Transcript Document

Phase II
Guidance for Target-Setting and
Healthy People 2020 Topic Areas
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
March 26, 2009
Revised Agenda
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Update on HHS and FIW Activities
State of the USA (SUSA) Presentation
Guidance for Target-setting Recommendations
Discussion of HP2020 Topic Areas
Update on Other Subcommittee Efforts
Next Steps
Desired Outcomes for the Meeting
 Update on HHS and Federal Interagency
Workgroup progress and next steps.
 Identify potential links between the SUSA
initiative and the HP2020 process.
 Provide guidance to the Subcommittee on
Target-setting.
 Clarify approach and next steps to finalize the
HP 2020 Topic Areas.
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Key Dates for Deliverables
 Topic Area categories: March, 2009
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Broad guidance to be developed at this meeting
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Final recommendations to be refined in coming weeks and approved on April 20
 Target-setting Methodology: April, 2009
 Final inclusion criteria for evidence-based
resources: May, 2009
 Implementation strategies: June-July, 2009
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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
 Status of Phase I
 HHS timeline for development of the
objectives and public engagement
 Work of the HHS Workgroup Coordinators
 Activities of the Federal Interagency
Workgroup (FIW)
Healthy People 2020 Framework
FIW Recommendations to the Acting Secretary
Vision Statement
A society in which all people live long, healthy lives.
Mission Statement
Healthy People 2020 strives to:
 Identify nationwide health improvement priorities;
 Increase public awareness and understanding of the determinants of health, disease, and disability
and the opportunities for progress;
 Provide measurable objectives and goals that are applicable at the national, state, and local levels;
 Engage multiple sectors to take actions to strengthen policies and improve practices that are driven
by the best available evidence and knowledge;
 Identify critical research, evaluation, and data collection needs
Healthy People 2020 Framework
FIW Recommendations to the Acting Secretary
Overarching Goals
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Attain high quality, longer lives free of preventable disease, disability, injury, and premature death.
Achieve health equity, eliminate disparities, and improve the health of all groups.
Create social and physical environments that promote good health for all.
Promote quality of life, healthy development and healthy behaviors across all life stages.
Developing Healthy People 2020
Objectives
 Sources of input on development of objectives
Objective
Development
Process Input
Public
Comment
Consortium
Members
Secretary’s
Advisory
Committee
Federal
Interagency
Workgroup
2020 Planning
Workgroups
PRESENTATION: State of the USA
Christopher Hoenig
President and Chief Executive Officer
State of the USA
Discussion
 How does SUSA relate to the Healthy
People 2020 process?
Defining Objectives
and Targets
What is an Objective?
1. Proposed definition and poll results
 “Results of specific activities to be achieved
over a stated time.”
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5 of 9 poll participants thought this language should be used.
2 thought it should be revised, and 2 said it should be deleted.
 “Objectives are specific, measurable, and
realistic statements of intention.”
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3 of 9 poll participants agreed with this statement.
5 thought it should be revised, and 1 said it should be deleted.
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What is an Objective?
 Four of five poll comments indicated that an
objective should be:
• “Specific and measurable”
• “Time-bound (by 2020)”
• “Realistic”
 One comment indicated an objective should be”
• “Visionary. Visionary and reality objectives need to be balanced.”
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Proposed Revision: What is an Objective?
 “Objectives are specific, measurable, and
realistic statements of intended outcomes
over a stated period of time (by 2020).”
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Proposed Definition:
What is a Healthy People 2020 Target?
 A “target” is the level of progress or
performance expected for an objective.
 “Target-setting” involves the methods
used to select the value for a target.
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How does a target differ from an
objective?
 More specific?
 More practical?
 Focus on “sub-objectives,” (e.g., intermediate
measures based on a logic model)?
 May be for shorter periods of time (e.g., 3 to 5
years for achieving target vs. 10-year frame for
objective).
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Target-Setting Recommendations
Guidance to Help the Subcommittee on Target-setting
Prepare Draft Recommendations
Subcommittee on Target-setting
 Charge of the Subcommittee on Target-setting is to answer:
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What processes and data should be used in setting targets?
Should single or multiple targets be recommended for the same variable?
(e.g. can realistically be achieved, vs. optimistic)
How should targets incorporate knowledge of effective interventions?
How should time frames for targets be set?
(e.g. availability of data to monitor, time to mobilize interested organizations and
individuals around the issue etc.)
 What can be learned from the 2010 experience to help inform the
work of the Healthy People 2020 Working Groups?
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Target-setting: Types of Questions to
Address (Issues Previously Raised)
 What methods have been used in the past?
 What are the pros and cons associated with each method?
 If multiple methods are used, how should one determine which
method is appropriate?
 What would an ideal method of target-setting look like?
 What tools are available now that were not available for 2010?
 What compromises are acceptable…
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When there is essentially no evidence base?
When the available evidence is weak?
When the available evidence is strong but relevance is limited?
