Preventive Services Tool Kit Module 3 Epidemiology as

Preventive Services Tool. Kit Module 3 – Epidemiology as a Policy Tool 5/21/2018 Module 3 Epi as a Policy Tool AAPHP PSTK Advocacy Strategy Seminar Slide 1

Module 3 – Content o Translating science to policy o Epi Tools o Syndemics o Data Models o o o Medical Public Health Community 5/21/2018 Module 3 Epi as a Policy Tool AAPHP PSTK Advocacy Strategy Seminar Slide 2

Health Policy Errors that Should Have Been Prevented o Public Health o o Tobacco policy legislation (ref harm reduction) Interpretation of Louisiana Infant Mortality o Disease Management o o Untimely Demise of DM Programs Unwillingness to stratify health ed and outreach o (administrators and financial managers pay no attention to science if not forced to do so) 5/21/2018 Module 3 Epi as a Policy Tool AAPHP PSTK Advocacy Strategy Seminar Slide 3

Science to Policy o Science o o Risk and causation Natural history Efficacy of interventions Secondary benefits and harms o Policy o o o o Planning Evaluation Advocacy strategy Who pays, who benefits Values and perceptions Types of costs Types of benefits Secondary gains and losses 5/21/2018 Module 3 Epi as a Policy Tool AAPHP PSTK Advocacy Strategy Seminar Slide 4

Epi Approach to Translation o o o Numerators Denominators Patterns of cause and effect Identify interventions and outcomes Time dimension o o Project levels of intervention and outcomes by quarter and year Enable mid-course corrections Data needs for evaluation Eliminate perception of squishiness 5/21/2018 Module 3 Epi as a Policy Tool AAPHP PSTK Advocacy Strategy Seminar Slide 5

Direct Benefits (diabetes health ed. in healthcare settings) o Morbidity, mortality o Healthcare costs averted 5/21/2018 Module 3 Epi as a Policy Tool AAPHP PSTK Advocacy Strategy Seminar Slide 6

Indirect Benefits (diabetes health ed. in healthcare settings) o Adherence to recommendations o o Diabetes Other o Lifestyle o Satisfaction o Reputation and competitive advantage 5/21/2018 Module 3 Epi as a Policy Tool AAPHP PSTK Advocacy Strategy Seminar Slide 7

Adverse Consequences (diabetes health education in healthcare settings as example) o Costs o Medical complications o Adverse patient selection 5/21/2018 Module 3 Epi as a Policy Tool AAPHP PSTK Advocacy Strategy Seminar Slide 8

Small Numbers as basis for decisions o Research and Publication o o p<0. 05 Increase sample size as needed to secure “statistical significance” o Legal and Admin o o “more likely than not” 51% Proposed Public Health policy compromise p<0. 2 o Cannot increase sample size to secure p<0. 05 5/21/2018 Module 3 Epi as a Policy Tool AAPHP PSTK Advocacy Strategy Seminar Slide 9

diabetes as example of Multiple levels of intervention Goal Numerator Denominator Decrease mortality Deaths Severely Ill Diabetics Prevent deterioration and complications Severely Ill Diabetics All Diabetics Prevent onset of diabetes All Diabetics Obese Patients Prevent obesity Obese Patients Overweight Pts. Prevent overweight Overweight Pts. All Patients 5/21/2018 Module 3 Epi as a Policy Tool AAPHP PSTK Advocacy Strategy Seminar Slide 10

Diabetes – Lessons Learned o Primary, Secondary, Tertiary Prevention Model oversimplified o 5 levels demonstrated o (more levels if dealing with microvascular and other complications) o Must precisely define numerators, denominators, intervention(s) and outcomes o (best modeled with “stock and flow” software) 5/21/2018 Module 3 Epi as a Policy Tool AAPHP PSTK Advocacy Strategy Seminar Slide 11

Syndemics o “synergistic epidemics” o http: //www. cdc. gov/syndemics/overview-definition. htm o Community view 5/21/2018 Module 3 Epi as a Policy Tool AAPHP PSTK Advocacy Strategy Seminar Slide 12

Examples of Syndemics o Youth o STDs, AIDS, Substance Abuse, Unplanned or undesired pregnancy o Elderly o Diabetes, metabolic syndrome, cardiovascular and cerebrovascular disease o Urban inner city o Lead poisoning, asthma, interpersonal violence, depression, drug use, alcohol abuse o Suburban sprawl o Obesity, poor physical fitness, auto accidents, depression, tobacco use 5/21/2018 Module 3 Epi as a Policy Tool AAPHP PSTK Advocacy Strategy Seminar Slide 13

Bottom Line re: Epi as Policy Tool o Do not start with a literature review!!! o Start with Goal, feasibility, and Strategic plan o Consider syndemic interactions o Move to guidelines and literature summaries o Best place to start is usually the AHRQ National Guideline Clearinghouse http: //www. guidelines. gov o Seek guidance and consultation from public health colleagues 5/21/2018 Module 3 Epi as a Policy Tool AAPHP PSTK Advocacy Strategy Seminar Slide 14