us preventive services task force

Agency for Healthcare Research and QualityAgency for Healthcare Research and QualityAdvancing Excellence in Health CareAdvancing Excellence in Health Care • • www.ahrq.govwww.ahrq.gov

US Preventive Services Task Force US Preventive Services Task Force

Association of Community Health Nurse EducatorsAssociation of Community Health Nurse EducatorsLucy Marion, PhD, RNLucy Marion, PhD, RN

Dean, MCG School of Nursing Dean, MCG School of Nursing June 6, 2008June 6, 2008

Advancing Advancing Excellence in Excellence in Health CareHealth Care

History of the Task ForcesHistory of the Task Forces

1976 – Canadian Task Force on Periodic Health Exam1976 – Canadian Task Force on Periodic Health Exam 1984 – USPSTF established by PHS1984 – USPSTF established by PHS 1996 – Task Force on Community Preventive Services 1996 – Task Force on Community Preventive Services

(Community Guide) established by CDC (Community Guide) established by CDC 1998 - 31998 - 3rd rd USPSTF reconvened by AHRQUSPSTF reconvened by AHRQ 2001 – Present – Standing USPSTF2001 – Present – Standing USPSTF

Advancing Advancing Excellence in Excellence in Health CareHealth Care Who is the USPSTF?Who is the USPSTF?

■ Experts in primary care, prevention, research Experts in primary care, prevention, research methodsmethods

Government supported, by AHRQ, but independentGovernment supported, by AHRQ, but independent

Family medicine, internal medicine, pediatrics, Family medicine, internal medicine, pediatrics, obstetrics/gynecology, nursing, behavioral healthobstetrics/gynecology, nursing, behavioral health

Scientific support from Evidence-Based Practice Scientific support from Evidence-Based Practice Centers (EPC)Centers (EPC)

Non-member liaisons from primary care clinician Non-member liaisons from primary care clinician associations, Federal agenciesassociations, Federal agencies


Current MembersCurrent Members of the USPSTF of the USPSTF

Thomas G. DeWitt, MDThomas G. DeWitt, MD

Allen Dietrich, MD, MPHAllen Dietrich, MD, MPH

Kimberly D. Gregory, MD, Kimberly D. Gregory, MD, MPHMPH

David Grossman, MD, MPHDavid Grossman, MD, MPH

George Isham, MD, M.P.H.George Isham, MD, M.P.H.

Michael LeFevre, MD, MSPHMichael LeFevre, MD, MSPH

Rosanne Leipzig, MD, PhDRosanne Leipzig, MD, PhD

Bernadette Melnyk, PhD, RN, Bernadette Melnyk, PhD, RN, CPNP/NPPCPNP/NPP

Lucy N. Marion, PhD, RNLucy N. Marion, PhD, RN

Virginia A. Moyer, MD, MPH Virginia A. Moyer, MD, MPH

Judith K. Ockene, PhD, MSEdJudith K. Ockene, PhD, MSEd

George F. Sawaya, MDGeorge F. Sawaya, MD

J. Sanford Schwartz, MD, ABJ. Sanford Schwartz, MD, AB

Timothy Wilt, MD, MPHTimothy Wilt, MD, MPH

Bruce N. (Ned) Calonge, M.D., M.P.H. (Chair)Bruce N. (Ned) Calonge, M.D., M.P.H. (Chair)Diana B. Petitti, M.D., M.P.H. (Vice Chair)Diana B. Petitti, M.D., M.P.H. (Vice Chair)


Nurse MembersNurse Members of the USPSTF of the USPSTF

Carolyn WilliamsCarolyn Williams Nola PenderNola Pender Janet AllanJanet Allan Carol Loveland-Carol Loveland-

CherryCherry Lucy MarionLucy Marion Bernadette MelnykBernadette Melnyk


Task Force ActivitiesTask Force Activities

Systematically reviews the evidence of Systematically reviews the evidence of effectiveness and develops recommendations for effectiveness and develops recommendations for clinicalclinical preventive services preventive services – Age- and risk-factor specific Age- and risk-factor specific

– For routine use in primary care practiceFor routine use in primary care practice

Recommendations include:Recommendations include:

– Screening testsScreening tests

– CounselingCounseling

– Preventive medicationsPreventive medications


Why Evidence-Based?Why Evidence-Based?