To account for the influence of secular trends?
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Other issues to consider in setting targets
 Should some objectives be tied to assumptions about other
objectives?
• Example: Where evidence suggests that effectiveness depends on a multilevel intervention.
 How can logic models be used?
 Should one target be set for the entire population? Or should
targets be set based on the current status of subpopulations?
• Example: the “better than best” approach uses a single target.
 When should modeling be used?
 Other issues?
Ad Hoc Group on Topic Areas
Subcommittee Chair: Patrick Remington, MD, MPH
University of Wisconsin Population Health Institute
Committee Chair, Jonathan Fielding, MD, MPH, MA, MBA
Review: Definitions Proposed by the
Subcommittee on Topic Areas in February
 Vision:
• A single, broad statement of what society will look like in 2020
 Goal:
• The broad result toward which effort is directed
 Focus Area/ Topic Area:
• Points of entry for each interested group into the Healthy People
framework
 Priorities:
• Priorities are given attention before competing alternatives.
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Question: How should objectives
relate to the HP2020 framework?
 For example:
• Should objectives related to a given topic link determinants, to
risk factors, to outcomes?
 The Subcommittee considered connecting objectives to
the framework by aligning Topic Areas with 5 broad
categories of the framework:
• Broad determinants; Individuals across the life course;
Outcomes; Assessment, monitoring, evaluation, dissemination;
Interventions.
 This approach was dropped because these five
categories are not mutually exclusive.
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Overview of Recent Subcommittee Activity
 Proposed another way to link objectives to framework:
developing topic areas independently of objectives.
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Rationale: The framework emphasizes overlapping issues, so it is not problematic
that objectives fall into multiple categories. Objectives for each topic area should
be developed independently, and then mapped to the framework.
 Grid was conceptualized to list all topic areas and show
which areas of the framework are relevant for each one.
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Proposed Approach to Link
Topic Areas to the HP2020 Framework
Proposed
Topic Areas
for HP2020
Programs
and
Policies
Social,
Economic,
and
Environmental
Determinants
Health
Behaviors
Disease,
Mental
Disorders,
Disability,
and Injury
Life Stages
and Health
Outcomes
Access to
health care
X
X
X
X
Quality of
health care
X
X
X
X
Reproductive
Health
X
X
X
X
X
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Decisions Needed to Prepare and
Finalize Topic Area Recommendations
1. What are the functions of HP2020 topic areas?
• Are the functions of HP 2020 Topic Areas the same as those of
Healthy People 2010 Focus Areas?
2. How should topic areas be conceptualized to best meet
the needs of users?
• What criteria should be used to decide what is and is not a “topic”?
3. What specific topic areas should be proposed?
• Poll of Committee members was conducted, 3/16/09 - 3/20/09.
• Process for refining and finalizing the list will be discussed.
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The Functions of Topic Areas
Based on the roles of HP 2010 Focus Areas, HP2020 Topic Areas can
be said to serve the following functions:
 “Topic Areas serve three main functions:
organizational, managerial, and
communication.”*
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7 of 9 participants agreed with this statement.
1 participant proposed edits to make definitions
more understandable to those who are new to HP.
*Note: There is currently a one-to-one correspondence between “Focus Areas” and
HHS “Working groups” that develop, track and monitor objectives in each area.
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Would an expanded number of
Topic Areas change their function?
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Committee members indicated preference for an expanded
number of topic areas:
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Participants voted to retain all 28 of the current HP2010 Focus Areas
(with some revisions).
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Participants voted to include all 8 new Topic Areas proposed by the
Subcommittee on Topic Areas (with some revisions).
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Participants recommended adding another 7 new Topic Areas.
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In addition, some participants recommended splitting existing HP 2010
categories into multiple sub-categories (an additional 9 Topic Areas).
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If all of these are retained, there would be approximately 52 Topic Areas in
HP 2020.
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Defining the Function of Topic Areas: Organizational
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Would an expanded number of topic areas change their function
as organizing principle?
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Draft element of Topic Areas definition (adapted from poll):
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Organizational:
Topic areas identify and group objectives of related content; a
single topic highlights like or closely related subjects.
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Objectives could be arrayed under one “primary” Topic Area, and multiple
“secondary” topic areas.
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Defining the Function of Topic Areas: Managerial
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Would an expanded number of topic areas change their
function in terms of designating responsibility for management?
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Draft element of Topic Areas definition (adapted from poll):
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Managerial:
Topic Areas are assigned by HHS to “lead agencies” within the
Federal government. Lead agencies coordinate the process of
developing Topic Area objectives, and are responsible for
tracking, monitoring, and periodically reporting on those
objectives over the course of a decade.
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Should “Working Groups” address more than one Topic Area?
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Should agencies “adopt” responsibility for specific objectives, instead of
topic areas?
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Defining the Function of Topic Areas: Communication
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Would an expanded number of topic areas change their function in
terms of communicating about Healthy People content?
