Advertisement

Current methods of the U.S. Preventive Services Task Force

A review of the process
  • Russell P. Harris
    Correspondence
    Address correspondence to: Russell P. Harris, MD, MPH, Cecil G. Sheps Center for Health Services Research, CB# 7590, 725 Airport Rd., The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7590
    Footnotes
    Affiliations
    School of Medicine and Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill (Harris), North Carolina, USA
    Search for articles by this author
  • Mark Helfand
    Affiliations
    Division of Medical Informatics and Outcomes Research, and Evidence-based Practice Center, Oregon Health Sciences University and Portland Veterans Affairs Medical Center (Helfand), Portland, Oregon, USA
    Search for articles by this author
  • Steven H. Woolf
    Affiliations
    Department of Family Practice, Medical College of Virginia, Virginia Commonwealth University (Woolf), Fairfax, Virginia, USA
    Search for articles by this author
  • Kathleen N. Lohr
    Affiliations
    Research Triangle Institute, Research Triangle Park, and University of North Carolina at Chapel Hill, Program on Health Outcomes and School of Public Health (Lohr), Chapel Hill, North Carolina, USA
    Search for articles by this author
  • Cynthia D. Mulrow
    Affiliations
    Department of Medicine, University of Texas Health Science Center (Mulrow), San Antonio, Texas, USA
    Search for articles by this author
  • Steven M. Teutsch
    Affiliations
    Outcomes Research and Management, Merck & Co., Inc. (Teutsch), West Point, Pennsylvania, USA
    Search for articles by this author
  • David Atkins
    Affiliations
    Center for Practice and Technology Assessment, Agency for Healthcare Research and Quality (Atkins), Rockville, Maryland, USA
    Search for articles by this author
  • Methods Work Group Third U.S. Preventive Services Task Force
  • Author Footnotes
    1 Other members of the Methods Work Group include: Alfred O. Berg, MD, MPH, University of Washington School of Medicine; Karen B. Eden, PhD, Oregon Health Sciences University; John Feightner, MD, MSc, FCFP, University of Western Ontario–Parkwood Hospital; Susan Mahon, MPH, Oregon Health Sciences University; and Michael Pignone, MD, MPH, University of North Carolina School of Medicine.
    2 Reprints are available from the AHRQ Web site at www.ahrq.gov/clinic/uspstfix.htm, through the National Guideline Clearinghouse (www.guideline.gov), or in print through the AHRQ Publications Clearinghouse (1-800-358-9295).

      Abstract

      Abstract: The U.S. Preventive Services Task Force (USPSTF/Task Force) represents one of several efforts to take a more evidence-based approach to the development of clinical practice guidelines. As methods have matured for assembling and reviewing evidence and for translating evidence into guidelines, so too have the methods of the USPSTF. This paper summarizes the current methods of the third USPSTF, supported by the Agency for Healthcare Research and Quality (AHRQ) and two of the AHRQ Evidence-based Practice Centers (EPCs). mThe Task Force limits the topics it reviews to those conditions that cause a large burden of suffering to society and that also have available a potentially effective preventive service. It focuses its reviews on the questions and evidence most critical to making a recommendation. It uses analytic frameworks to specify the linkages and key questions connecting the preventive service with health outcomes. These linkages, together with explicit inclusion criteria, guide the literature searches for admissible evidence. mOnce assembled, admissible evidence is reviewed at three strata: (1) the individual study, (2) the body of evidence concerning a single linkage in the analytic framework, and (3) the body of evidence concerning the entire preventive service. For each stratum, the Task Force uses explicit criteria as general guidelines to assign one of three grades of evidence: good, fair, or poor. Good or fair quality evidence for the entire preventive service must include studies of sufficient design and quality to provide an unbroken chain of evidence-supported linkages, generalizable to the general primary care population, that connect the preventive service with health outcomes. Poor evidence contains a formidable break in the evidence chain such that the connection between the preventive service and health outcomes is uncertain. For services supported by overall good or fair evidence, the Task Force uses outcomes tables to help categorize the magnitude of benefits, harms, and net benefit from implementation of the preventive service into one of four categories: substantial, moderate, small, or zero/negative. mThe Task Force uses its assessment of the evidence and magnitude of net benefit to make a recommendation, coded as a letter: from A (strongly recommended) to D (recommend against). It gives an I recommendation in situations in which the evidence is insufficient to determine net benefit. mThe third Task Force and the EPCs will continue to examine a variety of methodologic issues and document work group progress in future communications.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Preventive Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

      1. Field MJ, Lohr KN, eds. Guidelines for clinical practice: from development to use. Washington, DC: National Academy Press, 1992 (for Institute of Medicine).

        • Woolf S.H.
        • George J.N.
        Evidence-based medicine.
        Hematol Oncol Clin N Amer. 2000; 14: 761-784
      2. Mulrow CD, Cook D, eds. Systematic reviews: synthesis of best evidence for health care decisions. Philadelphia: American College of Physicians, 1998.

        • Cook D.
        • Giacomini M.
        The trials and tribulations of clinical practice guidelines.
        JAMA. 1999; 281: 1950-1951
        • Lawrence R.S.
        • Mickalide A.D.
        • Kamerow D.B.
        • Woolf S.H.
        Report of the U.S. Preventive Services Task Force.
        JAMA. 1990; 263: 436-437
      3. U.S. Preventive Services Task Force. Guide to clinical preventive services: report of the U.S. Preventive Services Task Force, 2nd ed., Washington, DC: Office of Disease Prevention and Health Promotion, U.S. Government Printing Office, 1996.