Need transparent, systematic process to obtain Need transparent, systematic process to obtain and distill best available (or best feasible) evidence and distill best available (or best feasible) evidence to support decision making to support decision making

– Identifying, evaluating and summarizing scientific Identifying, evaluating and summarizing scientific evidence about outcomes or interventions or evidence about outcomes or interventions or policiespolicies

– Translating evidence into practice Translating evidence into practice recommendationsrecommendations


Topic Selection Topic Selection

and Prioritizationand Prioritization


Review of Criteria for SelectingReview of Criteria for Selecting and Prioritization of Topics and Prioritization of Topics

1.1. The Task Force solicits The Task Force solicits newnew topics for consideration topics for consideration from public, professional orgs, and TF members. from public, professional orgs, and TF members.

2. 2. The USPSTF first considers whether newly The USPSTF first considers whether newly nominated topics are within nominated topics are within scopescope of of primary/secondary prevention, primary care primary/secondary prevention, primary care relevant, and with substantial health burden.relevant, and with substantial health burden.

3. The USPSTF prioritizes the topics according to 3. The USPSTF prioritizes the topics according to public health importance, potential for impact on public health importance, potential for impact on clinical practice, and addressing diverse clinical practice, and addressing diverse populations.populations.

Advancing Advancing Excellence in Excellence in Health CareHealth Care Process for Prioritization of TopicsProcess for Prioritization of Topics

USPSTF prioritizes topics on a 3 point scale USPSTF prioritizes topics on a 3 point scale (low, moderate, high) based on: (low, moderate, high) based on: – ImpactImpact

– BurdenBurden

– Intensity of resourcesIntensity of resources

Helps in determining the order of reviewsHelps in determining the order of reviews

Helps in allocating limited resourcesHelps in allocating limited resources


Methodology for Developing Methodology for Developing Task Force RecommendationsTask Force Recommendations


Steps in the Process Steps in the Process of Developing Recommendationsof Developing Recommendations

1.1. Define questions and outcomes of interestDefine questions and outcomes of interest

2.2. Define and retrieve relevant evidenceDefine and retrieve relevant evidence

3.3. Evaluate QUALITY of individual studiesEvaluate QUALITY of individual studies

4.4. Synthesize and judge STRENGTH of available Synthesize and judge STRENGTH of available evidenceevidence

5.5. Determine balance of benefits and harmsDetermine balance of benefits and harms

6.6. Link recommendation to judgment about net Link recommendation to judgment about net benefitsbenefits


Step 1: Analytic Framework on Step 1: Analytic Framework on Screening for a DiseaseScreening for a Disease


Step 1: Example Analytic Framework - Step 1: Example Analytic Framework - Prostate CancerProstate Cancer

Early ProstateCancer

Reduced prostate cancer morbidity,

mortality

AsymptomaticMen

Screen:Screen:PSA, PSA, DREDRE

TreatTreatradiation,radiation,

prostatectomyprostatectomy

3

Adverse effectsAdverse effectsof screening:of screening:false positive, false false positive, false negative, negative, inconvenience,inconvenience,labelinglabeling

Adverse effects of Rx:Adverse effects of Rx:Impotence, incontinence,Impotence, incontinence,death, overtreatmentdeath, overtreatment

1

2

45


Step 1: Example Analytic Framework – Step 1: Example Analytic Framework – Motor Vehicle Occupant Injuries Motor Vehicle Occupant Injuries

Clinical Populations

Infant/Child Adolescent

Young Adults Adult

Adverse effects

Decreased morbidity (injuries, severity of

injuries, length of hospitalizations, short-

and long-term disability) and/or mortality from

MVOIReduced driving or riding when

driver is under the influence of

alcohol

Correct use of age- and weight-

appropriate restraints (safety

seats, booster seats, seat belts)

Behavioral counseling

interventions

4

1

2

3


Steps in the Process Steps in the Process for Development of Recommendationsfor Development of Recommendations



3.3. Evaluate QUALITY of individual studiesEvaluate QUALITY of individual studies





Define and Retrieve Define and Retrieve Relevant EvidenceRelevant Evidence

For each For each Key QuestionKey Question developed from AF: developed from AF:

