 100 (95% CI=38.16, 39.18) in patients eligible for one guideline-recommended
service to 31.59 per 100 (95% CI=31.29, 31.89) in patients eligible for two services
and 25.43 per 100 (95% CI=24.68, 26.18) in patients eligible for six or more services
(p-trend<0.001). Results were robust to disease risk factors and observed for all but
two services (tobacco cessation, obesity reduction). However, for any given number
of guideline-recommended services, patients with more disease risk factors had higher
utilization rates.
Conclusions
The rate of preventive care utilization was lower when the number of guideline-recommended
services was higher. Prioritizing recommendations might improve utilization of high-value
services.
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References
- Measuring the Risks and Causes of Premature Death: Summary of Workshops.National Academies Press, Washington, DC2015
- Actual causes of death in the United States, 2000.JAMA. 2004; 291: 1238-1245https://doi.org/10.1001/jama.291.10.1238
- Actual causes of death in the United States.JAMA. 1993; 270: 2207-2212https://doi.org/10.1001/jama.1993.03510180077038
- Deaths preventable in the U.S. by improvements in use of clinical preventive services.Am J Prev Med. 2010; 38: 600-609https://doi.org/10.1016/j.amepre.2010.02.016
- Updated priorities among effective clinical preventive services.Ann Fam Med. 2017; 15: 14-22https://doi.org/10.1370/afm.2017
- Prevention priorities: guidance for value-driven health improvement.Ann Fam Med. 2017; 15: 6-8https://doi.org/10.1370/afm.2023
- The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General, 2014.DHHS, U.S.2014 (Accessed March 21, 2017)
- Heart disease and stroke statistics–2014 update: a report from the American Heart Association.Circulation. 2014; 129: E28-E292https://doi.org/10.1161/01.cir.0000441139.02102.80
- Economic costs of diabetes in the U.S. in 2012.Diabetes Care. 2013; 36: 1033-1046https://doi.org/10.2337/dc12-2625
- Economic costs of excessive alcohol consumption in the U.S., 2006.Am J Prev Med. 2011; 41: 516-524https://doi.org/10.1016/j.amepre.2011.06.045
- Annual medical spending attributable to obesity: payer- and service-specific estimates.Health Aff (Millwood). 2009; 28: W822-W831https://doi.org/10.1377/hlthaff.28.5.w822
National Guideline Clearinghouse. www.guideline.gov/search?f_Clinical_Specialty=Internal+Medicine%3bFamily+Practice&fLockTerm=Internal+Medicine&f_Guideline_Category=Prevention&page=1&f_Meets_Revised_Inclusion_Criteria=yes. Accessed February 27, 2017.
- Promoting Preventive Services for Adults 50-64: Community and Clinical Partnerships.National Association of Chronic Disease Directors, Atlanta, GA2009 (Accessed February 15, 2018)
Centers for Disease Control and Prevention (CDC). CDC focuses on need for older adults to receive clinical preventive services. www.cdc.gov/aging/pdf/cps-clinical-preventive-services.pdf. Published 2012. Accessed October 24, 2017.
- Medicare Program; Merit-Based Incentive Payment System (MIPS) and Alternative Payment Model (APM) Incentive Under the Physician Fee Schedule, and Criteria for Physician-Focused Payment Models. Final rule with comment period.Fed Regist. 2016; 81: 77008-77831
- Clinical decision support systems recommended to prevent cardiovascular disease.Am J Prev Med. 2015; 49: 796-799https://doi.org/10.1016/j.amepre.2015.03.041
- Improving injury prevention through health information technology.Am J Prev Med. 2015; 48: 219-228https://doi.org/10.1016/j.amepre.2014.08.018
- Effect of clinical decision-support systems: a systematic review.Ann Intern Med. 2012; 157: 29-43https://doi.org/10.7326/0003-4819-157-1-201207030-00450
- Personalized estimates of benefit from preventive care guidelines: a proof of concept.Ann Intern Med. 2013; 159: 161-168https://doi.org/10.7326/0003-4819-159-3-201308060-00005
- Prioritizing guideline-recommended interventions.Ann Intern Med. 2013; 159: 223-224https://doi.org/10.7326/0003-4819-159-3-201308060-00014
- Strategies to prioritize clinical options in primary care.Ann Fam Med. 2017; 15: 10-13https://doi.org/10.1370/afm.2027
- Consolidated financial statements and supplementary information.The Cleveland Clinic Foundation, 2016
- Behavioral and pharmacotherapy interventions for tobacco smoking cessation in adults, including pregnant women: U.S. Preventive Services Task Force recommendation statement.Ann Intern Med. 2015; 163: 622-634https://doi.org/10.7326/M15-2023
- Screening for and management of obesity in adults: U.S. Preventive Services Task Force recommendation statement.Ann Intern Med. 2012; 157: 373-378https://doi.org/10.7326/0003-4819-157-5-201209040-00475
- Executive summary: Guidelines (2013) for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Obesity Society published by the Obesity Society and American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Based on a systematic review from the Obesity Expert Panel, 2013.Obesity (Silver Spring). 2014; 22: S5-39https://doi.org/10.1002/oby.20821
- Screening for high blood pressure in adults: U.S. Preventive Services Task Force recommendation statement.Ann Intern Med. 2015; 163: 778-786https://doi.org/10.7326/M15-2223
- Statin use for the primary prevention of cardiovascular disease in adults: U.S. Preventive Services Task Force recommendation statement.JAMA. 2016; 316: 1997-2007https://doi.org/10.1001/jama.2016.15450
- Executive summary of the third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III).JAMA. 2001; 285: 2486-2497https://doi.org/10.1001/jama.285.19.2486
Selph S, Dana T, Bougatsos C, Blazina I, Patel H, Chou R. Screening for Abnormal Glucose and Type 2 Diabetes Mellitus: A Systematic Review to Update the 2008 U.S. Preventive Services Task Force Recommendation. Rockville, MD: Agency for Healthcare Research and Quality; 2015.
