US Preventive Services Task Force

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US Preventive ServicesTask Force

• Ned Calonge, M.D., M.P.H.

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The U.S. Preventive Services Task Force (USPSTF)

• Independent panel of nationally renowned,
  non-federal experts in primary care and
  evidence-based medicine
• Disciplines family medicine, internal
  medicine/geriatrics, preventive medicine,
  pediatrics/adolescent medicine, Ob/Gyn, nursing,
  counseling/behavioral medicine

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The U.S. Preventive Services Task Force (USPSTF)

• Charged by Congress to
• review the scientific evidence for clinical
  preventive services and
• develop evidence-based recommendations for the
  health care community

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The U.S. Preventive Services Task Force (USPSTF)

• Convened and supported by the Agency for Health
  Research and Quality (AHRQ)
• Works with Evidence-based Practice Centers (EPCs)
  to conduct rigorous, impartial assessments of
  scientific evidence
• USPSTF recommendations are considered the gold
  standard for clinical preventive services

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AHRQ Support of USPSTF
USPSTF
Convenes
Recommendations
AHRQ
Analytic framework development
Evidence presented
Contract to synthesize evidence
EPC
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Process Used by the USPSTF to Make Recommendations

• TF defines question and outcomes of interest in
  the analytic framework
• The EPC conducts review (retrieves relevant
  evidence, evaluates QUALITY of individual
  studies, produces report)
• The TF synthesizes and judges STRENGTH of
  available evidence
• Determines balance of benefits and harms and
  makes recommendations

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Analytic Framework on Screening for a Disease
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Grades of Recommendation
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Wording of recommendations

• A - Strongly recommend
• benefits substantially outweigh harms
• B - Recommend
• benefits outweigh harms
• C - USPSTF makes no recommendation
• benefits and harms closely balanced
• D - Recommend against routine use
• ineffective interventions or harms outweigh
  potential benefits

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The I letter grade

• Insufficient Evidence to Recommend for or against
  the intervention
• Common reasons
• Lack of evidence on clinical outcomes
• Poor quality of existing studies
• Good quality studies with conflicting results
• Possibility of clinically important benefits but
  more research needed to show the benefits

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A recommendations

• Cervical cancer screening
• Colorectal cancer screening
• Hypertension screening
• Lipid disorders screening
• Tobacco counseling
• Chlamydia infection screening
• (non-pregnant adults)

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B recommendations

• Breast cancer screening
• Osteoporosis screening
• Obesity screening
• Depression screening
• Alcohol misuse and behavioral screening
• (non-pregnant adults)

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Pregnancy (all As)

• Asymptomatic bacteriuria screening
• Hepatitis B screening
• Syphilis screening
• Rh(D) incompatibility screening

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Children and adolescents

• Breastfeeding (B)
• Visual impairment screening in children younger
  than 5 years of age (B)
• Dental caries prevention (B)

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High risk group recommendations

• Breast cancer chemoprophylaxis (B)
• Aspirin preventive medication for cardiovascular
  events (A)
• Diabetes, type 2 screening (B)
• Healthy diet-counseling (B)
• Syphilis