Preventive screenings and services are an important step in enhancing people’s health and quality of life, and are critical to improving the overall health system. The 2016 America’s Health Rankings® Spotlight: Prevention report, published by the United Health Foundation and co-released with the American College of Preventive Medicine, shines an important light on the gaps in use of preventive services and areas for health system improvement. For example, a significantly lower percentage of Hispanic adults access clinical preventive services than non-Hispanic white and non-Hispanic black adults, and most states lag behind U.S. Department of Health and Human Services’ (HHS) Healthy People (HP) 2020 targets.
The good news: the data show some regions are performing better in preventive care, and innovative projects and programs are delivering positive results in reducing barriers to such care. These efforts can provide best practices and insight as we work to address the issues uncovered in Spotlight: Prevention.
Why Preventive Health Care Matters
According to HHS, access to health services affects an individual’s physical, social and mental health status, as well as health outcomes, quality of life, and the prevention of disease, disability and death.
The Centers for Disease Control and Prevention (CDC) reports that chronic diseases – such as heart disease, cancer and diabetes – are responsible for 70 percent of deaths in the United States each year and account for 86 percent of the country’s health care spending.
Most of these chronic diseases are preventable, and treatment is most effective when diseases are detected early through appropriate screenings. Yet, the CDC reports that Americans use clinical preventive services at half the recommended rate.
“Addressing the skyrocketing incidence of preventable chronic illness will take collaboration from the clinical health care system, the public health sector, and individuals and the communities in which they live,” said Reed Tuckson, M.D., external senior medical adviser to United Health Foundation. “Achieving optimal health requires greater access for everyone to a regular source of care; enhanced attention to evidence-based clinical prevention services; better coordination between public health and medical care professionals; and activated consumers who are motivated and prepared to make personally appropriate health decisions.”
Vaccines are among the most cost-effective, evidence-based clinical preventive services available; however, about 42,000 adults and 300 children die each year in the United States from vaccine-preventable diseases, according to HHS. Childhood immunizations, in particular, provide a very high return on investment. The U.S. childhood immunization program is estimated to prevent 42,000 premature deaths and 20 million cases of disease among children born in 2009, with direct cost savings of $13.5 billion.
Spotlight: Prevention Unveils Troubling Gaps in Use of Preventive Health Care
Spotlight: Prevention took an in-depth look at prevention measures across all 50 states through the lenses of health care access, immunizations and chronic-disease prevention. It found that the use of clinical preventive services and interventions is uneven and varies by race, income, education and geography.
At a national level, too few children, adolescents and adults are receiving recommended preventive services and screenings. For example, 40.4 percent of U.S. adults reported receiving an influenza vaccination, far short of the federal government’s Healthy People 2020 target of 70 percent.
At the state level, childhood immunization rates range from 63.4 percent in West Virginia to 84.7 percent in Maine, and adult influenza immunization rates range from 31.7 percent in Florida to 50.2 percent in South Dakota.
A study published in Applied Clinical Informatics showed that the use of an EHR system at a community health center improved childhood vaccination rates by tracking patients in need of vaccines, facilitating the ordering and coding of multiple vaccines and promoting interdisciplinary communication among clinical personnel.
“The silver lining in this report is that some communities and states are excelling on certain preventive care measures,” said Daniel S. Blumenthal, M.D., M.P.H., F.A.C.P.M, president of the American College of Preventive Medicine. “We need to do a much better job of sharing best practices so we can learn from one another.”
When it comes to chronic disease prevention, Spotlight: Prevention found inequities related to race and ethnicity, income, education and geography. For example, just 59.2 percent of Hispanic adults reported having a dedicated health care provider, compared with 82.1 percent of non-Hispanic white adults and 76.5 percent of non-Hispanic black adults. Hispanic adults also reported receiving colorectal cancer screenings and cholesterol screenings at a lower rate than non-Hispanic white and non-Hispanic black adults.
Among adults aged 50 to 74 with incomes less than $25,000 annually 55.6 percent reported having received recommended colorectal cancer screenings, compared with 73.4 percent of adults making $75,000 or more. Use of preventive health care services also varies by education. Among adults age 25 and older with less than a high-school education, 67.6 percent reported having a dedicated health care provider, compared with 79.2 percent of adults with a high school degree, 81.6 percent of adults with some college and 85 percent of college graduates.
“The inequities highlighted in Spotlight: Prevention are unacceptable. As a health system and as a nation, we must make it a priority to fully address the barriers to accessing preventive health care,” said Daniel M. Suarez, MA, RN, president of the National Association of Hispanic Nurses.
Driving Health Care System Improvements
The findings of Spotlight: Prevention provide important insight for policymakers, health professionals and others seeking to modernize the health care system – at the national, state and local levels – and improve the health of individuals and communities.
Spotlight: Prevention shows that access to care is critical for overall prevention. For example, having a dedicated health care provider is highly correlated with receiving recommended colorectal cancer screening tests.
Several communities have adopted alternative approaches for expanding access to care, such as using telemedicine to bridge geographic barriers or leveraging in-home clinical visits to prevent admissions into hospitals or nursing homes. Targeted education and outreach campaigns have also been shown to help people access health care coverage and care.
Spotlight: Prevention also reveals that many people fail to receive recommended preventive-care services. Research shows that connected electronic health records (EHRs) can help care providers identify missed immunizations and screenings among their patients and provide clinicians with a more complete understanding of patients’ health status and needs, while data analytics can alert care providers to treatment gaps and identify missed screenings and immunizations at the point of care.
The findings of Spotlight: Prevention and successful on-the-ground health system improvements will be essential as the nation works to modernize the health care delivery system to provide better care and ultimately improve patient health and outcomes.
A separate study published in Medical Care found that a computerized reminder system yielded significant increases in colorectal screening rates across diverse community primary care practices.
As part of a new and expanded America’s Health Rankings series for 2016, Spotlight: Prevention marks the first of several spotlights to be released this year by United Health Foundation focused on important markers of our nation’s health, including impacts of unhealthy living, substance abuse and mental health. Spotlights are intended to shine a light on the role these issues and their associated factors play in our nation’s health. The spotlights complement the America’s Health Rankings Annual Report and the America’s Health Rankings Senior Report, as well as new population reports examining the health of mothers and children and the health of our nation’s veterans.