Topic: Cost-Effectiveness Analysis in Practice

Coffee Chat: An Action Kit for Prevention: Prioritizing Cost-Effective and Equitable Healthy Eating and Physical Activity Strategies

Posted on November 16, 2023

In this coffee chat hosted by the CHOICES Community of Practice, Dr. Steven Gortmaker, Principal Investigator of the CHOICES Project at the Harvard T.H. Chan School of Public Health, highlights the new features available in the Action Kit 2.0, including more detailed information on costs and health equity impacts. Dr. Gortmaker also discusses how this information can be helpful for planning and prioritization purposes to ensure responsible investments to improve child health, nutrition, physical activity, and health equity.

View the resource round-up from this coffee chat

Download the November 2023 coffee chat presentation slides

← Back to Resources

Coffee Chat: Cost-Effective Communication Resources to Engage Your Community

Posted on September 28, 2023

In this coffee chat, guest speakers Suzanne Gates, Strategic Communication Team Lead, Division of Nutrition and Physical Activity and Obesity Prevention, Centers for Disease Control and Prevention, and Jana Scoville, Project Director, State and Community Health Media Center/Banyan Communications, shared about free and low-cost resources and best practices to support public health professionals in effectively communicating their work to their community.

View the resource round-up from this coffee chat.

Download the September 2023 coffee chat presentation slides

← Back to Resources

Coffee Chat: MAPPing your way to data-based decision-making

Posted on February 23, 2023

In this coffee chat, Anna Clayton, Senior Program Analyst from the National Association of County and City Health Officials, provides an overview of the recent updates to the Mobilizing for Action through Planning and Partnership (MAPP) framework and highlights available resources and tools to support community health improvement work.

← Back to Resources

Stories from the Field: Allegheny County Strengthens Partnerships to Make Progress Toward Local Impact

Posted on June 24, 2021

Three kids at the playground

The information in this Story from the Field is intended only to provide educational information.

In this Story from the Field, partners in Allegheny County, Pennsylvania, used the CHOICES framework and tools to engage partners in identifying and prioritizing strategic opportunities for action to promote healthy weight for children in their community.

Identifying Priorities in Allegheny County, PA

The Allegheny County Health Department (ACHD) engaged community members and public health partners through the Mobilization for Action through Planning and Partnerships (MAPP) process to help prioritize their planning efforts. The ACHD identified reducing obesity among school-aged children as a key objective to improve chronic disease risk factors – a priority area identified in their Community Health Improvement Plan.

Strategic Alignment to Promote Child Health

The ACHD leveraged funds to support capacity building and infrastructure to establish the Healthy Kids Allegheny Task Force. This task force brought together partners with a multi-sectoral, collaborative focus on children’s health and wellness.

The task force looked to identify strategies to effectively reduce childhood obesity and to ensure their resources were being invested responsibly. They also were looking for ways to advance the strategic priorities of Live Well Allegheny – a county-wide campaign to improve the overall health and wellness of Allegheny County residents.

Engaging Partners to Create Evidence for Action

The ACHD teamed up with the Childhood Obesity Intervention Cost-Effectiveness Study (CHOICES) Project through its Learning Collaborative Partnership program. In this program, the CHOICES Project works with health agencies to create new, local evidence to inform decision-making. The ACHD team saw an opportunity to identify strategies to promote child health and learned how to use local data and apply cost-effectiveness analysis methods to prioritize effective strategies to reduce childhood obesity in Allegheny County. To identify relevant strategies, the ACHD team assembled a group of key partners:

• the Healthy Kids Allegheny Task Force
• Allegheny Partners for Out-of-School Time
• Healthy Out-of-School Time
• the United Way of Southwestern Pennsylvania
• Children’s Hospital of Pittsburgh
• Live Well Allegheny Schools and Community Partners

Evaluating Opportunities to Address Key Priorities

ACHD identified partners early in the process. This facilitated engagement in the selection of school and afterschool settings as key areas for collaboration. The ACHD CHOICES team opted to focus on Active Physical Education in schools and a Healthy Snack Policy in afterschool programs from the CHOICES menu of strategies with strong evidence for impact on health and data on cost-effectiveness.

