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How
To Write An ACPM Policy Statement
Procedure
for Topic Selection
Topic Selection Criteria
for ACPM Practice Policy and Public Policy
Statements
From Creation to
Publication…The Path That Policies
Follow
Practice Policy and
Public Policy Content and Format
Requirements
How To Get Involved
Procedure
for Topic Selection
ACPM
policy statements are authored by: 1) ACPM
members; or 2) Preventive medicine
residents, in conjunction with their
residency directors or other mentors.
Qualified
candidates who are interested in writing a
practice or public policy statement must
submit a written request to ACPM staff
before beginning work on the policy.
Authors must note which type of statement
they would like to complete. Authors must
address each of the "Topic Selection
Criteria" (see below) in
preparing their written justification for
developing a particular practice policy or
public policy.
Residents
wishing to complete a policy must have
their faculty preceptors co-sign their
policy requests, which should state the
preceptors' commitment to mentor the
residents in development of their
policies. Signed requests should be faxed
directly to 202-466-2662, attention of
Jennifer Bretsch.
Topic
Selection Criteria for ACPM Practice
Policy and Public Policy Statements
Approval
of a practice policy or public policy
topic requires the demonstration of the
following:
- Importance
of the target condition to preventive
medicine and public health.
The target condition should be
responsible for a large burden of
suffering (as measured by mortality,
morbidity, or quality of life) or
represent that potential (e.g.,
epidemics, disasters).
- Uncertainty
regarding the impact of the
intervention on mortality, morbidity,
or quality of life.
Questions regarding the efficacy
and effectiveness of the intervention
and potential harm should be
identified.
- Relevance
to preventive medicine practitioners.
The topic should relate to the
practice of preventive medicine in
clinical or population-based settings.
- Focused
scope of topic.
The scope should be targeted
narrowly enough for key issues to be
identified and addressed clearly and
succinctly in the development of the
practice policy.
From Creation to
Publication…The Path That Policies
Follow
1)
Author submits the first draft of a policy
to the ACPM coordinator, who shares it
with the Chair or Vice Chair of the
Prevention Practice Committee for initial
review. Revisions may need to be made by
the author before the draft is submitted
for further review.
2)
The coordinator submits the draft to the
Prevention Practice Committee members and
at least one content expert.
3)
The Chair, Vice Chair, and Coordinator
review and edit the committee and expert
responses and submit them to the author
along with suggestions for further
revisions. If discord exists among the
committee members, the Chair or Vice-Chair
is responsible for resolving
disagreements, soliciting additional
information or discussion as necessary.
4)
The Chair/Vice Chair and Coordinator
review the revised draft and suggest
further revisions if needed.
5)
The Coordinator concurrently submits the
revised draft, if approved by the
Committee, to the ACPM Board, the Policy
and Science Committee chairs, and to American
Journal of Preventive Medicine (AJPM)
for peer review.
6)
The Chair/Vice Chair and the coordinator
assemble, consolidate, and edit the
comments and submit them to author for
further revisions.
7)
If substantive changes have been made, the
ACPM Board again reviews the policy when
the author resubmits it.
8)
The Coordinator submits the approved
policy to AJPM for publication.
Practice
Policy and Public Policy Content and
Format Requirements
The
manuscript should be typed, double-spaced
and submitted by e-mail. The writing
should be concise and in the traditional
style of medical journals. Citations
should be numbered in the sequence in
which they appear in the text and should
conform with the style used by JAMA.
Evidence cited in the practice policy
statement should generally be limited to
articles published in peer-reviewed
journals. In some cases, a thoughtful
discussion of the evidence cannot be
prepared without first examining the
complete body of evidence. Key primary
studies that are central to the discussion
can be cited, but a comprehensive listing
of all published literature is not
required. Secondary sources may be listed.
Separately, a list of the references
reviewed but not cited in the policy
should be submitted. Unpublished data or
studies in press should generally not be
cited as supporting evidence.
Authorship:
Individuals should be listed as authors
only if they have made substantial
contributions to analysis and
interpretation of the data; and to the
drafting of the article or critical
revision for important intellectual
content. The lead author of the policy
should be the physician who had the major
responsibility for the project including:
overall design, analysis, and drafting of
the manuscript. The lead author must be an
ACPM member, preventive medicine resident,
or preventive medicine residency director.
In
most cases, the practice policy should be
organized in the following format:
Title
Page: The title of the practice policy
should be the limited to the name of the
preventive maneuver. "Screening for
Cervical Cancer" is appropriate,
"Cervical Cancer" or
"Controversies in Cervical Cancer
Screening" are not. The subtitle
should be: "American College of
Preventive Medicine Practice/Public
Policy." The authors and their
affiliations, as well as the supervising
faculty member, should be listed on the
title page.
Burden
of Suffering: This is a one-paragraph
overview of the morbidity and mortality
associated with the target condition
(e.g., colon cancer, coronary artery
disease). It includes brief review of the
incidence/prevalence of the condition,
mortality and survival rates, and
description of the morbidity associated
with the condition. A sentence about
principal risk factors (not an
encyclopedic list of all possible
causes/risk factors) is appropriate. A
sentence about the economic implications
of the condition is also appropriate.
