Spotlight on the Pathways to Prevention Program

Newsletter | Summer 2018

Newsletter | January 2016

PARTNERSfor Prevention

Partners for Prevention Newsletter ┃ Summer 2018

NIH Office of Disease Prevention ┃

In This Issue

1 About the P2P Program

1 The P2P Process

2 Assessing the Impact of the P2P Program

6 What’s Next for P2P?

7 About the Office of Disease Prevention

8 ODP Staff Contacts

About the P2P Program

Sponsored by the NIH Office of Disease Prevention (ODP), the Pathways to Prevention (P2P) program addresses complex public health issues that have incomplete or underdeveloped research and for which there is a need for a critical assessment of the current state of the science. Each year, the P2P program conducts workshops that apply an unbiased, evidence-based approach to identify research gaps in a selected scientific area and suggest ways to move the field forward.

To date, the ODP has sponsored six P2P workshops:

�� Methods for Evaluating Natural Experiments in Obesity (2017)�� Advancing Research To Prevent Youth Suicide (YSP) (2016)�� Total Worker Health®—What’s Work Got To Do With It? (2015)�� Advancing the Research on Myalgic Encephalomyelitis/Chronic Fatigue Syndrome

(ME/CFS) (2014)�� The Role of Opioids in the Treatment of Chronic Pain (Opioids) (2014)�� Polycystic Ovary Syndrome (2012).

This summer supplement spotlights key outcomes of two P2P workshops, The Role of Opioids in the Treatment of Chronic Pain and Advancing the Research on Myalgic Encephalomyelitis/Chronic Fatigue Syndrome, showing how the P2P program might benefit areas of research within individual NIH Institutes or Centers (ICs).

The P2P Process

Each P2P workshop is planned through a collaboration of partners from across the NIH, other federal agencies, experts in the field, and individuals representing public-centered values and concerns.

Any two or more ICs may submit a proposal to the ODP outlining a workshop idea. Other government agencies or trans-agency workgroups, professional societies, and advocacy organizations may also propose topics in collaboration with an IC as a co-sponsor.

Topics that qualify for a P2P workshop must have:

�� A primary or secondary disease-prevention focus�� Broad public health importance�� Limited published data, or incomplete or underdeveloped research�� A need for a systematic review of the existing evidence base�� Two or more ICs committed to addressing the topic by participating in workshop activities,

such as planning the scientific agenda for the workshop and the post-workshop Federal Partners Meeting.

Once an application is reviewed and accepted, the ODP P2P Coordinator works with the IC Coordinators, the Agency for Healthcare Research and Quality (AHRQ) Evidence-based Practice Centers Program, the P2P workshop panel, and the Workshop and Panel Chair to plan and conduct the workshop (Figure 1).

| NIH Office of Disease Prevention

Partners for Prevention Newsletter | Summer 2018

Figure 1: NIH ODP Pathways to Prevention Process

PROPOSAL REVIEW AND APPROVAL

PLANNING AND IMPLEMENTATION

ODP ReceivesP2P WorkshopProposal

*IC Leads

ODP AcceptsP2P WorkshopProposal

*ODP

DISSEMINATION AND FOLLOW-UP

Post-WorkshopDissemination

*ODP & IC Leads

FederalPartnersMeeting

*ODP & IC Leads

Systematic Evidence Review

OrganizationalMeeting

*ODP & IC Leads

Content-Area Expert Group Meeting

*ODP & IC Leads

*AHRQ EPC

Pathways to Prevention Workshop

*ODP & IC Leads

*Responsible Party [Agency for Healthcare Research and Quality (AHRQ); Evidence-based Practice Centers (EPC); Institute and Centers (IC); Office of Disease Prevention (ODP)]

A key feature of the P2P program is the workshop panel. For each workshop, an unbiased, independent panel of experts is recruited by the ODP to appropriately reflect a diverse set of professional and experiential perspectives, such as epidemiologists, biostatisticians, and other academic health professionals. The panel’s purpose is to give balanced, objective, and informed attention to the scientific topic. The panel moderates the workshop and writes a report that summarizes areas where research is needed and provides key recommendations for next steps.

