Preventive Women's Health Services & Preventive Women's Health Services & Health Care Reform: Closing the GapsHealth Care Reform: Closing the Gaps

The Charge to The Charge to the Institute of Medicinethe Institute of Medicine

Angela Diaz, MD, MPHAngela Diaz, MD, MPHJean C. and James W. Crystal Professor of Pediatrics and Preventive Medicine

Mount Sinai School of Medicine

Women’s Health 2012 CongressWomen’s Health 2012 CongressMarch 18, 2012March 18, 2012

The Charge to The Charge to the Institute of Medicine (IOM)the Institute of Medicine (IOM)

Convene a Committee of expertsConvene a Committee of experts• To review women’s health preventive services andTo review women’s health preventive services and identify critical gaps, as identified in the ACA by the:identify critical gaps, as identified in the ACA by the:

US Preventive Services Task ForceUS Preventive Services Task Force

American Academy of Pediatrics Bright FuturesAmerican Academy of Pediatrics Bright Futures Recommendations for AdolescentsRecommendations for Adolescents

Center for Disease Control & Prevention’s AdvisoryCenter for Disease Control & Prevention’s Advisory Committee on Immunization PracticesCommittee on Immunization Practices

• To recommend what should be considered in the To recommend what should be considered in the development of comprehensive national guidelinesdevelopment of comprehensive national guidelines

IOM PSW IOM PSW CommitteeCommittee

Linda Rosenstock, M.D., M.P.H., Chair UCLA School of Public Health 

Alfred O. Berg, M.D., M.P.H.University of Washington

Claire D. Brindis, Dr.P.H.University of California, San Francisco

Angela Diaz, M.D., M.P.H.Mount Sinai Medical Center, NY

Francisco Garcia, M.D., M.P.H.University of Arizona

Kimberly Gregory, M.D., M.P.H.Cedars-Sinai Medical Center, Los Angeles

Paula A. Johnson, M.D., M.P.H. Brigham and Women's Hospital, Boston

Anthony Lo Sasso, Ph.D.University of Illinois at Chicago Jeanette H. Magnus, M.D., Ph.D.Tulane University

Heidi Nelson, M.D., M.P.H., FACPOregon Health and Science University

Roberta B. Ness, M.D., M.P.H. University of Texas School of Public Health

Magda Peck, Sc.D. University of Nebraska Medical Center

E. Albert Reece, M.D., Ph.D., M.B.A.University of Maryland (Baltimore)

Alina Salganicoff, Ph.D. Kaiser Family Foundation

Sally Vernon, Ph.D. University of Texas School of Public Health

Carol S. Weisman, Ph.D. Penn State College of Medicine

Statement of TaskStatement of Task

• What is the scope of preventive services for women not included in those graded A and B by the United States Preventive Services Task Force (USPSTF)?

• What additional screenings and preventive services have been shown to be effective for women?

• What services and screenings are needed to fill gaps in recommended preventive services for women?

• What models could HHS and its agencies use to coordinate regular updates of the comprehensive guidelines for preventive services and screenings for women and adolescent girls?

Committee ProcessCommittee ProcessThe committee held three open meetings in Washington, DC, The committee held three open meetings in Washington, DC, which featured presentations from experts in the following which featured presentations from experts in the following areas:areas:

Women’s healthWomen’s healthPreconception carePreconception careAdolescent healthAdolescent healthReproductive healthReproductive healthMental healthMental healthOral healthOral healthOccupational healthOccupational health

The Committee reviewed written testimony submitted by The Committee reviewed written testimony submitted by interest groups, professional associations, and individualsinterest groups, professional associations, and individuals

The Committee met five times in closed session for The Committee met five times in closed session for deliberationdeliberation

Evidence-based medicineEvidence-based medicine Quality of careQuality of care Health insuranceHealth insurance Guidelines developmentGuidelines development

ApproachApproachThe Committee defined preventive health services as The Committee defined preventive health services as measures shown to improve well-being and / ormeasures shown to improve well-being and / ordecrease the likelihood or delay the onset of a targeted decrease the likelihood or delay the onset of a targeted disease or conditiondisease or condition

The Committee developed four overarching questions: The Committee developed four overarching questions:

Are there high-quality systematic evidence reviews toAre there high-quality systematic evidence reviews to show that the service is effective in women?show that the service is effective in women?

