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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