Description
of Preventive Measure(s): This is a
one-paragraph description of the nature of
the preventive measure(s) to be addressed
in the practice/public policy. It should
include a short explanation of how the
intervention generally is performed and
the intended rationale for the
intervention. For example, "The
principal screening tests for breast
cancer include the clinical breast
examination, mammography, and breast
self-examination, which are performed to
detect early-stage tumors..."
Evidence
of Effectiveness: This is a one- or
two-paragraph summary of existing evidence
regarding the clinical effectiveness
of the preventive measures. The discussion
should be limited to evidence of an effect
on clinical outcomes (e.g., mortality,
survival, cardiac events) and should not
digress into discussions of the effect of
interventions on intermediate outcomes
(e.g., HDL-cholesterol levels, hemoglobin
concentration). Both the data and quality
of the evidence should be discussed:
i.e., the results of studies should be
qualified by a comment on their
methodologic quality. For example, rather
than stating "Studies indicate that
screening improves survival," the
text should be broadened: "Numerous
uncontrolled observational studies have
reported improved survival for early-stage
disease, but the results may reflect
lead-time and length biases rather than an
improvement in clinical outcomes." A
single evidence table can be included that
provides the following information on key
studies: authors and year of publication,
study design, sample size, intervention,
outcome, and comments on quality and
validity.
To
save space, the discussion should be
limited to the key scientific issues that
relate to effectiveness. For screening
tests, these issues include (1) the
accuracy of the screening test (e.g.,
sensitivity, specificity, positive
predictive value, reliability) and (2) the
effectiveness of early detection (i.e.,
evidence that screened persons experience
better outcomes than those who are not
screened). For health promotion and
patient education interventions (e.g.,
smoking cessation counseling), the issues
include (1) evidence that risk
modification reduces the risk of the
target condition and (2) evidence
regarding the effectiveness of clinical or
community-based interventions to motivate
behavior change. For immunizations or
chemoprophylactic regimens (e.g., estrogen
replacement therapy), the issues center on
the biological efficacy of the vaccine.
In
addition to discussing the potential
benefits of the maneuver(s), this section
also should address the potential adverse
effects or complications associated with
the procedure or its follow-up. Decision
analyses and meta-analyses that have
attempted to pool results regarding
benefits and harms can be cited, but it is
not necessary (or feasible) for the
writers of the practice policy to conduct
their own modeling analyses.
Public
Policy Considerations: This is a
one-paragraph summary of the issues
affecting the feasibility and
affordability of performing the preventive
maneuver. When indicated, this section
should address such concerns as
cost-effectiveness, patient/provider
compliance, and access to care if they are
essential to understanding current
controversies about appropriate
indications.
Recommendations
of Other Groups: This is a
one-paragraph summary of the positions of
major medical and public health
organizations and government agencies
regarding the maneuver(s) discussed in the
practice policy. Only the position of the
organization should be listed; the
underlying rationale need not be
discussed. In general, no more than one
sentence should be devoted to a single
organizational position. Recommendations
issued by expert panels and some
international bodies may also be
appropriate, but the recommendations of
individual authors or of minor
organizations (e.g., local health plan,
hospital association) should not be
listed.
Rationale
Statement: This is a one-paragraph
summary including an explanation of why
ACPM is taking the following position.
This explanation should focus on the key
controversies that surround the issue and
should provide a brief scientific or
policy argument for the position taken.
Recommendations
of the American College of Preventive
Medicine: This section should include
the recommended position of ACPM, not to
exceed two paragraphs. The recommendations
should provide a crisp, practical summary
of the recommended practice, addressing
such issues as who should receive the
preventive maneuver, at what age, how
often, and the manner in which it should
be performed. Often, special
recommendations for high-risk groups are
necessary. For some topics, a detailed
explanation of how to perform the maneuver
will be beyond the scope of the practice
policy. In such cases, the reader should
be referred to other sources for more
details. Digression into the rationale for
the recommendation or a discussion of the
supporting evidence should be avoided;
these topics should instead be addressed
in earlier sections. In addition to
practice recommendations, the practice
policy should include a one-to-two
sentence summary of recommended research
priorities for providing better evidence
of effectiveness.
Summary
for Prevention Practice Committee: On
a separate page, the authors of the
practice policy should provide a brief,
but complete summary of the differences -
if any - between the proposed practice
policy and the position taken by the U.S.
Preventive Services Task Force (USPSTF).
Although, in the past, ACPM has endorsed
the recommendations of the USPSTF, ACPM
practice policies need not conform with
USPSTF positions. In reviewing proposed
practice policies, however, the ACPM
Practice Guidelines Committee finds it
useful to consider the author's rationale
for departures from the USPSTF
recommendations.
Please
note that the format of ACPM Practice
Policies will evolve over time as
participating departments and reviewers
provide suggestions. Improvements in the
format will be reflected in revised drafts
of this document.
How To Get
Involved
Contact
Jennifer Rogers, ACPM
Program
Manager and Staff to the ACPM Practice
Guidelines Committee, at 202-466-2044,
ext. 107 or
jer@acpm.org.
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