Are quality peer-reviewed studies available thatAre quality peer-reviewed studies available that demonstrate effectiveness in women?demonstrate effectiveness in women?

Has the measure been identified as a federal priority? Has the measure been identified as a federal priority?

Are there existing federal, state, or international Are there existing federal, state, or international practices, professional guidelines, or federalpractices, professional guidelines, or federal reimbursement policies, that support the measure?reimbursement policies, that support the measure?

ApproachApproach

The committee followed the following in its analysis:The committee followed the following in its analysis:

• The condition to be prevented affects a The condition to be prevented affects a broad populationbroad population

• The condition to be prevented has a large The condition to be prevented has a large potential impact on health and well-beingpotential impact on health and well-being

• The quality and strength of evidence is supportiveThe quality and strength of evidence is supportive

The Report from the Committee on The Report from the Committee on Preventive Services for WomenPreventive Services for Women

Recommendation 1Recommendation 1Screening for gestational diabetes Screening for gestational diabetes in pregnant women between in pregnant women between 24 and 28 weeks of gestation and at the first prenatal visit for 24 and 28 weeks of gestation and at the first prenatal visit for pregnant women identified to be at high risk for diabetespregnant women identified to be at high risk for diabetes

Recommendation 2Recommendation 2The addition of The addition of high-risk human papillomavirus (HPV) DNA high-risk human papillomavirus (HPV) DNA testingtesting to cytology testingto cytology testing in women with normal cytology in women with normal cytology results. Screening should begin at 30 years of age and should results. Screening should begin at 30 years of age and should occur no more frequently than every 3 yearsoccur no more frequently than every 3 years

Committee RecommendationsCommittee Recommendations

Recommendation 3Recommendation 3Annual counseling on sexually transmitted infections Annual counseling on sexually transmitted infections for for sexually active women sexually active women Recommendation 4Recommendation 4Counseling and screening for HIV infection Counseling and screening for HIV infection on an annual basis on an annual basis for sexually active womenfor sexually active women

Recommendation 5Recommendation 5The full range of The full range of FDA-approved contraceptive methods, FDA-approved contraceptive methods, sterilization procedures, and patient education and counseling sterilization procedures, and patient education and counseling for women with reproductive capacityfor women with reproductive capacity

Committee RecommendationsCommittee Recommendations

Recommendation 6Recommendation 6Comprehensive lactation support and counseling and costs of Comprehensive lactation support and counseling and costs of renting breastfeeding equipmentrenting breastfeeding equipment. . A trained provider should A trained provider should provide counseling services to all pregnant women and to those provide counseling services to all pregnant women and to those in the postpartum period to ensure the successful initiation and in the postpartum period to ensure the successful initiation and duration of breastfeedingduration of breastfeeding

Committee RecommendationsCommittee Recommendations

Recommendation 7Recommendation 7Screening and counseling for interpersonal and domestic Screening and counseling for interpersonal and domestic violence.violence. Screening and counseling involve elicitation of Screening and counseling involve elicitation of information from women and adolescents about current and information from women and adolescents about current and past violence and abuse in a culturally sensitive and supportive past violence and abuse in a culturally sensitive and supportive manner to address current health concerns about safety and manner to address current health concerns about safety and other current or future health problemsother current or future health problems

Committee RecommendationsCommittee Recommendations

Recommendation 8Recommendation 8At least one well-woman preventive care visit annually At least one well-woman preventive care visit annually for for adult women to obtain the recommended preventive services, adult women to obtain the recommended preventive services, including preconception and prenatal careincluding preconception and prenatal care

Committee RecommendationsCommittee Recommendations