An Integrated Framework for Assessing the Value of Community-Based Prevention (2012) / Chapter Skim
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4 Existing Frameworks
4 Existing Frameworks
Pages 89-118
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From page 89... ...
Model. The committee concluded that existing frameworks are inadequate for assessing the value of community-based prevention because none meet all of the most important criteria outlined in Chapter 3 and this chapter.
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From page 90... ...
A prospective assessment of value is performed before an intervention takes place and is designed to help policy makers decide whether to undertake the intervention. An example of a prospective assessment is a cost estimate produced by the Congressional Budget Office.
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From page 91... ...
For example, while family-planning activities are legal and may be a valued outcome, they can be constrained by ethical attitudes toward abortion and contraception. Differing ethical and religious views in the community may need to be considered outside the valuation framework.
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From page 92... ...
Some frameworks make explicit the sources of evidence that are taken into consideration and the standards that each source of evidence must meet. The Community Preventive Services Guide, for example, includes a clear description of the sources from which the task force draws evidence and the standards that are used to grade the quality of different pieces of evidence (Carande-Kulis et al., 2000)
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From page 93... ...
EIGHT EXISTING FRAMEWORKS The committee has identified eight existing frameworks that have been used to assess the value of community-based preventions: 1. benefit–cost analysis, 2.
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From page 94... ...
framework, 7. the Community Preventive Services Task Force (CPSTF)
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A difficult problem occurs when an important outcome that is affected by the intervention is not traded in markets and, therefore, has no price. In this case, the analyst must rely on systematic reviews of published academic literature on such topics as willingness to pay as well as on expert opinion and on his or her personal judgments.
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From page 96... ...
For projects that generate a stream of future benefits or costs, the benefit–cost ratio (B/C) is B/C = Total discounted value of future expected benefits/ Total discounted value of future expected costs, or Net Present Value of Program = Present value of benefits/ Present value of costs by the analyst.
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From page 97... ...
The third step in the analysis is the development of a set of weights that reflect judgments about the comparative importance of progress toward each of the goals -- the goal trade-offs. Valued outcomes in BCA can be grouped into two principal categories: (1)
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From page 98... ...
begins with many of the core elements of BCA framework, but it is tailored to the assessment of medical and health interventions. The key difference between CEA and BCA is that CEA focuses on health as the valued outcome and measures health by methods that avoid the use of dollars (Donaldson, 1998; Gold et al., 1996)
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From page 99... ...
CEA takes into account the health improvements and adverse effects from the intervention that occur over a specific time horizon, often the lifetime of patients, to calculate the net health benefits, which are defined as improvements minus adverse effects. As noted, health improvements include both longer life and better quality of life.
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Preventive Services Task Force, 2012)
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is a nonpartisan congressional support agency that analyzes existing federal programs and proposed legislation to provide budget, economic, and other information for Congress. The agency staff is made up of economists and research staff who develop cost estimates, reports, and other products.
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Written cost estimates sometimes include information about health impact and other outcomes of interest (for example, expected changes in smoking rates from amendments to the Food, Drug, and Cosmetic Act or expected changes in insurance coverage under the Affordable Care Act) , but discussion of these non-budget outcomes is limited.
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From page 103... ...
Another shortcoming is the use of the 10-year budget window, which can be too short to pick up some important outcomes, such as long-term health improvements from policies or programs that reduce childhood obesity. Finally, the process of selecting policies for scoring is very limited -- formal cost estimates are produced only for pieces of legislation that have been reported out of a committee of Congress.
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From page 104... ...
More Details and Examples Many of the more than 1,000 published applications, tests, reviews, and reflections relating to PRECEDE–PROCEED have focused on developing, valuing, or evaluating interventions, programs, and policies in specific community settings, such as school health promotion or worksite wellness programs, or have examined specific components such as the mass media component of a program or the policy impact of a new law or regulation (Buta et al., 2011; Green, 2012a)
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From page 105... ...
The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) Framework Decision-Making Context The RE-AIM framework has been widely used in the community health promotion field to assess whether a specific intervention is likely to have a positive impact on health (Glasgow et al., 1999)
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From page 106... ...
is a framework for assessing the health impacts of interventions primarily in non-health sectors for the purpose of mitigating potential harms or enhancing potential benefits. HIAs can be used to examine policies, such as living wage laws, zoning restrictions to reduce sensitive use development around high-use roadways, or agricultural subsidies as well as to assess projects, such as the development of a subway system or the introduction of a farmer's market.
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. FIGURE 4-1 Framework for a Health Impact Assessment, illustrating steps and outputs.
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From page 108... ...
. Community Preventive Services Task Force Guidelines The Community Preventive Services Task Force (CPSTF)
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From page 109... ...
population as a whole based on estimated reach, impact, and feasibility; • potential to reduce health disparities across varied populations based on age, gender, race/ethnicity, income, disability, setting, context, and other factors; • degree and immediacy of interest expressed by major Community Guide audiences and constituencies, including public health and health care practitioners, community decision makers, the public, and policy makers; • alignment with other strategic community prevention initiatives, including, but not limited to, Healthy People 2020, the National Prevention Strategy; the County Health Rankings, and America's Health Rankings; • synergies with topically related recommendations from the U.S. Pre ventive Services Task Force and Advisory Committee on Immunization Practices; • availability of sufficient research to support informative systematic evi dence reviews; and • the need to balance reviews and recommendations across health topics, risk factors, and types of services, settings, and populations.
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From page 110... ...
. Criteria for Admissible Evidence The CPSTF guidelines are based on systematic reviews of the published academic literature.
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From page 111... ...
model -- also referred to as the Lomas model after Jonathan Lomas, the first chief executive officer of the CHSRF -- provides a conceptual framework for combining evidence of different types to inform health system decision making. It is not a full-fledged framework for assessing value because it does not specify a list of valued outcomes.
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From page 112... ...
VALUING COMMUNITY-BASED PREVENTION: IS A NEW FRAMEWORK NEEDED? This chapter has identified eight existing frameworks for assessing value.
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From page 113... ...
Benefit–cost analysis, which is comprehensive in accounting for benefits and always estimates costs, does not routinely consider the unique characteristics of the decision-making context and the community. PRECEDE–PROCEED, which measures health and community process benefits and takes the unique characteristics of the community into account, does not require that costs be estimated.
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From page 114... ...
The Task Force on Community Preventive Services. American Journal of Preventive Medicine 18(1 Suppl)
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From page 115... ...
Atlanta, GA: Community Preventive Services Task Force. Community Guide.
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2009. RWJF, the Pew Charitable Trusts launch health impact project.
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From page 117... ...
U.S. Preventive Services Task Force.
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