An Integrated Framework for Assessing the Value of Community-Based Prevention (2012) / Chapter Skim
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5 A Framework for Assessing the Value of Community-Based Prevention
5 A Framework for Assessing the Value of Community-Based Prevention
Pages 119-138
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From page 119... ...
The chapter then reviews the data needed to quantify value within this framework along with the limitations of the data, discusses how communities and other stakeholders can use the framework to value community-based prevention, and concludes with a discussion of the implications for state and national policy. A FRAMEWORK FOR ASSESSING VALUE Existing frameworks for community-based prevention interventions neglect one or more of the elements previously identified as being key to the success of such a framework.
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From page 120... ...
Identification of Savings Community Costs Investments Monetary Units (USD) and Costs Resources FIGURE 5-1 Conceptual framework for valuing community-based prevention interventions.
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From page 121... ...
Table 5-1 provides a summary of the proposed framework compared to the eight existing frameworks discussed in Chapter 4. Proposed Summary Measures There are a variety of sources of data on health, including surveys (e.g., the National Health Interview Survey and the Behavioral Risk Factor Surveillance System)
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From page 122... ...
. Identifying measures and sources of information for community well-being and community process elements is even more challenging than identifying these items for health.
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The committee also recognizes that the development of the single indicator is a long-term goal, since such indicators do not currently exist for the community well-being and community process domains. The National Prevention, Health Promotion, and Public Health Council (Prevention Council)
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From page 124... ...
According to a previous IOM committee (2011) HALE weights "have the ability to take into account the effects of particular illnesses; provide insight into regional differences associated with social, environmental, and behavioral risk factors; and allow examination of the health experiences of subpopulations by race/ethnicity." In other words, HALE can account for differences in preferences and population.
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From page 125... ...
Unlike the health domain, which has developed the QALY and the HALE, a single metric does not currently exist for the domain of community well-being nor does a single metric exist for the domain of community process. Therefore, other options must be used until such time as those metrics are developed.
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From page 126... ...
Box 5-1 provides an example. BOX 5-1 Valuing the Construction of a Greenway Using the Proposed Framework A community concerned about obesity is looking for ways to encourage more physical activity.
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A shift in transportation preferences away from car trips could, over time, lead to better outdoor air quality. From these projected changes from the current baseline, decision makers could derive an idea of the potential net community benefit even if widely accepted summary measures of community well-being and community process are currently unavailable.
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It should be noted that if the community benefit indicator is determined to be negative, no further valuation need be conducted. Summary measures for each of the three domains of benefit and for resources used are a first step toward a possible future overall summary measure.
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What is important for one community may not be important for another. Recommendation 5: The committee recommends that those involved in decision making ensure that the elements included in valuing c ommunity-based prevention interventions reflect the preferences of an inclusive range of stakeholders.
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is critical to the success and thus to the projected impact of the intervention. The focus on intervention context encourages those engaged in the valuing process to recognize that community-based prevention can be a complex system within which prevention policies, programs, determinants, stakeholders, and strategies interact dynamically.
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From page 131... ...
Or it could become weaker as the initial enthusiasm for a change wears off, as with the fitness initiatives of the early 1960s. The evaluation process follows projection processes closely.
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Including such an examination in the evaluation process also provides information that can be used to determine how well the framework accurately projected change. The evaluation component considers the short-, intermediate-, and long-term impacts of the community-based prevention intervention and provides ongoing reports of progress over time.
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From page 133... ...
The proposed framework is intended to aid decision making about adopting community-based prevention interventions in a broad range of contexts. It is also intended to assist in the task of monitoring and evaluating community-based prevention interventions once they have been adopted and implemented.
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A community-based prevention intervention may be good at improving aggregate health, but it may have a greater effect on those already better off in some important way -- say by income or residential location or occupational status -- and this may increase health disparities. The willingness of people to trade off increased inequality for aggregate improvement may vary significantly.
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From page 135... ...
The comprehensive identification of the specific benefits, harms, and resources used that were included in the value of the intervention should guide the monitoring and evaluation process, for it will track the resulting intervention to see if estimated net benefits are realized. Ideally, a good monitoring and evaluation process can identify ways to improve the implementation or revise the intervention so that negative effects, or costs can be reduced.
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From page 136... ...
Although much work remains, the committee's proposed framework is designed to capture the value of community-based prevention by taking a comprehensive approach, comparing benefits, harms, and resources used in three domains, and taking into account community context. Expanding the influence of this framework will require building a consensus that the outcomes on which it focuses (health, community wellbeing, community process, and resources used)
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From page 137... ...
The framework proposed by the committee is comprehensive and includes the assessment of the benefits, harms, and resource use of c ommunity-based prevention interventions in the three major domains of health, community well-being, and community process. The framework also proposes that summary measures or single indicators be developed to assess value in these three areas and that these be compared with a summary measure of resource use.
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From page 138... ...
As stated earlier, the proposed framework is in its very early stages and much is yet to be learned. However, the framework identifies critical areas for valuing and the report proposes additional areas where work needs to be undertaken.
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