Key outcomes of each P2P workshop include the systematic evidence review, panel report, and Federal Partners Meeting report.

Assessing the Impact of the P2P Program

In considering the impact of the P2P program, we sought to answer three key questions:

�� How many people participated in the P2P program workshops and what was their professional makeup? �� How have the P2P program’s published reports

impacted the research community?�� Did the P2P program catalyze new research to address

the gap areas identified by each workshop?

The next four pages highlight some initial findings from two P2P workshops conducted in 2014—The Role of Opioids in the Treatment of Chronic Pain (Opioids) and Advancing the Research on Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS).

Program Registrants Represent a Broad Spectrum of  StakeholdersEach of the six completed P2P workshops had between 400 and 900 registrants (combined in-person and online viewers) (Figure 2). Registration varied by topic, with the Methods for Evaluating Natural Experiments in Obesity workshop having the largest total number of registrants at 887.

The Opioids and ME/CFS workshops attracted attendees representing a wide variety of professions (Figures 3 and 4). A total of 43% of the registrants for the Opioids workshop were comprised of researchers and physicians; the other 57% represented key stakeholder groups (e.g., psychologists, nurses, advocates). Similarly, the attendees at the ME/CFS workshop were primarily physicians, advocates, and researchers. For both workshops, about 20% of attendees identified their profession as “other,” which included, for example, people who identified themselves as those impacted by the health issue of interest (such as people who reported they had chronic pain or ME/CFS). These data show that P2P workshops serve as a forum for individuals from multiple disciplines to discuss research needs and gaps on a given complex public health topic.

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Figure 2: Number of Registrants per P2P Workshop

Estimated In-person Attendance (IA)

Web-based Attendance (WA)

Total Registrants (TR)

IA WA TR

365

490

887

Obesity Methods(2017)

IA WA TR

174

404

556

Youth Suicide Prevention

(2016)

IA WA TR

127

506

715

Total Worker Health

(2015)

IA WA TR

176235

441

ME/CFS

(2014)

IA WA TR

442

226

668

Opioids andChronic Pain

(2014)

359

IA WA TR

293

634

Polycystic Ovary Syndrome

(2012)

Figure 3: P2P Opioids and Chronic Pain Registrants by Profession

Figure 4: P2P ME/CFS Registrants by Profession

Published Reports from P2P Workshops

Systematic Evidence ReviewPrepared by one of the AHRQ Evidence-based Practice Centers, the review provides a comprehensive and objective assessment of the state of the science, including a summary of published research and a summary of research needs and gaps. The systematic evidence review summarizes the state of published research for each workshop.

Panel ReportWritten by the independent panel immediately following the P2P workshop, the panel report provides a synthesis of the evidence review and information presented by experts during the workshop. It lays out the panel’s key recommendations for addressing research gaps and moving the field forward.

Federal Partners Meeting ReportPrepared by the ODP at the conclusion of the Federal Partners Meeting, this report summarizes the opportunities that participating federal agencies have identified for collaboration and next steps in addressing the panel’s recommendations. The Federal Partners Meeting provides a forum for experts from across the federal government to develop an action plan for addressing the topic’s research needs and gaps.

You can read reports from past P2P workshops online.

Nurse 5%

Administrator 10%

Nurse 10%

Researcher 18%

Other 20%

Physician 25%

Unknown 1%

Psychologist 4%

Press 2%

Advocate 5%Other

Allied Health Professional

7%

Physician 22%

Other 21%

Administrator 8%

Researcher 15%

Advocate 19%

Psychologist 3%

Press 3%

Other Allied Health Professional

4%

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| NIH Office of Disease Prevention

Partners for Prevention Newsletter | Summer 2018

Relative Citation Ratio (RCR) was developed by the NIH Office of Portfolio Analysis as a measure of a publication’s impact in the literature, normalized for publication age and field publication rate. The RCR is a ratio; an RCR of 1.0 means that the publication has the same citation rate as the average for the field.

