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Introduction: This paper provides the first detailed analysis of the NIH prevention research portfolio for primary and secondary prevention research in humans and related methods research.Methods: The Office of Disease Prevention developed a taxonomy of 128 topics and applied it to 11,082 projects representing 91.7% of all new projects and 84.1% of all dollars used for new projects awarded using grant and cooperative agreement activity codes that supported research in fiscal years 2012-2017. Projects were coded in 2016-2018 and analyzed in 2018.Results: Only 16.7% of projects and 22.6% of dollars were used for primary and secondary prevention research in humans or related methods research. Most of the leading risk factors for death and disability in the U.S. were selected as an outcome in <5% of the projects. Many more projects included an observational study, or an analysis of existing data, than a randomized intervention. These patterns were consistent over time.Conclusions: The appropriate level of support for primary and secondary prevention research in humans from NIH will differ by field and stage of research. The estimates reported here may be overestimates, as credit was given for a project even if only a portion of that project addressed prevention research. Given that 74% of the variability in county-level life expectancy across the U.S. is explained by established risk factors, it seems appropriate to devote additional resources to developing and testing interventions to address those risk factors. [ABSTRACT FROM AUTHOR]

Shared decision making is a process in which patients are involved as active partners with the clinician in clarifying acceptable medical options and in choosing a preferred course of clinical care. Shared decision making offers a way of individualizing recommendations, according to patients'' special needs and preferences, when some patients may benefit from an intervention but others may not. This paper clarifies how the U.S. Preventive Services Task Force (USPSTF) envisions the application of shared decision making in the execution of screening and chemoprevention. Unlike conventional USPSTF reports, this paper is neither a systematic review nor a formal recommendation. Instead, it is a concept paper that includes a commentary on the current thinking and evidence regarding shared decision making.Although the USPSTF does not endorse a specific style of decision making, it does encourage informed and joint decisions. This means that patients should be informed about preventive services before they are performed, and that the patient–clinician partnership is central to decision making. The USPSTF suggests that clinicians inform patients about preventive services for which there is clear evidence of net benefit, and, if time permits, about other services with high visibility or special individual importance. Clinicians should make sure that balanced, evidence-based information about the service (including the potential benefits and harms, alternatives, and uncertainties) is available to the patient if needed. For preventive services for which the balance of potential benefits and harms is a close call, or for which the evidence is insufficient to guide a decision for or against screening, clinicians should additionally assist patients in determining whether individual characteristics and personal preferences favor performing or not performing the preventive service.The USPSTF believes that clinicians generally have no obligation to initiate discussion about services that have either no benefit or net harm. Nonetheless, clinicians should be prepared to explain why these services are discouraged and should consider a proactive discussion for services with high visibility or special individual importance or for services for which new evidence has prompted withdrawal of previous recommendations. [Copyright &y& Elsevier]

: PurposeTo calculate the cost structure of a suite of immunization improvement interventions recommended by the Centers for Disease Control and Prevention (CDC).: MethodsA determination was made of the cost to clinics and agencies that implement a suite of CDC-recommended practice improvement interventions to fully immunize a child for diphtheria–tetanus–attenuated pertussis (DTaP), inactivated poliovirus (IPV), and measles–mumps–rubella (MMR) vaccines. Patient data were collected through chart analysis of 16-month-old children in clinics participating in this study''s interventions between May 1997 and August 2000. The study began on October 1, 1996, and was funded for 5 years (until September 30, 2002).: ResultsStudy calculations suggest that an additional $0.013/per patient per month would be needed to cover these activities.: ConclusionsIdentifiable cost structures are associated with the practice improvement strategies recommended by the CDC. The method of implementation may be as important as the interventions themselves. Present compensation for immunization may not actually cover the cost of service provision, and it is unlikely to cover the costs of practice improvement, as described in this paper. [Copyright &y& Elsevier]

State health departments and Prevention Research Centers (PRCs) have complementary mandates and expertise important to improving population health. State health departments manage and administer numerous programs with broad population reach. PRCs bridge dissemination and implementation research and public health practice to improve health programming and outcomes. This paper describes the 15-year partnership between the Washington State Department of Health and the PRC at the University of Washington. Through this partnership, the Washington State Department of Health increases their research and evaluation capacity by working with the University of Washington PRC, and the University of Washington PRC receives opportunities to apply evidence in a variety of practice settings, expand the reach of their research-tested programs to new populations, and form new partnerships. The partnership focused initially on improving colorectal cancer screening rates through increased dissemination and implementation of evidence-based interventions. The partnership scope has grown to include small cancer screening projects in worksites and healthcare systems, Washington's Colorectal Cancer Control Program, breast and cervical cancer screening, hypertension control, and worksite health promotion. The partnership yields three main types of outcomes that strengthen practice and science: (1) findings from each major assessment or evaluation activity, published in the peer-reviewed literature when possible; (2) use of the findings to improve public health practice and impact; and (3) training opportunities for employees of local and state health departments and public health students. PRCs, health departments, and the populations they serve have much to gain from this type of partnership. [ABSTRACT FROM AUTHOR]