Third Meeting: June 5 and 6, 2008

Appendix 5

Draft Framework Elements and Overall Approach
Prepared by Dr. Jonathan Fielding, June 5, 2008

Develop Web-based, easy to navigate query system to customize a specific set of solutions from a database with current health status, health objectives, and alternative interventions for reducing disease/ injury or risk factor(s) in a query defined population. Product would be detailed print out reflective of customer needs. For example, customers could ask such questions as:

1. I am the director of a worksite wellness program but we have not seen much change in risk factors or disease rates despite our efforts to date. What are the most cost-effective interventions for me to reduce cardio-vascular disease and preventable/screenable cancers?
2. I am the director of chronic disease for a city of 100,000 with a mortality rate 10% higher than our state average. What are the highest priority policies that I should consider advocating to my city council consistent with our goal of reducing our overall mortality rate to national? State the 2020 goal by that year.
3. I am a state senator in Indiana. I want to make my mark in the legislature by championing a few policies that could increase physical activity in my state. What are my best options based on good science and what kind of effect would we likely see by adopting each of these?
4. Add an example of a individual seeking information/guidance form HP2020

Framework Elements

Goals / Objectives

1. By disease or risk factor
2. Start with baseline
   1. How determined
   2. National only versus also state and local where data exists
3. Objectives
   1. Methods of calculation (provide rating based on priority scheme)
      1. Evidence based, i.e. ameliorability, or portion thereof
      2. Extrapolation
         1. From prior historical trend
         2. By trend in disease risk factor(s) plus latency
      3. Expert advice—explain process
      4. Other (e.g. based on best practice in limited geographic area, etc.)
4. Possible interventions—for each reference to systematic review source (grade each based on combo of potential change and cost-effectiveness). For each:
   1. Description
   2. Type (e.g. clinical, community etc.)
   3. Average effect size and standard error
   4. Populations in studies
   5. Date of review
   6. Who recommends (e.g., Community Guide, Clinical Guide etc. and year of recommendation)
   7. Economic data
      1. cost
      2. cost/ benefit or net cost
      3. cost effectiveness

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Last revised: September 23, 2008