Altmetric Attention Scores are available from Altmetric.com. Altmetrics are “alternative” metrics and qualitative data that are complementary to traditional, citation-based metrics. A score is weighted to account for citations in many different venues, including peer reviews on Faculty of 1000, citations on Wikipedia, public policy documents, discussions on research blogs, mainstream media coverage, and mentions on social networks such as Twitter.

P2P Publications Attract Widespread Attention and EngagementThe published P2P workshop evidence review and panel report are an important way for the ODP to communicate identified research gaps to researchers, the public, and other funding institutions.

Both the systematic evidence reviews and the independent panel reports from the Opioids and ME/CFS workshops have RCR values that exceed 1.0, indicating a higher citation rate than the average publication in the field (Figure 5). The systematic evidence review and panel reports for the ME/CFS workshop are three to four times more impactful than the average publication, while the systematic evidence review for the Opioids workshop is especially influential, with a citation rate that is 50 times greater than the average publication. This metric suggests that the systematic evidence review for Opioids is playing a particularly important role in the current larger discussion about the use of opioids in the treatment of chronic pain.

Figure 5: Relative Citation Ratio of P2P Publications

4.6

4.8

3.7

7.9

56.6Opioids and Chronic Pain: Systematic Evidence Review

Opioids and Chronic Pain: Panel Report

ME/CFS Diagnosis: Systematic Evidence Review

ME/CFS Treatment: Systematic Evidence Review

ME/CFS: Panel Report

To assess the impact of P2P publications beyond the scientific community, we obtained Altmetric Attention Scores for the Opioids and ME/CFS workshop reports (Figure 6). Compared to documents published within 6 weeks of each article (to avoid biases due to the age of a publication), we found that these reports score within the top 5% of similar documents. They were referenced in news articles (Table 1), tweets, and policy documents (Table 2). This suggests that the research gaps identified in the workshops are being disseminated broadly and have stimulated public discussion.

Figure 6: Altmetric Score Normalized Publication Percentile Rank

TWH: Systematic Review

YSP: Systematic Review

YSP: Panel Report

TWH: Panel Report

ME/CFS Diagnosis: Systematic Review

ME/CFS: Panel Report

ME/CFS Treatment: Systematic Review

Opioids and Chronic Pain: Panel Report

Opioids and Chronic Pain: Systematic Review 99.86%

99.60%

98.75%

98.61%

97.96%

95.68%

95.66%

94.54%

94.01%

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Partners for Prevention Newsletter | Summer 2018

5NIH Office of Disease Prevention |

Figure 7: Number of News Articles

TWH: Systematic Review

YSP: Systematic Review

YSP: Panel Report

TWH: Panel Report

ME/CFS Diagnosis: Systematic Review

ME/CFS: Panel Report

ME/CFS Treatment: Systematic Review

Opioids and Chronic Pain: Panel Report

Opioids and Chronic Pain: Systematic Review 27

17

4

2

4

2

4

3

2

Table 1: Sample of News Articles Mentioning the P2P Workshops

Title P2P

NIH Study Aims To Unravel the Illness Known as ‘Chronic Fatigue Syndrome’ ME/CFS

NIH Announces Centers for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Research ME/CFS

A Reboot for Chronic Fatigue Syndrome Research ME/CFS

Chou Urges Non-Opioid Therapies for Chronic Pain Opioids

Reflections on the Role of Opioids in the Treatment of Chronic Pain: A Shared Solution for Prescription Opioid Abuse and Pain

Opioids

Chronic Pain: Do Opioid Painkillers Really Help? Opioids

Suicide Prevention: Creating a Safer Culture YSP

The National Action Alliance for Suicide Prevention Responds to Youth Suicide Data Published in the Morbidity and Mortality Weekly Report

