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Measuring Adherence to U.S. Preventive Services Task Force Diabetes Prevention Guidelines Within Two Healthcare Systems.

ABSTRACT:

Abstract

Measuring adherence to the 2015 U.S. Preventive Services Task Force (USPSTF) diabetes prevention guidelines can inform implementation efforts to prevent or delay Type 2 diabetes. A retrospective cohort was used to study patients without a diagnosis of diabetes attributed to primary care clinics within two large healthcare systems in our state to study adherence to the following: (1) screening at-risk patients and (2) referring individuals with confirmed prediabetes to participate in an intensive behavioral counseling intervention, defined as a Center for Disease Control and Prevention (CDC)-recognized Diabetes Prevention Program (DPP). Among 461,866 adults attributed to 79 primary care clinics, 45.7% of patients were screened, yet variability at the level of the clinic ranged from 14.5% to 83.2%. Very few patients participated in a CDC-recognized DPP (0.52%; range 0%-3.53%). These findings support the importance of a systematic implementation strategy to specifically target barriers to diabetes prevention screening and referral to treatment.

SUBMITTER: Brunisholz KD

PROVIDER: S-EPMC7878570 | biostudies-literature | 2021 Mar-Apr 01

REPOSITORIES: biostudies-literature

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Publications

Measuring Adherence to U.S. Preventive Services Task Force Diabetes Prevention Guidelines Within Two Healthcare Systems.

Brunisholz Kimberly D KD Conroy Molly B MB Belnap Thomas T Joy Elizabeth A EA Srivastava Raj R

Journal for healthcare quality : official publication of the National Association for Healthcare Quality 20210301 2

<h4>Abstract</h4>Measuring adherence to the 2015 U.S. Preventive Services Task Force (USPSTF) diabetes prevention guidelines can inform implementation efforts to prevent or delay Type 2 diabetes. A retrospective cohort was used to study patients without a diagnosis of diabetes attributed to primary care clinics within two large healthcare systems in our state to study adherence to the following: (1) screening at-risk patients and (2) referring individuals with confirmed prediabetes to participat ...[more]

PMID: 32842020

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Project description:BackgroundThis systematic review is an update of evidence since the 2002 U.S. Preventive Services Task Force recommendation on breast cancer screening.PurposeTo determine the effectiveness of mammography screening in decreasing breast cancer mortality among average-risk women aged 40 to 49 years and 70 years or older, the effectiveness of clinical breast examination and breast self-examination, and the harms of screening.Data sourcesCochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews (through the fourth quarter of 2008), MEDLINE (January 2001 to December 2008), reference lists, and Web of Science searches for published studies and Breast Cancer Surveillance Consortium for screening mammography data.Study selectionRandomized, controlled trials with breast cancer mortality outcomes for screening effectiveness, and studies of various designs and multiple data sources for harms.Data extractionRelevant data were abstracted, and study quality was rated by using established criteria.Data synthesisMammography screening reduces breast cancer mortality by 15% for women aged 39 to 49 years (relative risk, 0.85 [95% credible interval, 0.75 to 0.96]; 8 trials). Data are lacking for women aged 70 years or older. Radiation exposure from mammography is low. Patient adverse experiences are common and transient and do not affect screening practices. Estimates of overdiagnosis vary from 1% to 10%. Younger women have more false-positive mammography results and additional imaging but fewer biopsies than older women. Trials of clinical breast examination are ongoing; trials for breast self-examination showed no reductions in mortality but increases in benign biopsy results.LimitationStudies of older women, digital mammography, and magnetic resonance imaging are lacking.ConclusionMammography screening reduces breast cancer mortality for women aged 39 to 69 years; data are insufficient for older women. False-positive mammography results and additional imaging are common. No benefit has been shown for clinical breast examination or breast self-examination.

