Guide to Clinical Preventive Services, 2008

Preface

Since its inception 24 years ago, the U.S. Preventive Services Task Force (USPSTF) has been dedicated to: 1) evaluating the benefits of primary and secondary preventive services in apparently healthy persons based on age, sex, and risk factors for disease, and 2) making recommendations about which preventive services should be incorporated into primary care practice. While the intended audience for these recommendations continues to be primary care clinicians, the reach of the Task Force has expanded over time: recommendations of the USPSTF are now considered by many to provide definitive standards for preventive services, informing recommendations developed by professional societies, coverage policies of many health plans and insurers, health care quality measures, and national health objectives.

USPSTF methods have evolved to incorporate not only the quality of evidence supporting a specific preventive service, but also the magnitude of net benefit (benefits minus harms) in providing the service. Each recommendation is based on a rigorous review of the evidence involving a series of steps:

• Creation of an analytic framework and a set of key questions that determine the scope of the literature review.
• Systematic review of the relevant literature to answer the key questions.
• Quality rating of bodies of literature supporting each key question, as well as the quality and certainty of the evidence overall.
• Estimation of benefits and harms.
• Determination of the balance of benefits and harms of the service, or net benefit.

The recommendation is then linked to a letter grade that reflects the magnitude of net benefit and the strength and certainty of the evidence supporting the provision of a specific preventive service. The recommendation is graded from "A" (recommended) to "D" (recommended against). The Task Force makes an "I" statement when the evidence is insufficient to determine net benefit.

The USPSTF realizes that clinical decisions about patients involve more complex considerations than the evidence alone; clinicians should always understand the evidence but individualize decisionmaking to the specific patient and situation. The Clinical Considerations section of each USPSTF Recommendation Statement helps clinicians implement the recommendations by offering practical information so they can tailor these recommendations to individual patients. The USPSTF suggests that clinicians:

• Discuss services with "A" and "B" recommendations with eligible patients and offer them as a priority.
• Discourage the use of services with "D" recommendations unless there are unusual additional considerations.
• Give lower priority to services with "C" recommendations; they need not be provided unless there are individual considerations in favor of providing the service.
• For services with "I" statements, carefully read the Clinical Considerations section for guidance, and help patients understand the uncertainty surrounding these services.

The Guide to Clinical Preventive Services 2008 is a compilation of abridged USPSTF recommendations released from 2001 to March 2008 and can be used as an evidence-based tool at the point of patient care. Some recommendations have been updated from those made by the USPSTF in 1996, while others address preventive services not previously considered by the USPSTF. The complete USPSTF recommendation statements, including those that were in revision while this edition of the Guide was being printed, are available along with their supporting scientific evidence at http://www.preventiveservices.ahrq.gov.

As is true of all patient care, preventive services have become much more complex in view of ongoing research. I strongly encourage clinicians to visit the Web site and read the complete recommendation statements for those services they provide in their practice settings, as the additional information can be useful in providing the highest quality preventive care. In addition, the USPSTF Electronic Preventive Services Selector (ePSS), available via PDA or on the Web at http://epss.ahrq.gov, allows users to search USPSTF recommendations by patient age and other clinical characteristics.

I hope you find The Guide to Clinical Preventive Services 2008 to be a useful tool as you care for patients.

Ned Calonge, M.D., M.P.H.
Chair, U.S. Preventive Services Task Force

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