– Create inclusion/exclusion criteria based on the key Create inclusion/exclusion criteria based on the key questions defined from the analytic frameworkquestions defined from the analytic framework

– PubMed, Cochrane, and Other database search PubMed, Cochrane, and Other database search (CINAHL, etc)(CINAHL, etc)

– References from key articles, editorials, review References from key articles, editorials, review articlesarticles

– Expert consultation (others, TF members)Expert consultation (others, TF members)


Steps in the ProcessSteps in the Process for Development of Recommendations for Development of Recommendations



3.3. Evaluate quality of individual studiesEvaluate quality of individual studies





Assess Quality of EvidenceAssess Quality of Evidence

What do we mean byWhat do we mean by quality of evidence? quality of evidence?

““Extent to which a study’s design, conduct, and analysis Extent to which a study’s design, conduct, and analysis has minimized selection, measurement, and has minimized selection, measurement, and confounding biases.”confounding biases.”

– Lohr, Lohr, J Qual ImprovementJ Qual Improvement, 1999, 1999

““Extent to which one can be confident that an estimate of Extent to which one can be confident that an estimate of effect is correct” effect is correct”

– GRADE , GRADE , BMJ BMJ 20042004


Evaluate Quality Evaluate Quality of Individual Studiesof Individual Studies

Good::

– Uses a credible reference standardUses a credible reference standard

– Reliability of test assessedReliability of test assessed

– Includes large number of subjectsIncludes large number of subjects



Fair:

– Uses reasonable although not best standardUses reasonable although not best standard

– Interprets reference standard independent of Interprets reference standard independent of screening testscreening test

– Moderate sample size Moderate sample size



Poor:Poor: Has fatal flaw such as: Has fatal flaw such as:

– Uses inappropriate reference standardsUses inappropriate reference standards

– Biased ascertainment of reference standardBiased ascertainment of reference standard

– Very small sample size or very selected Very small sample size or very selected patients. patients.


Steps in the ProcessSteps in the Process for Development of Recommendations for Development of Recommendations




4.4. Synthesize and judge STRENGTH of overall Synthesize and judge STRENGTH of overall evidenceevidence



Advancing Advancing Excellence in Excellence in Health CareHealth Care Critical Appraisal QuestionsCritical Appraisal Questions

Do the studies have the appropriate research Do the studies have the appropriate research design to answer the key questions?design to answer the key questions?

To what extent are the existing studies high To what extent are the existing studies high quality? quality?

To what extent are the results of the studies To what extent are the results of the studies generalizable (or “applicable”) to the general US generalizable (or “applicable”) to the general US primary care population and situation? primary care population and situation?

Advancing Advancing Excellence in Excellence in Health CareHealth Care Critical Appraisal QuestionsCritical Appraisal Questions

How many studies have been conducted that How many studies have been conducted that address each key question? How large are the address each key question? How large are the samples in the studies? samples in the studies?

How consistent/coherent are the results of the How consistent/coherent are the results of the studies?studies?

Are there additional factors that assist us in Are there additional factors that assist us in drawing conclusions about the certainty of the drawing conclusions about the certainty of the evidence? (e.g., presence or absence of dose-evidence? (e.g., presence or absence of dose-response effects; fit within a biologic model)response effects; fit within a biologic model)


Step 4: Synthesize and Step 4: Synthesize and Judge Strength of Overall EvidenceJudge Strength of Overall Evidence

Evidence reportsEvidence reports– Evidence tables summarizing studiesEvidence tables summarizing studies

– Narrative discussing overall strength of evidenceNarrative discussing overall strength of evidence

Meta-analysisMeta-analysis

ModelingModeling

Systematic reviews from others –Systematic reviews from others –

Cochrane, etc. Cochrane, etc.


