Putting Evidence Into Practice: An Update on the US Preventive Services Task Force Methods for Developing Recommendations for Preventive Services

Abstract

Purpose: The US Preventive Services Task Force (USPSTF) is an independent body that makes evidence-based recommendations regarding preventive services to improve health for people nationwide. Here, we summarize current USPSTF methods, describe how methods are evolving to address preventive health equity, and define evidence gaps for future research.

Methods: We summarize current USPSTF methods as well as ongoing methods development.

Results: The USPSTF prioritizes topics on the basis of disease burden, extent of new evidence, and whether the service can be provided in primary care and going forward will increasingly consider health equity. Analytic frameworks specify the key questions and linkages connecting the preventive service to health outcomes. Contextual questions provide information on natural history, current practice, health outcomes in high-risk groups, and health equity. The USPSTF assigns a level of certainty to the estimate of net benefit of a preventive service (high, moderate, or low). The magnitude of net benefit is also judged (substantial, moderate, small, or zero/negative). The USPSTF uses these assessments to assign a letter grade from A (recommend) to D (recommend against). I statements are issued when evidence is insufficient.

Conclusions: The USPSTF will continue to evolve its methods for simulation modeling and to use evidence to address conditions for which there are limited data for population groups who bear a disproportionate burden of disease. Additional pilot work is underway to better understand the relations of the social constructs of race, ethnicity, and gender with health outcomes to inform the development of a USPSTF health equity framework.

Keywords: clinical practice guidelines; health equity; methodology; preventive medicine.

Figure 1.

Steps in topic prioritization. TP WG = Topic Prioritization Workgroup.

Figure 2.

Generic screening analytic framework. Note: Numbers in figure correspond to key questions that are addressed by the systematic evidence review. For example, Key Question 1 relates to the direct evidence as to whether screening for a condition affects health outcomes that are important to patients. For more information about analytic frameworks, see the Task Force Procedure Manual.

Figure 3.

Estimates of the benefits and harms of PSA screening for prostate cancer. PSA = prostate-specific antigen. Note: Reprinted with permission from the Agency for Healthcare Research and Quality, acting on its own behalf and that of the US Preventive Services Task Force.