Delivering clinical preventive services: A framework mapping the gaps for future research

While the role of prevention in reducing illness and disability is well-documented, many Americans do not receive optimal preventive care. This gap is recognized by the federal government, which identified Clinical and Community Preventive Services as one of the four strategic directions to achieving healthy living in an important policy document called the National Prevention Strategy (NPS). The Agency for Healthcare Research and Quality (AHRQ) is contributing to this strategic direction by funding three Research Centers for Excellence in Clinical Preventive Services (CfEs). The CfEs conduct research, training, and dissemination activities in the areas of health equity, patient safety and implementation.

As the NPS provides general guidance on the importance of preventive care, but not specific details on how to achieve the goals of successful implementation, the authors developed a diagram of steps necessary to achieve effective delivery of clinical preventive services in a primary care setting. To develop the framework, the authors integrated the expertise of the CfE researchers with AHRQ's vision of clinical preventive services. The framework includes six steps: 1) Patient Access; 2) Identification and Indication; 3) Education and Shared Decision-Making; 4) Delivery of Clinical Preventive Services; 5) Delivery of Results; and 6) Maintenance and/or Follow-up, and underscores the importance of team models of care delivery.

By systematically laying out the steps, the authors have developed a framework for assessing evidence gaps and barriers to effective delivery of preventive care. The utility of the framework was explored by conducting an environmental scan, which included a review of the NPS strategy; reports issued by the Department of Health and Human Services (HHS); and published literature on clinical preventive services. Additionally, the authors mapped HHS programs and initiatives related to clinical preventive services (including the AHRQ CfEs) onto the framework to indicate contribution at each step in the framework. The authors will present the framework, the gaps in evidence, and the HHS programmatic contributions at each step.