Step 4: Synthesize & Judge Step 4: Synthesize & Judge Strength of Key Question EvidenceStrength of Key Question Evidence

ConvincingConvincing:: Well-designed, well-conducted Well-designed, well-conducted studies in representative populations that studies in representative populations that directly assess effects on health outcomesdirectly assess effects on health outcomes



Adequate:Adequate: Evidence sufficient to determine Evidence sufficient to determine effects on health outcomes, but limited by effects on health outcomes, but limited by number, quality, or consistency of studies, number, quality, or consistency of studies, generalizability to routine practice, or indirect generalizability to routine practice, or indirect nature of the evidence nature of the evidence



Inadequate Inadequate :: Insufficient evidence to Insufficient evidence to determine effect on health outcomes due to determine effect on health outcomes due to limited number or power of studies, important limited number or power of studies, important flaws in their design or conduct, gaps in the flaws in their design or conduct, gaps in the chain of evidence, or lack of information on chain of evidence, or lack of information on important health outcomesimportant health outcomes

Advancing Advancing Excellence in Excellence in Health CareHealth Care USPSTF Defines CertaintyUSPSTF Defines Certainty

Likelihood that the assessment of the Likelihood that the assessment of the net net benefitbenefit of a preventive service is correct of a preventive service is correct..

– The net benefit is defined as The net benefit is defined as benefit minus harmbenefit minus harm of the preventive serviceof the preventive service as implemented in a as implemented in a primary care population. primary care population.

– The USPSTF assigns a certainty level based on The USPSTF assigns a certainty level based on the nature of the overall evidence available to the nature of the overall evidence available to assess the net benefit of a preventive service.assess the net benefit of a preventive service.

Advancing Advancing Excellence in Excellence in Health CareHealth Care Levels of Certainty – HIGH Levels of Certainty – HIGH

The available evidence usually includes The available evidence usually includes consistent results from well-designed, well-consistent results from well-designed, well-conducted studies in representative primary conducted studies in representative primary care populations. care populations. – These studies assess the effects of the These studies assess the effects of the

preventive service on health outcomes.preventive service on health outcomes.

– This conclusion is therefore unlikely to be This conclusion is therefore unlikely to be strongly affected by the results of future studies.strongly affected by the results of future studies.


Levels of Certainty – MODERATE Levels of Certainty – MODERATE

The available evidence The available evidence isis sufficient to determine the sufficient to determine the effects of the preventive service on health outcomes, effects of the preventive service on health outcomes, butbut confidence in the estimate is constrained by confidence in the estimate is constrained by factors such as: factors such as: – the number, size, or quality of individual studiesthe number, size, or quality of individual studies– inconsistency of findings across individual studiesinconsistency of findings across individual studies– limited generalizability of findings to routine primary care limited generalizability of findings to routine primary care

practicepractice– or lack of coherence in the chain of evidence. or lack of coherence in the chain of evidence.

As more information becomes available, the As more information becomes available, the magnitude or direction of the observed effect could magnitude or direction of the observed effect could change, and this change may be large enough to alter change, and this change may be large enough to alter the conclusion.the conclusion.

Advancing Advancing Excellence in Excellence in Health CareHealth Care Levels of Certainty – LOW Levels of Certainty – LOW

Low:Low: The available evidence is insufficient to The available evidence is insufficient to assess effects on health outcomes.assess effects on health outcomes.

– Evidence is insufficient because of:Evidence is insufficient because of: the limited number the limited number or size of studies; important flaws in study design or or size of studies; important flaws in study design or methods; inconsistency of findings across individual methods; inconsistency of findings across individual studies gaps in the chain of evidence; findings not studies gaps in the chain of evidence; findings not generalizable to routine primary care practice; or a lack generalizable to routine primary care practice; or a lack of information on important health outcomes. of information on important health outcomes.

More information may allow an estimation of More information may allow an estimation of effects on health outcomes. effects on health outcomes.


Steps in USPSTF ProcessSteps in USPSTF Process for Development of Recommendations for Development of Recommendations




4.4. Synthesize and judge STRENGTH of overall evidenceSynthesize and judge STRENGTH of overall evidence


6.6. Link recommendation to net benefitsLink recommendation to net benefits


Step 5: Determine Balance of Step 5: Determine Balance of Benefits and Harms: Benefits and Harms: Assessing Assessing HarmsHarms

Potential harms are real, but hard to quantifyPotential harms are real, but hard to quantify

Include psychological and physical consequences Include psychological and physical consequences of false-positives, false-negatives, “labeling”, over of false-positives, false-negatives, “labeling”, over treatmenttreatment


Step 5: Determine Balance of Step 5: Determine Balance of Benefits and Harms: Benefits and Harms: Assessing Assessing HarmsHarms

