If you had to form a task force to review evidence for population health interventions from across the nation, who would you pick? What would they do? How would you use their recommendations? In this module, we're going to discuss the composition, role, and responsibilities of the Community Preventative Services Task Force, and outline how different stakeholders use the recommendations. So just to remind you, the Community Preventative Services Task Force is an independent, rotating, and non-federal task force. It has experts from public health, community health, health promotion, and preventative services, as well as policy and research. The nominations come from both the public health and the health care sector. They are appointed by the CDC Director. But again, remember, they're independent, they're not federal, they're not a part of the CDC. So what are their roles and responsibilities? Well, a lot of it has to do with the systematic review of evidence. But one of the very first things they do is oversee priority setting. What should they review first, or in what order? Then follows their participation. Many of them are participating on individuals systematic review teams. The whole task force isn't on every review. They really split them up by the domains of their expertise and interest. Another key thing that they add is the ability to develop new methods or to refine the methods for the systematic review. This helps to actually keep advising the process as the evidence and as the research grows. The last but not least, they're responsible for the recommendations. These recommendations are framed in terms of policies, practices, or research that forms the basis of what shows up on the Community Guide website. So who are these task force members? A lot of the times, they're coming from academia, the professors in health policy, community health, preventative medicine, epidemiology, or the practitioners. So for instance, directors of the public health departments in the state or the state epidemiologists or state medical officers. Then there are leaders from the academic side, so the deans of the schools of public health and medicine are often Task Force members, and leaders from national foundations and trusts are also participants on this task force. Some of the key challenges that have to be addressed in thinking about rolling out recommendations about evidence-based interventions is thinking from the user's perspective. So typical user is going to say, "I wonder if these findings are generalizable across all the settings and situations and policies for which I'm responsible?" Or they might think, "Well, are the findings applicable to my specific setting, situation, or population?" So the Community Preventative Services Task Force takes that into their deliberation, and some of the key questions that they ask is, does the intervention work? How well, and for whom? When is the intervention appropriate? What does it cost? Does it provide value, and value really, you think about it in multiple ways, but some of it has to do with lives saved, health outcomes improved, dollars saved. Are there barriers to the use of these interventions? Are there any potential harms? Then what are the potential unanticipated outcomes? So this is a lot of the way in which the Community Preventative Services Task Force has got to think about the whole picture. When a task force makes a recommendation, it basically takes one of three stances. Either it recommends the intervention, because there's strong evidence or at least sufficient evidence to recommend it. There are times when they recommend against an intervention because of either strong evidence or sufficient evidence that this is not an intervention that either works or it has harmful consequences that negate some of the positive. Then there's this third option of the task force saying, "We have insufficient evidence, we can't really recommend for or against this intervention." How is this information organized in the Community Guide? Well, there's a snapshot that gives the summary of the findings and the intervention. Then they have a whole other section on what the Community Preventive Services Task Force found. That's the systematic review, and the summary, as well as this is more the summary of the results in the economic evidence and some of the applicability in evidence gaps even, and the characteristics of the studies. Then third level down is the supporting materials. What's the analytic framework, the summary statistics, the review materials that they actually use including what were the publications that were a part of that systematic review? Then last but not least on the Community Guide, are considerations for implementation and cross walks to other programs or to other resources that you might need for implementation. So who is using it and how? Well, public health practitioners and health departments are using it all the time in program planning, grant guidance, and focus for research funding goals. So when they put out a request for proposals, they're often using these interventions and saying, "We're going to actually fund people using these evidence-based interventions." Healthcare providers and systems are really thinking about it from a different vantage point. They're going to use the evidence-based interventions that help with system-level interventions for their clinical services delivery because they're looking to actually improve or become more effective, and have this improved population health goal actualized in their system. Community-based organizations, a little bit like the public health, are thinking about it more from a program planning, grant guidance, or to focus on research funding goals. So if they're funding people to do research in their community, it might be that they're looking for added information about a bridge to this intervention for their specific community. Employers and purchasers also use this information on the Community Guide for things like their healthy worksite interventions, or benefit plan design and selection. You want things that are actually demonstrated to be of benefit, and while there's a lot of information that's flowing, not all of it is evidence-based. So legislators and policy makers also use the Community Guide for broad policies or targeted laws, as well as infusing some of this information into the education system requirements, or in deciding about community interventions. Because the Community Guide has this evidence-based approach, it's something that legislators and policy makers really feel like they're on solid ground when they make a decision. Researchers also use this information, but in a slightly different way. They're looking more at where there's insufficient evidence and trying to figure out how can we actually be part of the solution of filling those gaps? Government agencies and funders are using this information to develop requests for proposals, or to actually prioritize who to fund to facilitate the gaps being filled. So Government Agencies and Funders could look specifically at those interventions where there's insufficient evidence and say, "This is really where we want to put our money." Then last but not least, the general public who also has access to these great resources can use it to advocate for their communities' health by looking in and saying, "Hey, we've got an opioid problem, what is out there that might be of use to us here in our state?" So what do you do with a recommendation? So first step might be combining the recommendation with other information that you know. What are the key needs of your community? What has or has not worked? You want to use that information to tailor it, and what resources do you already have available versus those that you have to get for implementing that intervention? Second is a bit more of a refinement of assessing the fit to the community. Often, this means going to stakeholders and say, "What do you think about using this intervention in your location and your organization for your constituents?" Third is really estimating the costs and the cost effectiveness because any implementation is going to take costs. That's going to take money, and the cost-effectiveness of it is something that you can go to funder, city councils, basically the organizations that are willing to help in the funding and to demonstrate in your setting, what is it really going to be in terms of community benefit? Then last but not least, is really to hold in mind that it's not a one-size-fits-all solution. There's no intervention that doesn't need customization, as well as for the community to breathe its own cultural norms into the actions that are going to unfold from that choice of an intervention, even if it's evidence-based. So last but not least is what to do with insufficient evidence. There's a lot going on in this slide because there's a lot of options. So if you're using the intervention, a couple of things come to mind. One, you may want to continue using it if there's no real associated harms, and maybe collect evidence that could be used by the systematic review in its next iteration. You could also choose to stop due to the issues, such as that it's costing you money and you don't know whether or not it's effective. If the intervention is not being used, well, you may not want to begin using it because there's not enough evidence that says it's really going to be worth your time, effort, and money. Or you may choose to site that it's insufficient evidence in your funding proposal to really motivate the study that demonstrates, maybe they just didn't have enough evidence, and your study, your intervention into the community could really provide a benefit for everyone if you carried through with it. Then last but not least, are there better documented alternatives for reaching the same goal? So if you have insufficient evidence around this intervention, is there a neighboring intervention where there is a good evidence? Maybe you try that one. We're incredibly lucky that the Community Preventative Services Task Force is willing to do this really important work, usually on top of their regular jobs. So remember to check back in. They're always putting new recommendations up. There's over 250 recommendations right now, and the list keeps growing.