Then, the team used CHOICES tools to identify the activities and resources needed to put these strategies into action, considered the interests of partners, and discussed what would be feasible to implement. These tools helped the team answer several key questions for planning:

1. What is the strategy?
2. Where is it implemented?
3. Which populations are impacted?
4. Who will be involved in implementing the strategy?
5. What is the status of this strategy in your state, county, or city?

Lessons Learned

The ACHD CHOICES team engaged partners to establish what would need to happen to implement their chosen strategies, who would need to be involved, and what impact these strategies would have in their community. These efforts enabled them to identify feasible implementation plans that are projected to make an impact on health. Using CHOICES tools and resources, the ACHD CHOICES team and partners developed evidence they could use to make a case for investing in these efforts to promote a healthy weight.

 

Active Physical Education in Schools

A policy requiring provision of 50% moderate-to-vigorous physical activity in physical education classes.

See what would happen if Active PE was implemented in schools in Allegheny County

Healthy Snack Policy in Afterschool Programs

A policy that sets nutrition standards to ensure that all food and beverages available in programs meet national standards to support good nutrition.

See what would happen if a healthy snack policy was implemented in afterschool programs in Allegheny County 

 

“Partnering with the CHOICES Team equipped the ACHD Team with a clear understanding of what it would take to implement the strategies that we modeled, and a very specific guide for doing so. Strategic alignment of our partners and the evidence from this work with CHOICES helped us to have more informed conversations with decision-makers.” – Hannah E. Hardy, Director, Chronic Disease & Injury Prevention Program, Allegheny County Health Department

 

Suggested Citation:

CHOICES Stories from the Field: Allegheny County Strengthens Partnerships to Make Progress Toward Local Impact. Allegheny County Health Department, Pittsburgh, PA, and the CHOICES Project Team at the Harvard T.H. Chan School of Public Health, Boston, MA; June 2021. For more information, please visit www.choicesproject.org
Funding

This work has been supported by The JPB Foundation and the Centers for Disease Control and Prevention (U48DP006376). This story from the field is intended for education use only. The findings and conclusions are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention, or other funders.

← Back to Resources

Making CHOICES in a Health Department: Case 2 (Advanced)

Posted on May 13, 2021

People drawing on a whiteboard

In this advanced teaching case, which builds on Case 1, a fictional health department continues to work with the CHOICES Project’s Learning Collaborative Partnership to determine how to implement an evidence-based strategy that requires substantial investment, but they face a variety of additional challenges such as state politics and the complexities of health policy.

← Back to Resources

Making CHOICES in a Health Department: Case 1 (Introductory)

Posted on May 13, 2021

In this introductory teaching case, a fictional health department engages with the CHOICES Project’s Learning Collaborative Partnership to help them narrow down a list of potential strategies to reduce childhood obesity in their county through a cost-effectiveness lens.

← Back to Resources

Stories from the Field: Denver Takes Action to Promote Healthy Child Weight

Posted on November 30, 2020

The information in this Story from the Field is intended only to provide educational information.

In this story from the field, partners at Denver Health worked with the CHOICES Team to see what might happen if they made changes to their electronic medical record systems to prompt pediatric medical providers to recognize children with too much weight for their health during well-child visits, and provide follow-up supportive care, education, and educational messages to families.

Identifying Priorities in Denver

Two departments of Denver Health – Denver Public Health and Community Health Services – identified healthy weight as a goal of their local Community Health Improvement Plan to address local population health priorities. Many partners had several ongoing initiatives to ensure that Denver’s children did not have too much weight for their health. As the health care provider for one-third of Denver’s children, Denver Health recognized its potential to reach more families by undertaking additional actions within its health system. Evidence suggests that racial, ethnic, and low-income groups in U.S. communities tend to have greater exposure to negative environmental influences and less access to protective factors, making maintaining a healthy weight more challenging.

Gathering Information for Action

In 2017, partners in Denver teamed up with the Childhood Obesity Intervention Cost-Effectiveness Study (CHOICES) Project at the Harvard T.H. Chan School of Public Health’s Learning Collaborative Partnership. The CHOICES Project works with health agencies to create new evidence to inform decision-making. Using local data, health agencies learn how to apply evaluations of effectiveness, reach, and cost to understand the relative cost-effectiveness of strategies to prevent and treat childhood obesity.

