# Redesigning Preventive Care Recommendations for Diverse Populations of Veterans

> **NIH VA I01** · VETERANS HEALTH ADMINISTRATION · 2024 · —

## Abstract

Background: Conventional recommendations in national prevention guidelines often fail to address
differences in outcome risk and life expectancy across the target population. By ignoring such differences,
conventional recommendations can inadvertently lead to substantial underuse (by excluding Veterans with
potentially high net benefit who do not meet a conventional cutoff) and overuse (by including Veterans for
whom net benefit would be limited). Further, minoritized patients who could most benefit from prevention are
often disproportionately excluded by conventional recommendations, exacerbating racial disparities. The long-
term goal of the proposed research is to support optimal preventive care decisions for all Veterans. The overall
objective of this proposal is to study an alternative guideline approach (“tailored” recommendations based on
multivariable prediction) that can better support individualized prevention efforts. A second goal is to study the
extent to which optimizing decisions for individuals can broaden the public health impact of preventive care
programs within VA. We use lung cancer screening, statin use, and blood pressure treatment as case studies
as they are ideal models for studying the key issues.
Significance: This work is significant because current knowledge gaps in guideline development, which we
address in this proposal, inhibit progress toward more nuanced preventive care recommendations that often
better identify high-benefit patients and enable more Veteran-centered care.
Innovation and Impact: The proposed research is innovative because it will advance a different paradigm for
developing preventive care guidelines both within and outside VA, which will open new horizons for optimizing
the delivery of cancer screening, cardiovascular prevention, and other prevention. The rationale underlying the
proposed work is that its successful completion would enable guideline-level assessment of when tailored
recommendations would be highly advantageous, to promote more effective and personalized care and
reduce racial disparities.
Specific Aims: Aim 1: Estimate “individualized” net benefit for lung cancer screening, statin use, and blood
pressure treatment. Aim 2: Estimate the comparative effects of conventional recommendations vs. tailored
recommendations. Aim 3: Identify best practices for examining tailored recommendations in future guidelines.
Methods: Under Aim 1, we will adapt existing microsimulation models for each preventive service to estimate
the distribution of predicted (“individualized”) net benefit across the target Veteran population. This will inform
the development of tailored recommendations under the guidance of the Aim 3 Expert Panel. Then, in Aim 2,
we will use Aim 1 microsimulation evidence to examine the pros and cons of conventional vs. tailored
approaches, again with close input from the Expert Panel. For Aim 3a, an Expert Advisory Panel of guideline
experts will engage in a longitudinal process t...

## Key facts

- **NIH application ID:** 10871683
- **Project number:** 5I01HX003505-02
- **Recipient organization:** VETERANS HEALTH ADMINISTRATION
- **Principal Investigator:** TANNER J CAVERLY
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2024
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2023-05-01 → 2027-04-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10871683

## Citation

> US National Institutes of Health, RePORTER application 10871683, Redesigning Preventive Care Recommendations for Diverse Populations of Veterans (5I01HX003505-02). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10871683. Licensed CC0.

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