Opportunity costsOpportunity costs

Magnitude and duration of harm subjective, Magnitude and duration of harm subjective, hard to compare to benefits hard to compare to benefits – May translate into QALYs to compareMay translate into QALYs to compare

– NNHNNH


Step 5: Determine Balance of Benefits & Harms: Step 5: Determine Balance of Benefits & Harms: Assessing Magnitude of Net Assessing Magnitude of Net BenefitBenefit

No explicit criteria for magnitude of net benefitNo explicit criteria for magnitude of net benefit

SubstantialSubstantial benefitbenefit: impact on high burden : impact on high burden oror major effect on uncommon outcomemajor effect on uncommon outcome

Problems: requires evidence on harms and Problems: requires evidence on harms and common metric for benefit and harmscommon metric for benefit and harms


Step 5: Step 5: Determine BalanceDetermine Balance of Benefits and Harms of Benefits and Harms

Estimate Magnitude of Net BenefitEstimate Magnitude of Net Benefit

BenefitsBenefits – – HarmsHarms = Net Benefit = Net Benefit


Steps in the Process Steps in the Process for Development of Recommendationsfor Development of Recommendations




4.4. Synthesize and judge STRENGTH of overall evidenceSynthesize and judge STRENGTH of overall evidence


6.6. Link recommendation to net benefitsLink recommendation to net benefits


Step 6: Step 6: Link recommendation to net benefits:Link recommendation to net benefits: USPSTF Grades RecommendationsUSPSTF Grades Recommendations

Certainty of Certainty of Net BenefitNet Benefit

Magnitude of Net BenefitMagnitude of Net Benefit

SubstantialSubstantial ModerateModerate SmallSmall Zero/negativeZero/negative

HighHigh AA BB CC DD

ModerateModerate BB BB CC DD

LowLowInsufficient (I Statement)Insufficient (I Statement)


RSRS: USPSTF Conclusion about : USPSTF Conclusion about Evidence and Net BenefitEvidence and Net Benefit

Grade Statement

A There is high certainty that the net benefit is substantial. B There is at least moderate certainty that the net benefit is at least moderate. C There is at least moderate certainty that the net benefit is small. D There is at least moderate certainty that the service has no net benefit or that

the harms outweigh the benefits. I

Statement Evidence is lacking, of poor quality or conflicting, and the balance of benefits and harms cannot be determined.


GradeGrade Grade DefinitionGrade Definition Suggestion for PracticeSuggestion for Practice

AA The USPSTF recommends the service. There is high certainty that the net benefit is substantial.

Offer or provide this service.

BBThe USPSTF recommends the service. There is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial.

Offer or provide this service.

CCThe USPSTF recommends against routinely providing the service. There may be considerations that support providing the service in an individual patient. There is moderate or high certainty that the net benefit is small.

Offer or provide this service only if there are other considerations in support of the offering or providing the service in an individual patient.

DDThe USPSTF recommends against the service. There is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits.

Discourage the use of this service.

IIThe USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of the service. Evidence is lacking, of poor quality, or conflicting, and the balance of benefits and harms cannot be determined.

Read “Clinical Considerations” section of Recommendation Statement. If offered the service, patients should understand the uncertainty about the balance of benefits and harms.


Step 6: Link Recommendation to Net Step 6: Link Recommendation to Net Benefits: Benefits: Insufficient EvidenceInsufficient Evidence

Lack of evidence on harms or benefitsLack of evidence on harms or benefits

Poor quality of existing studiesPoor quality of existing studies

Good quality studies with conflicting resultsGood quality studies with conflicting results


Communicating the Task Communicating the Task Force Recommendations:Force Recommendations:

The Recommendation StatementThe Recommendation Statement


Template for USPSTF Template for USPSTF Recommendation Statement (RS)Recommendation Statement (RS)

Preamble Preamble

Summary of Recommendation & EvidenceSummary of Recommendation & Evidence

Structured RationaleStructured Rationale

Clinical Considerations Clinical Considerations

Discussion Discussion

Advancing Advancing Excellence in Excellence in Health CareHealth Care RSRS: Preamble: Preamble

• The USPSTF makes recommendations about The USPSTF makes recommendations about preventive care services for patients without preventive care services for patients without recognized signs or symptoms of the target recognized signs or symptoms of the target condition. condition.