      4. Eddy DM. Clinical decision making: from theory to practice. A collection of essays from JAMA. Boston: Jones and Bartlett Publishers, 1995.

      5. Pignone MP, Phillips CJ, Atkins D, Teutsch SM, Mulrow CD, Lohr KN. Screening and treating adults for lipids disorders. Am J Prev Med 2001;20(suppl 3):77–89.

      6. Briss PA, Zaza S, Pappaioanou M, et al. Developing an evidence-based guide to community preventive services: methods. Am J Prev Med 2000;18(suppl 1):35–43.

      7. Meade MO, Richardson WS. Selecting and appraising studies for a systematic review. In: Mulrow CD, Cook D, eds. Systematic reviews: synthesis of best evidence for health care decisions. Philadelphia: American College of Physicians, 1998:81–90.

        • Woolf S.H.
        • DiGuiseppi C.G.
        • Atkins D.
        • Kamerow D.B.
        Developing evidence-based clinical practice guidelines.
        Ann Rev Public Health. 1996; 17: 511-538
      8. Battista RN, Fletcher SW. Making recommendations on preventive practices: methodological issues. Am J Prev Med 1988;4(suppl 4):53–67.

      9. Mulrow C, Langhorne P, Grimshaw J. Integrating heterogeneous pieces of evidence in systematic reviews. In: Mulrow CD, Cook D, eds. Systematic reviews: synthesis of best evidence for health care decisions. Philadelphia: American College of Physicians, 1998:103–12.

      10. Nelson HD, Helfand M. Screening for chlamydial infection. Am J Prev Med 2001;20(suppl 3):95–107.

      11. Helfand M, Mahon SM, Eden KB, Frame PS, Orleans CT. Screening for skin cancer. Am J Prev Med 2001;20(suppl 3):47–58.

      12. Wilson JMG, Junger G. Principles and practice of screening for disease. Geneva: World Health Organization, 1968 (Public Health Papers No. 34).

      13. Frame PS, Carlson SJ. A critical review of periodic health screening using specific screening criteria. J Fam Pract 1975;2:29–36, 123–9, 189–94, 283–9.

        • Bucher H.C.
        • Guyatt G.H.
        • Cook D.J.
        • Holbrook A.
        • McAlister F.A.
        Users’ guides to the medical literature. XIX. Applying clinical trial results. A. How to use an article measuring the effect of an intervention on surrogate end points.
        JAMA. 1999; 282: 771-778
        • Gøtzsche P.C.
        • Liberati A.
        • Torri V.
        • Rossetti L.
        Beware of surrogate outcome measures.
        Int J Tech Assess Health Care. 1996; 12: 238-246
        • Lohr K.N.
        • Carey T.S.
        Assessing “best evidence”.
        J Qual Improv. 1999; 25: 470-479
        • Hornberger J.
        • Wrone E.
        When to base clinical policies on observational versus randomized trial data.
        Ann Intern Med. 1997; 127: 697-703
        • Feinstein A.R.
        • Horwitz R.I.
        Problems in the “evidence” of “evidence-based medicine.
        ” Am J Med. 1997; 103: 529-535
      14. Oxman AD, Cook DJ, Guyatt GH, Evidence-Based Medicine Working Group. Users’ guides to the medical literature: how to use an overview. JAMA 1994;272:1367–71.

        • Mulrow C.D.
        • Linn W.D.
        • Gaul M.K.
        • Pugh J.A.
        Assessing quality of a diagnostic test evaluation.
        J Gen Intern Med. 1989; 4: 288-295
      15. Guyatt GH, Sackett DL, Cook DJ, Evidence-Based Medicine Working Group. Users’ guides to the medical literature. I. How to use an article about therapy or prevention. A. Are the results of the study valid? JAMA 1993;270:2598–601.

      16. Laupacis A, Wells G, Richardson WS, Tugwell P, Evidence-Based Medicine Working Group. Users’ guides to the medical literature V. How to use an article about prognosis. JAMA 1994;272:234–7.

        • Russell M.A.
        • Wilson C.
        • Taylor C.
        • Baker C.D.
        Effect of general practitioners’ advice against smoking.
        BMJ. 1979; 2: 231-235
      17. Eddy DM. Comparing benefits and harms: the balance sheet. JAMA 1990;263:2493, 2498, 2501.

        • Braddick M.
        • Stuart M.
        • Hrachovec J.
        The use of balance sheets in developing clinical guidelines.
        J Am Board Fam Pract. 1999; 12: 48-54
        • Ewart R.M.
        Primum non nocere and the quality of evidence.
        J Am Board Fam Pract. 2000; 13: 188-196
        • Fletcher S.W.
        • Black W.
        • Harris R.
        • Rimer B.
        • Shapiro S.
        Report of the International Workshop on Screening for Breast Cancer.
        J Natl Cancer Inst. 1993; 85: 644-656
        • Elmore J.G.
        • Barton M.B.
        • Moceri V.M.
        • Polk S.
        • Arena P.J.
        • Fletcher S.W.
        Ten-year risk of false positive screening mammograms and clinical breast examinations.
        N Engl J Med. 1998; 338: 1089-1096
        • Nease Jr, R.F.
        • Kneeland T.
        • O’Connor G.T.
        • et al.
        Variation in patient utilities for outcomes of the management of chronic stable angina.
        JAMA. 1995; 273: 1185-1190
        • Woolf S.H.
        • Dickey L.L.
        Differing perspectives on preventive care guidelines.
        Am J Prev Med. 1999; 17: 260-268
      18. Coffield AB, Maciosek MV, McGinnis JM, et al. Priorities among recommended clinical preventive services. Am J Prev Med 2001. In press.