Strategy Selection

The Denver Learning Collaborative Partnership Team attended a CHOICES training and reviewed strategies to find best-value-for-money options for preventing children from having too much weight for health. One approach seemed particularly relevant: The Study of Technology to Accelerate Research (STAR), a clinical strategy that had been shown effective in a randomized trial.1

The Intervention

STAR uses decision support tools in the Epic electronic medical record system to help the health care team recognize and engage supports for children at annual well-child visits. Families receive education and can opt to receive text messages on healthy habits, like increasing physical activity and adopting healthier nutrition practices.

The Change Needed

While Denver Health had many pieces for STAR already in place, they would need several adjustments. Denver Health needed to modify its health record protocol to include diagnosis, screening, and decision support prompts for children with a BMI at or above 85%. Denver Health could build on its existing text messaging system and develop materials to provide relevant education and resources to parents and families, and then ensure training opportunities for pediatricians.

Steps Taken for Implementation

  • Interviewed clinicians to build engagement and incorporate feedback in Epic modifications to include decision support tools and prompts to help identify and manage children with too much weight for health

  • Surveyed families to inform educational content and text message program

  • Modified Epic to include decision support tools

  • Trained the health care team on the changes in Epic and the available resources for families

Helping Change Happen

Through the CHOICES Learning Collaborative Partnership, the CHOICES Team works with local stakeholders to make projections about what may happen if they implement a program or policy. Here they calculated that STAR could reach 19,400 children in Denver over ten years and prevent 300 children from having too much weight for their health. For every dollar spent implementing STAR, $0.78 would be saved in health care costs because more children would have a healthier weight.2 This strategy is projected to both improve overall population health, as well as reduce disparities in too much weight for health among children. What’s more, this information gave Denver Health data to support a grant application for strategy implementation. With leadership support and funding, Denver Health was well positioned to begin implementing components from STAR in 2019.

Impact & Lessons Learned

Since 2019:
An info graphic that states: "11 Denver health clinics implementing the strategy," and "8 Denver health training materials created."

With the STAR clinical strategy, it was so feasible compared to other strategies, and when looking at our entire budget, it is a drop in the overall bucket of funding.” – Jennifer Moreland, Chronic Disease Manager, Denver Public Health

References

  1. Taveras E., Marshall R., Kleinman KP, Gillman MW, Hacker K…Simon SR. (2015). Comparative Effectiveness of Childhood Obesity Interventions in Pediatric Primary Care: A Cluster-Randomized Clinical Trial, JAMA Pediatrics, 169(6):535-542

  2. Moreland J, Rosen J, Kraus E, Reiner J, Gortmaker S, Giles C, Ward Z. Denver: Study of Technology to Advance Research (STAR) [Issue Brief]. Denver Public Health and Denver Health, Denver, CO, and the CHOICES Learning Collaborative Partnership at the Harvard T.H. Chan School of Public Health, Boston, MA; July 2018.

Suggested Citation:

CHOICES Stories from the Field: Denver Takes Action to Promote Healthy Child Weight. Denver Public Health, a Department of Denver Health, Denver, CO, and the CHOICES Project Team at the Harvard T.H. Chan School of Public Health, Boston, MA; October 2020.

← Back to Resources

Stories from the Field: Oklahoma Takes Action to Improve Child Health

Posted on May 29, 2020

The information in this Story from the Field is intended only to provide educational information.

In this story from the field, partners in Oklahoma worked with the CHOICES Team to see what would happen if they took actions in the Special Supplemental Program for Women, Infants, and Children (WIC) in Oklahoma that could help families reduce the time their young children spent watching TV, where they are frequently exposed to ads for unhealthy foods.