YSP

Table 2: Federal Reports and Clinical Guidelines Referencing P2P Workshops

Document P2P

Pain Management and the Opioid Epidemic, National Academies of Sciences Engineering Medicine Opioids

CDC Guideline for Prescribing Opioids for Chronic Pain—United States, 2016, CDC Opioids

Pain Management and Prescription Opioid-Related Harms, National Academies of Sciences Engineering Medicine Opioids

Chronic Fatigue Syndrome: Advancing Research and Clinical Education, CDC ME/CFS

| NIH Office of Disease Prevention

Partners for Prevention Newsletter | Summer 2018

The P2P Program Helps To Identify Areas That Need Greater Research InvestmentIC coordinators highlighted several Funding Opportunity Announcements (FOAs) that were influenced by the research gaps identified in P2P workshops (Table 3). We hope to continue highlighting areas for greater investment by the NIH through the P2P program.

Table 3: Funding Opportunity Announcements

FOA Number Title P2P

RFA-MH-18-400 Addressing Suicide Research Gaps: Aggregating and Mining Existing Data Sets for Secondary Analyses (R01)

YSP

RFA-MH-18-410 Addressing Suicide Research Gaps: Understanding Mortality Outcomes (R01) YSP

RFA-NS-17-021 Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) Collaborative Research Centers (CRCs) (U54)

ME/CFS

RFA-NS-17-022 Data Management and Coordinating Center (DMCC) for the Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) Collaborative Research Centers (CRC) (U24)

ME/CFS

What’s Next for P2P?

Methods for Evaluating Natural Experiments in Obesity Final Panel Report and Federal Partners  MeetingThe P2P program’s most recent workshop, Methods for Evaluating Natural Experiments in Obesity, was held on December 5–6, 2017, on the NIH Main Campus. The workshop was co-sponsored by the National Cancer Institute (NCI); National Heart, Lung, and Blood Institute (NHLBI); and National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). It garnered almost 900 registrants and was attended by a broad spectrum of the obesity research and policy community.

The workshop topic was timely, as the prevalence of obesity in the United States and globally has grown rapidly in the last three decades despite a steady increase in messaging from health care providers (and society, in general) about the importance of avoiding weight gain. The workshop panel assessed the available scientific evidence and considered the most appropriate, high-quality natural experiment research designs in obesity prevention and control that could lead to societal and systems-level changes to help people achieve and maintain a healthy weight.

Pathways to Prevention Workshop: The Role of Opioids in the Treatment of Chronic Pain: (Left to Right): Anika A.H. Alvanzo, Takamaru Ashikaga, G. Anne Bogat, Christopher M. Callahan, Victoria Ruffing, David C. Steffens, David B. Reuben, Nora D. Volkow.

Pathways to Prevention Workshop Panel: Methods for Evaluating Natural Experiments in Obesity: Back Row (Left to Right): Maria E. Fernandez, Jonathan M. Samet, Chyke A. Doubeni, Front Row (Left to Right): Karen M. Emmons, Diana L. Miglioretti.

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Partners for Prevention Newsletter | Summer 2018

The workshop panel’s report, and the systematic evidence review completed by the Johns Hopkins Evidence-based Practice Center, were published in tandem in Annals of Internal Medicine and are available on the Workshop Resources page.

The workshop co-sponsors are in the final phase of the P2P process and planning the Federal Partners Meeting. Look for the Federal Partners Meeting report on the ODP website later this year.

Upcoming P2P Workshops

Fall 2018: Appropriate Use of Drug Therapies for Osteoporotic Fracture Prevention

The NIH P2P program will host its next workshop: Appropriate Use of Drug Therapies for Osteoporotic Fracture Prevention, October 30–31, 2018, in the Natcher Conference Center, NIH Main Campus, Bethesda, Maryland. The workshop’s topic is important because more than 10 million people in the United States have osteoporosis,1 a skeletal disorder that causes bones to become weak and fragile as a result of low bone mass. The condition makes people more susceptible to fractures, which can impair their ability to live independently and even threaten their lives.2 There is a gap in scientific data about the appropriate long-term use of many osteoporosis drugs, and uncertainties about which people will benefit or may be harmed if they take the drugs  long-term.

