One Clear Path to Better Health: Wider Participation in Preventive Services
We all know that there are steps we can take to stay well, including being active, getting enough sleep, and eating healthy. Another important strategy is working with your doctor or nurse to get the right clinical preventive services, such as vaccinations or screenings, to protect you from diseases.
For example, this can include screenings for certain cancers, talking with your doctor about your use of alcohol and tobacco, taking a daily aspirin to prevent heart attacks and strokes, and getting a vaccine to protect against the flu virus.
People should expect and deserve to receive all of the recommended preventive services appropriate for them. This is a critical step in staying healthy.
However, new research shows that adults often don’t get all of the preventive services they need.
My colleagues and I found that, in 2015, only 8 percent of adults 35 and older were getting all of the highly recommended preventive services that offer the greatest potential for improving health. We also found that nearly 5 percent reported that they had not received any of them. The results were published in the June issue of Health Affairs.
Our study also had good news: More than 20 percent of adults reported receiving more than 75 percent of the recommended services. This shows that improvement is possible. Overall, the most commonly received preventive service for all adults was blood pressure screening, at close to 90 percent. The least commonly received service was vaccination against shingles, at less than 40 percent.
Previous studies have not taken such a comprehensive approach to measuring preventive service uptake. They have focused only on specific preventive services such as colorectal cancer screening or flu vaccinations, or a group of related services, such as cardiovascular care. But we used a patient-centered perspective to develop a more comprehensive understanding of whether adults are getting the preventive services recommended for them.
Clearly, as the broader picture shows, we have room for improvement.
A key to improving is knowing where we are and where we need to go. To that end, we created a questionnaire and a first-of-its-kind “composite measure” that gauges the use of a diverse and comprehensive spectrum of preventive services, including screening, counseling, preventive medications, and vaccinations. We piloted it in 2015 with AHRQ’s Medical Expenditure Panel Survey (MEPS).
A National Steering Committee helped AHRQ select the fifteen clinical preventive services to include in the measure and survey, based on the level of scientific research available and their potential for improving health. They are all recommended by either the US Preventive Services Task Force or the Advisory Committee on Immunization Practices.
We worked with stakeholders, including patient representatives and quality improvement experts, to develop the questionnaire, and we will continue to work with them to discover how to improve the delivery of preventive services in our health care system.
A critical first step is to use the questionnaire to monitor the delivery of preventive care so we can improve. To that end, AHRQ has incorporated the questionnaire into the MEPS family of surveys so we will be able to get a better understanding of preventive services use and monitor progress. In addition, the measure and questionnaire are designed so leaders at health systems and health care practices can use it to measure their own rates and create solutions targeted to their own needs.
Over time, with additional national data, AHRQ will be able produce more precise measurements to track our Nation’s progress toward fuller use of preventive services. Given how much improvement is needed, the solution will require system-level quality improvement efforts, and I believe that together we can make a positive difference in the quality of health care for all Americans.
Dr. Borsky is Dissemination and Implementation Advisor at AHRQ.
Page originally created June 2018