• It bases its recommendations on a systematic It bases its recommendations on a systematic review of the evidence of the benefits and harms and review of the evidence of the benefits and harms and an assessment of the net benefit of the service. an assessment of the net benefit of the service.

•The USPSTF recognizes that clinical or policy The USPSTF recognizes that clinical or policy decisions involve more considerations than this body decisions involve more considerations than this body of evidence alone. Clinicians and policy-makers of evidence alone. Clinicians and policy-makers should understand the evidence but individualize should understand the evidence but individualize decision-making to the specific patient or situation.decision-making to the specific patient or situation.


RSRS: Summary of : Summary of Recommendation & EvidenceRecommendation & Evidence

DODO

The USPSTF recommends X service for Y population. The USPSTF recommends X service for Y population. ((AA recommendation) recommendation)

The USPSTF recommends X service for Y population. The USPSTF recommends X service for Y population. ((BB recommendation) recommendation)



DON’T DODON’T DO

The USPTF recommends against routinely The USPTF recommends against routinely (providing) X service for Y population. There may (providing) X service for Y population. There may be considerations that support (providing) the be considerations that support (providing) the service in an individual patient. service in an individual patient.

((CC recommendation) recommendation)

The USPSTF recommends against X service for Y The USPSTF recommends against X service for Y population. population.

((DD recommendation) recommendation)



WE DON’T KNOWWE DON’T KNOW

The USPSTF concludes that the current evidence The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits is insufficient to assess the balance of benefits and harms of X service in Y population. and harms of X service in Y population. ((II statement) statement)

See Clinical Considerations for suggestions for See Clinical Considerations for suggestions for practice for I recommendations and a discussion of practice for I recommendations and a discussion of known risk factors, etc.known risk factors, etc.

Advancing Advancing Excellence in Excellence in Health CareHealth Care RSRS: Structured Rationale: Structured Rationale

ImportanceImportance: :

DetectionDetection: :

Benefits of detection and early intervention:Benefits of detection and early intervention:

– Bullets for different populationsBullets for different populations

Harms of detection and early intervetion: Harms of detection and early intervetion: – Bullets for different populationsBullets for different populations

The USPSTF concludes that for :The USPSTF concludes that for :

– Statement about certaintyStatement about certainty – Bullets for each populationBullets for each population

Advancing Advancing Excellence in Excellence in Health CareHealth Care RSRS: Clinical Considerations: Clinical Considerations

1.1. Patient Population Under ConsiderationPatient Population Under Consideration

2.2. Suggestions for Practice Regarding I statementSuggestions for Practice Regarding I statement

3.3. Assessment of RiskAssessment of Risk

4.4. Screening TestsScreening Tests

5.5. TreatmentTreatment

6.6. Screening IntervalScreening Interval

7.7. Other Approaches to PreventionOther Approaches to Prevention

8.8. Useful ResourcesUseful Resources

Advancing Advancing Excellence in Excellence in Health CareHealth Care RSRS: Discussion: Discussion

Burden of DiseaseBurden of Disease

Scope of ReviewScope of Review

Accuracy of Screening TestsAccuracy of Screening Tests

Effectiveness of Early Detection and/or TreatmentEffectiveness of Early Detection and/or Treatment

Potential Harms of Screening and/or TreatmentPotential Harms of Screening and/or Treatment

Estimate of Magnitude of Net BenefitEstimate of Magnitude of Net Benefit

How Does Evidence Fit with Biological UnderstandingHow Does Evidence Fit with Biological Understanding

Advancing Advancing Excellence in Excellence in Health CareHealth Care RSRS: Other Sections: Other Sections

Recommendations of OthersRecommendations of Others

ReferencesReferences

DateDate


Dissemination & Implementation Dissemination & Implementation of Recommendationsof Recommendations


Decision Support ResourcesDecision Support Resources for Different Audiences for Different Audiences

CliniciansClinicians

ConsumersConsumers

Businesses, Employers, and Health Care Businesses, Employers, and Health Care PurchasersPurchasers


Electronic Resources for Electronic Resources for CliniciansClinicians

ePSS – electronic Preventive Services Selector ePSS – electronic Preventive Services Selector Tool Tool