Project description:ImportanceThe 2009 US Preventive Services Task Force breast cancer screening guideline changes led to decreases in screening mammography, raising concern about potential increases in late-stage disease and more invasive surgical treatments.ObjectiveTo investigate the incidence of breast cancer by stage at diagnosis and surgical treatment before and after the 2009 guideline changes.Design, setting, and participantsThis population-based, epidemiologic cohort study of women aged 40 years or older used 2004 to 2019 data from the National Cancer Institute's Surveillance, Epidemiology, and End Results Program. Age- and stage-specific breast cancer incidence rates and the proportion of breast cancers treated by partial mastectomy, total mastectomy, and total mastectomy with reconstruction were calculated. Data analyses were conducted from August 2023 to February 2024.Interventions or exposuresAge group (40-49, 50-74, and ≥75 years).Main outcomes and measuresAnnual percent changes (APCs) in stage-specific breast cancer incidence and proportions of cases treated with each surgery type.ResultsThis cohort study included 2 022 250 women (354 263 [17.5%] aged 40-49 years, 1 279 542 [63.2%] aged 50-74 years, and 388 445 [19.2%] aged ≥75 age group, from a total of 2 023 541 women) diagnosed with breast cancer. Rates of in situ breast cancer decreased since 2009 (eg, APC, -0.69 [95% CI, -2.77 to -0.18] for women aged 50-74 years). Localized breast cancer rates increased steadily during 2004 to 2019 in women aged 40 to 74 years (eg, APC, 1.18 [95% CI, 1.02-1.34] for women aged 50-74 years), with no evidence of a change in trend during the study period. Regional cancer rates decreased or did not change. Distant cancer rates were flat since 2012 among women aged 40 to 74 years and increased steadily for those 75 years or older during 2004 to 2019 (APC, 1.40 [95% CI, 1.00-1.82]). The proportion of cases treated with partial mastectomy decreased during 2004 to 2012 (eg, APC, -0.77 [95% CI, -2.96 to -0.03] among women aged 50-74 years with localized cancer), whereas the proportion of cases treated with total mastectomy with reconstruction increased (eg, APC, 20.17 [95% CI, 16.50-33.16]). During 2012 to 2019, the proportion of cases treated with total mastectomy decreased (eg, APC, -2.44 [95% CI, -3.45 to -1.61] for women aged 50-74 years with localized cancer), and the proportion of cases treated with partial mastectomy increased (eg, APC, 1.70 [95% CI, 0.90-4.08] for women aged 50-74 years).Conclusions and relevanceIn this cohort study, in situ breast cancer decreased since 2009, consistent with decreasing use of screening mammography since the 2009 guideline changes, but this decrease did not appear to have translated to more advanced breast cancer stages at diagnosis or decreases in the proportion of cases treated with partial mastectomy. Further research is needed to understand the long-standing increase in localized invasive breast cancer and the decrease in regional invasive breast cancer observed during the past 20 years in the context of decreased breast cancer screening.

Project description:ImportanceThere are important differences among guideline recommendations for using statin therapy in primary prevention. New recommendations from the US Preventive Services Task Force (USPSTF) emphasize therapy based on the presence of 1 or more cardiovascular disease (CVD) risk factors and a 10-year global CVD risk of 10% or greater.ObjectiveTo determine the difference in eligibility for primary prevention statin treatment among US adults, assuming full application of USPSTF recommendations compared with the American College of Cardiology/American Heart Association (ACC/AHA) guidelines.Design, setting, and participantsNational Health and Nutrition Examination Survey (NHANES) data (2009-2014) were used to assess statin eligibility under the 2016 USPSTF recommendations vs the 2013 ACC/AHA cholesterol guidelines among a nationally representative sample of 3416 US adults aged 40 to 75 years with fasting lipid data and triglyceride levels of 400 mg/dL or less, without prior CVD.ExposuresThe 2016 USPSTF recommendations vs 2013 ACC/AHA guidelines.Main outcomes and measuresEligibility for primary prevention statin therapy.ResultsAmong the US primary prevention population represented by 3416 individuals in NHANES, the median weighted age was 53 years (interquartile range, 46-61), and 53% (95% CI, 52%-55%) were women. Along with the 21.5% (95% CI, 19.3%-23.7%) of patients who reported currently taking lipid-lowering medication, full implementation of the USPSTF recommendations would be associated with initiation of statin therapy in an additional 15.8% (95% CI, 14.0%-17.5%) of patients, compared with an additional 24.3% (95% CI, 22.3%-26.3%) of patients who would be recommended for statin initiation under full implementation of the 2013 ACC/AHA guidelines. Among the 8.9% of individuals in the primary prevention population who would be recommended for statins by ACC/AHA guidelines but not by USPSTF recommendations, 55% would be adults aged 40 to 59 years with a mean 30-year cardiovascular risk greater than 30%, and 28% would have diabetes.Conclusions and relevanceIn this sample of US adults from 2009-2014, adherence to the 2016 USPSTF recommendations for statin therapy, compared with the 2013 ACC/AHA guidelines, could lead to a lower number of individuals recommended for primary prevention statin therapy, including many younger adults with high mean long-term CVD risk.

Dataset Information

Measuring Adherence to U.S. Preventive Services Task Force Diabetes Prevention Guidelines Within Two Healthcare Systems.

Abstract

Publications

Measuring Adherence to U.S. Preventive Services Task Force Diabetes Prevention Guidelines Within Two Healthcare Systems.

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