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Draft element of Topic Areas definition (adapted from poll):
3. Communication:
Topic areas enable users to locate the content they are seeking by
organizing Healthy People information in a user-friendly way.
• HP 2020 Topic Areas should be more than a “point of entry”
• How can criteria ensure they reflect a coherent, available literature that
can be accessed to improve health and prevent disease/ injury?
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Criteria Used for HP2010 Focus Areas
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Criteria that were informally used to choose HP2010 Focus Areas:
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The focus area was an “organizing principle” (i.e., groups of related objectives
could be organized within that category)
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The number of objectives was not too large to manage, and it was not too small
to be of consequence (Injury & Violence Prevention had 39 objectives; Chronic
Kidney Disease had 8 objectives).
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A Federal agency was willing to be the “lead agency” for the Focus Area (i.e.,
to take responsibility for coordinating the development, tracking of, and reporting
on objectives for the Focus Area).
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What criteria should be used to select
Healthy People 2020 Topic Areas?
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A logic model to clarify pathways of intervention
Coherence of content; clarity of boundaries between Topic Areas:
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Reflects a body of available literature that can be accessed to promote health and
prevent disease and injury;
Reflects our understanding of the pathophysiology and multiple underlying
determinants of health;
Relates to a schema or logic model that links back to the HP2020 framework;
Can be “owned” by a group of individuals with complementary expertise to
adequately address the issue;
Allows sufficient focus (e.g., a manageable number of objectives).
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Healthy People 2010 Focus Areas
1. Access to quality health services
2. Education & community-based programs
3. Family planning
4. Food safety
5. Health communications
6. Immunization & inf. disease
7. Medical product safety
8. Public health infrastructure
9. Environmental health
10. Occupational safety & health
11. Nutrition & overweight
12. Physical activity & fitness
13. Substance abuse
14. Tobacco use
15. Arthritis
16. Cancer
17. Chronic kidney disease
18. Diabetes
19. Disability
20. Heart disease/stroke
21. HIV
22. Injury & violence prevention
23. Mental health/mental disorders
24. Oral health
25. Respiratory diseases
26. STDs
27. Vision & hearing
28. Maternal, infant, & child health
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Topic Areas Poll: Choosing Topic Areas
1. HP2010 Categories: majority voted to retain without revisions
Physical activity & fitness
Tobacco use
Arthritis, Osteoporosis, Chronic back conditions
Chronic Kidney Disease
Diabetes
Mental health/ mental Disorders
Oral Health
Respiratory diseases
Occupational safety & health
Heart disease/ stroke
Public health infrastructure
Disability
HIV
Nutrition & overweight
Substance abuse
Medical product safety.
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Examples of Topic Areas that Could be Split
 Nutrition & Overweight
• Nutrition
• Overweight
 Substance Abuse
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Alcohol
Tobacco
Illicit Drugs
Prescription Drugs
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Topic Areas Poll: Choosing Topic Areas
2. HP2010 Categories: majority voted to retain with revisions
See “Topic Areas Poll” Report for Proposed Revisions
Access to quality health services
Food safety
Immunization & Infectious disease
Environmental health
Education & community-based programs
Vision & hearing
Maternal, infant & child health
Injury & violence prevention
Health communication
Family planning
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Examples of Topic Areas that Could be Split
 Access to quality health services
• Access to health care
• Quality health care
 Immunization and Infectious Disease
• Immunization
• Infectious disease
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Topic Areas Poll: Choosing Topic Areas
3. Subcommittee’s Proposed New Topic Areas: Majority voted to Add
Emergency Preparedness
Health equity/ disparities
Quality of Life
Healthy Aging
Adolescent Health
Global Health
Blood Diseases
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Topic Areas Poll: Choosing Topic Areas
4. Additional New Topic Areas Proposed by Poll Participants
Costs
Healthy People Community
Overall measure for the U.S.
Social and Economic Determinants
Health Promotion
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Conceptual Groupings for Topic Areas
 What should guide decisions about when to split and
when to clump Topic Areas?
 Review objectives within existing HP 2010 Focus Areas
to understand how content is currently arrayed.
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Process for Finalizing Topic Areas
Next Steps:
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Refine and finalize a list of topic areas offline by:
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Apply today’s decisions about guidance for conceptual groupings of topic areas
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Finalize a list of criteria for selecting Healthy People 2020 topic areas
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Complete a second round of “word-smithing/” revision of topic areas through a
web-based poll
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Apply selection criteria to yield a final list of recommended topic areas.
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Other Subcommittee Efforts
 System Specifications
• Final report has been submitted
 Implementation
 Data & IT
 Priorities
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Summary and Next Steps
 Remaining work on topic areas
 Next steps for subcommittees
 Next Committee meeting dates
• Monday, April 20th: 12:00- 2:00 PM (ET)
• Friday, May 15th: 1:00 PM- 3:00 PM (ET)
 Other issues
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