Identifying Priorities in Oklahoma

In 2014, Oklahoma Governor Mary Fallin requested a plan for using data and evidence to inform public health decision-making and minimize costs. Leaders from the state health and human services agencies came together and prioritized obesity as the most important issue to address.1

The Oklahoma State Department of Health (OSDH) and the Oklahoma Department of Human Services (OKDHS) identified the Special Supplemental Program for Women, Infants, and Children (WIC) as a key opportunity for focusing on obesity prevention because more than 40,000 Oklahoma children ages 2 to 4 (27%) participate in WIC – and nearly 15% of those children have obesity.2

Gathering Information for Action

In 2016, OSDH and OKDHS partnered with the Childhood Obesity Intervention Cost-Effectiveness Study (CHOICES) Project at the Harvard T.H. Chan School of Public Health’s Learning Collaborative Partnership (LCP). The CHOICES Project works with health agencies to create new evidence to inform decision-making. Using local data, state and local health agencies learn how to apply evaluations of effectiveness, reach, and cost to understand the relative cost-effectiveness of strategies to prevent and treat childhood obesity.

Strategy Selection

The Oklahoma CHOICES Team (OSDH and OKDHS) sought best-value-for-money strategies for preventing obesity among Oklahoma’s young children. The Oklahoma CHOICES Team attended a CHOICES training where they reviewed potential strategies with a strong evidence base. Limiting screen time is a recommended strategy to promote healthy weight among children.

The Intervention

In this scenario, WIC clinic staff would need to ask caregivers how much screen time their children view and talk with them about how to reduce that time. Prior research has shown this method to be effective.3 Reducing screen time can reduce the risk for obesity because of decreased exposure to unhealthy foods and drinks.

The Change Needed

The Oklahoma CHOICES Team, along with the OK WIC Service Team, determined that the WIC online electronic participant record needed modification so that WIC clinic staff could ask caregivers how much screen time their children view during WIC recertification visits, and provide tailored counseling to caregivers on how to reduce that time.

An infographic titled, "How much screen time should my child get?" It outlines screen time as television, computers, video games, and hand held devices like tablets, ipads, and smart phones).

Handout created by Oklahoma WIC Service given to participants during counseling sessions

 

Helping Change Happen

As part of the LCP, the CHOICES Team works with local stakeholders to make projections about what may happen when a program or policy is implemented. Through this collaboration, the partners determined that these program changes could result in 149,000 Oklahoma children adopting healthy screen time behaviors over 10 years and the prevention of 660 cases of childhood obesity in the final year. For every dollar spent putting this strategy into effect, $20.90 would be saved in obesity-related health care costs over 10 years. After reviewing these data and realizing how easy it would be to modify the WIC software, the Oklahoma Team decided to make the change. Screen time counseling in the Oklahoma WIC program was rolled out in 2017.

Steps Taken for Implementation

  • Modified the online system Public Health Oklahoma Client Information System (PHOCIS) to prompt WIC counselors to ask screen time question
  • Conducted staff training for WIC counselors
  • Created educational materials to use with families during counseling sessions
  • Asked participating families about their children’s screen time habits
  • Provided families the option to discuss screen time habits during the counseling session and/or to receive educational materials

Impact & Lessons Learned

Since 2017:
An infographic stating: "nearly 30,000 families received screentime guidance" and "75% are taking steps to reduce screentime."

We learned two key things: the very positive result of reducing screen time, and that this strategy was something we could not only model but implement, and we could do it fairly quickly.” – Terry Bryce, State WIC Director

References

  1. Oklahoma State Department of Health. Oklahoma Health 360° – Obesity Report. Retrieved from: https://www. ok.gov/health2/documents/Health%20360%20_OBESITY%20Final%20Report%2011.3.17.pdf 
  2. Communication with Oklahoma State Department of Health: WIC Service. (2017).
  3. Whaley SE, McGregor S, Jiang L, Gomez J, Harrison G, Jenks, E. A WIC-Based Intervention to Prevent Early Childhood Overweight. J Nutr Educ Behav. 2010;42(3 Suppl):S47-51.
Suggested Citation:

CHOICES Stories from the Field: Oklahoma Takes Action to Improve Child Health. Oklahoma State Department of Health & Oklahoma Department of Human Services, Oklahoma City, OK, and the CHOICES Project Team at the Harvard T.H. Chan School of Public Health, Boston, MA; May 2020.

← Back to Resources