– Search USPSTF recommendations by age, sex Search USPSTF recommendations by age, sex and risk factors and risk factors

– Available as a web-based tool or can be Available as a web-based tool or can be downloaded to PDAdownloaded to PDA

– www.epss.ahrq.govwww.epss.ahrq.gov


Print Resources for Print Resources for CliniciansClinicians

Annual Pocket Guide Annual Pocket Guide

Publication of Publication of Recommendations and Recommendations and Evidence Evidence


One Page Clinical Summary


ResourcesResourcesto Inform to Inform ConsumerConsumer Decisions Decisions

Print materials: based on recommendations of the Print materials: based on recommendations of the USPSTFUSPSTF

Men: Stay Healthy at Any Age – Your Checklist for Men: Stay Healthy at Any Age – Your Checklist for Health*Health*

Women: Stay Healthy at Any Age –Your Checklist Women: Stay Healthy at Any Age –Your Checklist for Health*for Health*

Adult Preventive Care Timeline – Adult Preventive Care Timeline – Wall chartWall chart

*Available in English and Spanish*Available in English and Spanish


ResourcesResourcesto Inform to Inform ConsumerConsumer Decisions Decisions

[email protected]


Resources for Resources for Clinicians and Clinicians and ConsumersConsumers

Based on Based on recommendations of the recommendations of the USPSTF. USPSTF.

At-a-glance At-a-glance wall chart wall chart for for appropriate preventive appropriate preventive services based on age, services based on age, sex, and risk status. sex, and risk status.

To be used in prompting To be used in prompting shared decision-making shared decision-making between consumers and between consumers and their primary care their primary care clinician.clinician.


Electronic Resources Electronic Resources for for All AudiencesAll Audiences

www.preventiveservices.ahrq.govwww.preventiveservices.ahrq.gov

Access toAccess to– USPSTF Recommendations, Reports, and Methods USPSTF Recommendations, Reports, and Methods

Papers Papers

– Prevention Dissemination and Implementation Prevention Dissemination and Implementation Information and Materials Information and Materials

– Links to our partners and their information, such as Links to our partners and their information, such as the NBGH the NBGH Purchaser’s Guide to Clinical Preventive Purchaser’s Guide to Clinical Preventive Services, Services, NCI’s Cancer Control P.L.A.N.E.T., and NCI’s Cancer Control P.L.A.N.E.T., and the National Commission on Prevention Prioritiesthe National Commission on Prevention Priorities


Resource for Resource for Employers and Policy MakersEmployers and Policy Makers

A Purchaser’s Guide to A Purchaser’s Guide to Clinical Preventive Clinical Preventive Services: Services: Moving Science Moving Science into Coverageinto Coverage– Promotes coverage and Promotes coverage and

promotion of preventive promotion of preventive services health benefits that services health benefits that are based on evidenceare based on evidence

– Published November 2006Published November 2006

– Partnership between NBGH, Partnership between NBGH, AHRQ and CDC.AHRQ and CDC.


Potential Potential BarriersBarriers to Delivering Preventive Servicesto Delivering Preventive Services

System barriersSystem barriers ClinicianClinician Patient/consumerPatient/consumer


Implications for Community Health Implications for Community Health Nurse EducatorsNurse Educators

Learn and teach rigorous methods of TFsLearn and teach rigorous methods of TFs Guide student applications: case studies, Guide student applications: case studies,

practicum experiences, discussionspracticum experiences, discussions Demonstrate how to integrate Community Guide Demonstrate how to integrate Community Guide

recommendations with USPSTFrecommendations with USPSTF– Put clinical guidelines in context of community and Put clinical guidelines in context of community and

familyfamily

– Consider “primary care referrable” for Community Consider “primary care referrable” for Community Guide recommendations as well as referrals from Guide recommendations as well as referrals from community health settings for primary carecommunity health settings for primary care


Implications for Community Health Implications for Community Health Nurse Educators: ExampleNurse Educators: Example

In collaboration with PHNs and CHNs in the In collaboration with PHNs and CHNs in the community, the CHNE with students conductscommunity, the CHNE with students conducts– Needs assessment to identify priority health needsNeeds assessment to identify priority health needs– Planning to include USPSTF recommendations for Planning to include USPSTF recommendations for

effective preventive interventions and CGTF effective preventive interventions and CGTF recommendations for effective strategies for recommendations for effective strategies for increasing the number of people screenedincreasing the number of people screened

