Estimating the Relative Impact of Clinical and Preventive Community-Based Interventions: An Example Based on the Community Transformation Grant Program

Abstract

Introduction Public health focuses on a range of evidence-based approaches for addressing chronic conditions, from individual-level clinical interventions to broader changes in policies and environments that protect people’s health and make healthy living easier. This study examined the potential long-term impact of clinical and community interventions as they were implemented by Community Transformation Grant (CTG) program awardees. Methods We used the Prevention Impacts Simulation Model, a system dynamics model of cardiovascular disease prevention, to simulate the potential 10-year and 25-year impact of clinical and community interventions implemented by 32 communities receiving a CTG program award, assuming that program interventions were sustained during these periods. Results Sustained clinical interventions implemented by CTG awardees could potentially avert more than 36,000 premature deaths and $3.2 billion in discounted direct medical costs (2017 US dollars) over 10 years and 109,000 premature deaths and $8.1 billion in discounted medical costs over 25 years. Sustained community interventions could avert more than 24,000 premature deaths and $3.4 billion in discounted direct medical costs over 10 years and 88,000 premature deaths and $9.1 billion in discounted direct medical costs over 25 years. CTG clinical activities had cost-effectiveness of $302,000 per death averted at the 10-year mark and $188,000 per death averted at the 25-year mark. Community interventions had cost-effectiveness of $169,000 and $57,000 per death averted at the 10- and 25-year marks, respectively. Conclusion Clinical interventions have the potential to avert more premature deaths than community interventions. However, community interventions, if sustained over the long term, have better cost-effectiveness.

Disparities in Cardiovascular Care and Outcomes for Women From Racial/Ethnic Minority Backgrounds

“…Given the important role that differential risk plays in the CV health of women from racial/ethnic minority backgrounds [20,[116][117][118][119], we recommend developing clinical, community, and virtual interventions to target risk factors in this group. These types of initiatives have proven effectiveness with respect to mortality and cost reduction [133]. While lifestyle and community interventions related to reducing the burden of type 2 DM [91][92][93][94], hypertension [134], and obesity [135] have been shown to be effective in women from racial/ethnic minority backgrounds, widespread incorporation of such initiatives is lacking [17].…”

Applications of System Dynamics Models in Chronic Disease Prevention: A Systematic Review

“…We examined the articles involving upstream prevention measures in detail. Among them, lifestyle approaches (balanced diet, moderate exercise, tobacco control, and mental health) were the most simulated prevention measures (n = 15, 44.1%) ( 9 – 12 , 19 – 29 ). Through simulation, the researchers found that lifestyle modification can reduce the incidence of chronic diseases, premature death, and medical costs among people with chronic disease, but the effect of lifestyle simulation prevention measures was more powerful in the long term ( 19 – 21 , 23 – 28 ).…”

“…Downstream prevention consists of clinical treatment and care of people with chronic diseases (n = 19 articles [55.9%]) ( 9 , 10 , 13 – 15 , 17 , 18 , 23 , 24 , 26 , 27 , 29 , 31 , 33 , 34 , 36 – 39 ). Some studies found that clinical treatment and care of people with chronic diseases could significantly reduce mortality.…”

Commentary on Scaling-up Evidence-based Interventions in US Public Systems to Prevent Behavioral Health Problems

“…For example, the Prevention Impacts Simulation Model (PRISM), developed by CDC, was designed to address chronic health conditions (e.g., cardiovascular disease, diabetes, and smoking) from a community perspective to estimate what it would take to implement evidence-based strategies, taking into account local contextual issues and policies related to funding health services (Burke et al, 2015). A simulation of long-term impacts of implementing clinical and community interventions in communities receiving Community Transformation Grants (CTGs) found that, assuming there was sustained funding of CTGs, up to 109,000 premature deaths could be averted and up to $8.1 billion in discounted medical costs could be produced over a 25-year period (Yarnoff et al, 2019). Modeling approaches also can address questions about how decisions might affect key populations, such as health disparity populations (McNulty et al, 2019).…”