- Screening for breast cancer: U.S. Preventive Services Task Force recommendation statement.Ann Intern Med. 2016; 164: 279-296https://doi.org/10.7326/M15-2886
- Screening for cervical cancer: U.S. Preventive Services Task Force recommendation statement.Ann Intern Med. 2012; 156: 880-891https://doi.org/10.7326/0003-4819-156-12-201206190-00424
Koretz RL. Evidence-based guideline: the USPSTF recommends screening for colorectal cancer in adults 50 to 75 years of age. Ann Intern Med. 201620;165(6):JC26. https://doi.org/10.7326/ACPJC-2016-165-6-026.
- Screening for abdominal aortic aneurysm: U.S. Preventive Services Task Force recommendation statement.Ann Intern Med. 2014; 161: 281-290https://doi.org/10.7326/M14-1204
- Screening for osteoporosis: U.S. Preventive Services Task Force recommendation statement.Ann Intern Med. 2011; 154: 356-364https://doi.org/10.7326/0003-4819-154-5-201103010-00307
2016 Cleveland Clinic Outcomes Book: Medicine Institute. Measuring outcomes promotes quality improvement. Cleveland Clinic. https://my.clevelandclinic.org/-/scassets/files/org/outcomes/outcomes-medicine.ashx. Accessed January 5, 2018.
- Screening for lung cancer: U.S. Preventive Services Task Force recommendation statement.Ann Intern Med. 2014; 160: 330-338https://doi.org/10.7326/M13-2771
- Has recommended preventive service use increased after elimination of cost-sharing as part of the Affordable Care Act in the United States?.Prev Med. 2015; 78: 85-91https://doi.org/10.1016/j.ypmed.2015.07.012
- Developing a composite weighted quality metric to reflect the total benefit conferred by a health plan.Am J Manag Care. 2015; 21: 221-227
- Preventive interventions: an immediate priority.Ann Fam Med. 2017; 15: 8-9https://doi.org/10.1370/afm.2026
- Paid sick leave and preventive health care service use among U.S. working adults.Prev Med. 2017; 99: 58-62https://doi.org/10.1016/j.ypmed.2017.01.020
- Tailoring tobacco counseling to the competing demands in the clinical encounter.J Fam Pract. 2001; 50: 859-863
- Competing demands of primary care: a model for the delivery of clinical preventive services.J Fam Pract. 1994; 38: 166-171
- Missed opportunities for prevention: smoking cessation counseling and the competing demands of practice.J Fam Pract. 1997; 45: 348-354
- Competing demands in the office visit: what influences mammography recommendations?.J Am Board Fam Pract. 2001; 14: 352-361
- Overwhelmed patients: a videographic analysis of how patients with type 2 diabetes and clinicians articulate and address treatment burden during clinical encounters.Diabetes Care. 2012; 35: 47-49https://doi.org/10.2337/dc11-1082
- Using clinical guidelines designed for older adults with diabetes mellitus and complex health status.JAMA. 2006; 295: 1935-1940https://doi.org/10.1001/jama.295.16.1935
- Towards a general theory of implementation.Implement Sci. 2013; 8: 18https://doi.org/10.1186/1748-5908-8-18
- Rethinking the patient: using Burden of Treatment Theory to understand the changing dynamics of illness.BMC Health Serv Res. 2014; 14: 281https://doi.org/10.1186/1472-6963-14-281
- Out of context: clinical practice guidelines and patients with multiple chronic conditions: a systematic review.Med Care. 2014; 52: S92-S100https://doi.org/10.1097/MLR.0b013e3182a51b3d
- Does diabetes care differ by type of chronic comorbidity?: An evaluation of the Piette and Kerr framework.Diabetes Care. 2012; 35: 1285-1292https://doi.org/10.2337/dc11-1569
- Addressing the needs of patients with multiple chronic illnesses: the case of diabetes and depression.Am J Manag Care. 2004; 10: 152-162
- The impact of concordant and discordant comorbidities on patient-assessed quality of diabetes care.Health Expect. 2015; 18: 1621-1632https://doi.org/10.1111/hex.12151
Article info
Publication history
Published online: May 14, 2018
Identification
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© 2018 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