Example:Example:– Clinical Guide recommends the breast, cervical, and Clinical Guide recommends the breast, cervical, and

colorectal screening test colorectal screening test – Community Guide recommends client reminders, one Community Guide recommends client reminders, one

on one education, and provider reminders on one education, and provider reminders

Advancing Advancing Excellence in Excellence in Health CareHealth Care US Preventive Services Task ForceUS Preventive Services Task Force

USPSTF Homepage - USPSTF Homepage - http://www.ahrq.gov/clinic/uspstfix.htmhttp://www.ahrq.gov/clinic/uspstfix.htm

Electronic Preventive Services Selector (ePSS) Electronic Preventive Services Selector (ePSS) http://epss.ahrq.gov/PDA/index.jsphttp://epss.ahrq.gov/PDA/index.jsp

USPSTF Fact Sheet USPSTF Fact Sheet http://www.ahrq.gov/clinic/uspstfab.htmhttp://www.ahrq.gov/clinic/uspstfab.htm

Guide to Clinical Preventive Services, 2007 Guide to Clinical Preventive Services, 2007 http://www.ahrq.gov/clinic/pocketgd.htmhttp://www.ahrq.gov/clinic/pocketgd.htm

Advancing Advancing Excellence in Excellence in Health CareHealth Care USPSTF Publications (Selected)USPSTF Publications (Selected)

Ockene, J., Edgerton, E., Teutsch, S., Marion, L., Miller, T., Genevro, J., Ockene, J., Edgerton, E., Teutsch, S., Marion, L., Miller, T., Genevro, J., Loveland-Cherry, C., Fielding, J., Briss, P. (March 2007). Integrating Loveland-Cherry, C., Fielding, J., Briss, P. (March 2007). Integrating Evidence-Based Clinical and Community Strategies to Improve Health. Evidence-Based Clinical and Community Strategies to Improve Health. American Journal of Preventive Medicine, 32American Journal of Preventive Medicine, 32(3), 244-252.(3), 244-252.

Whitlock EP., Orleans CT., Pender N., Allan J. (May 2002). Evaluating Whitlock EP., Orleans CT., Pender N., Allan J. (May 2002). Evaluating primary care behavioral counseling interventions: an evidence-based primary care behavioral counseling interventions: an evidence-based approach. approach. American Journal of Preventive Medicine, 22American Journal of Preventive Medicine, 22(4), 267-84.(4), 267-84.

Meyers D., Wolff T., Gregory K., Marion L., Moyer V., Nelson H., Petitti D., Meyers D., Wolff T., Gregory K., Marion L., Moyer V., Nelson H., Petitti D., Sawaya GF. (May 2008). USPSTF. USPSTF recommendations for STI Sawaya GF. (May 2008). USPSTF. USPSTF recommendations for STI screening. screening. American Family Physician, 77American Family Physician, 77(6), 819-24.(6), 819-24.

Sawaya GF., Guirguis-Blake J., LeFevre M., Harris R., Petitti D. (Dec 2007). Sawaya GF., Guirguis-Blake J., LeFevre M., Harris R., Petitti D. (Dec 2007). U.S. Preventive Services Task Force. Update on the methods of the U.S. U.S. Preventive Services Task Force. Update on the methods of the U.S. Preventive Services Task Force: estimating certainty and magnitude of net Preventive Services Task Force: estimating certainty and magnitude of net benefit. benefit. Annals of Internal Medicine, 147Annals of Internal Medicine, 147(12), 871-5.(12), 871-5.

Lin K., Watkins B., Johnson T., Rodriguez JA., Barton MB. (Apr 2008). Lin K., Watkins B., Johnson T., Rodriguez JA., Barton MB. (Apr 2008). Screening for chronic obstructive pulmonary disease using spirometry: Screening for chronic obstructive pulmonary disease using spirometry: summary of the evidence for the U.S. Preventive Services Task Force. summary of the evidence for the U.S. Preventive Services Task Force. Annals of Internal Medicine, 148Annals of Internal Medicine, 148(7), 535-43.(7), 535-43.

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