Co-sponsored by the National Institute on Aging (NIA), National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), and the ODP, the day and a half workshop will assess the available scientific evidence and address the following questions:

1. What are the benefits and risks (including major adverse events) of osteoporotic drugs with short-term use (from first use up to 3–5 years of treatment)? What factors influence outcomes?

2. What are the benefits and risks of osteoporotic drugs over the longer term (for treatment periods longer than 3–5 years)? What factors influence outcomes?

3. Do drug holidays improve outcomes?

4. What patient and clinician factors impact the use of and adherence to osteoporotic drugs?

Spring 2019: Achieving Health Equity in Preventive Services

The ODP is partnering with the NCI, NHLBI, NIDDK, and the National Institute on Minority Health and Health Disparities to host a workshop that will address barriers to the adoption, promotion, and implementation of evidence-based preventive services that target three leading causes of death in the United States: cancer, heart disease, and diabetes. The workshop will also address approaches and strategies to connecting and integrating evidence-based preventive practices among providers and patients, and the health information technologies and digital enterprises that may facilitate the adoption, implementation, and dissemination of evidence-based preventive services in settings that serve disparity populations.

Fall 2019: Can Physical Activity Improve the Health of Wheelchair Users?

The Eunice Kennedy Shriver National Institute of Child Health and Human Development’s National Center for Medical Rehabilitation Research and the National Institute of Neurological Disorders and Stroke have teamed up with the ODP to plan a P2P workshop that will focus on understanding the effects of physical activity interventions in the population of people currently using, or at risk for using, wheelchairs as a result of a disabling injury or illness. The workshop aims to improve research methodology in people who use wheelchairs, sharpen focus on areas of research need, improve patient lives, and provide potential health care cost savings.

About the Office of Disease  Prevention

The mission of the ODP is to improve public health by increasing the scope, quality, dissemination, and impact of prevention research supported by the NIH. Strategic Priority II of the ODP strategic plan is to identify prevention research areas for investment or expanded effort by the NIH. This includes working with stakeholders, such as the U.S. Preventive Services Task Force, the Community Preventive Services Task Force, and the Healthy People initiative, to identify needs in prevention research; comparing those needs to the NIH portfolio to highlight prevention research gaps; and then working with ICs and other federal agencies to address the prevention research gaps through new or intensified funding initiatives and other research endeavors.

Learn more at prevention.nih.gov.

1 Wright NC, Looker AC, Saag KG, et al. The recent prevalence of osteoporosis and low bone mass in the United States based on bone mineral density at the femoral neck or lumbar spine. Journal of Bone and Mineral Research. 2014;29(11):2520–2526. doi: 10.1002/jbmr.2269. 2 Sattui SE, Saag KG. Fracture mortality: associations with epidemiology and osteoporosis treatment. Nature Reviews. Endocrinology. 2014;10(10):592–602. doi: 10.1038/nrendo.2014.125.

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| NIH Office of Disease Prevention

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ODP Staff Contacts

Carrie Klabunde, Ph.D.

P2P Team Lead

KlabundC@od.nih.gov

Keisha Shropshire, M.P.H.

P2P Co-Coordinator

kshropsh@mail.nih.gov

Kate Winseck, M.S.W.

P2P Co-Coordinator

winseckk@mail.nih.gov

Jennifer Hession, M.S.P.H., CHES

P2P Communications

jen.hession@nih.gov

Deborah Langer, M.P.H.

P2P Communications

langerdh@mail.nih.gov

David Tilley, M.P.H., M.S., CPH

P2P Program Support

david.tilley@nih.gov

Isaah Vincent, Ph.D.

AAAS Fellow

isaah.vincent@nih.gov

| NIH Office of Disease Prevention