The U.S. Preventive Services Task Force (USPSTF) grades its recommendations based on the strength of evidence and magnitude of net benefit (benefits minus harms).
A. The USPSTF strongly recommends that clinicians provide [the service] to eligible patients. The USPSTF found good evidence that [the service] improves important health outcomes and concludes that benefits substantially outweigh harms.
B. The USPSTF recommends that clinicians provide [the service] to eligible patients. The USPSTF found at least fair evidence that [the service] improves important health outcomes and concludes that benefits outweigh harms.
C. The USPSTF makes no recommendation for or against routine provision of [the service]. The USPSTF found at least fair evidence that [the service] can improve health outcomes but concludes that the balance of benefits and harms is too close to justify a general recommendation.
D. The USPSTF recommends against routinely providing [the service] to asymptomatic patients. The USPSTF found at least fair evidence that [the service] is ineffective or that harms outweigh benefits.
I. The USPSTF concludes that the evidence is insufficient to recommend for or against routinely providing [the service]. Evidence that [the service] is effective is lacking, of poor quality, or conflicting, and the balance of benefits and harms cannot be determined.
The USPSTF grades the quality of the overall evidence for a service on a 3-point scale (good, fair, poor).
Good: Evidence includes consistent results from well-designed, well-conducted studies in representative populations that directly assess effects on health outcomes.
Fair: Evidence is sufficient to determine effects on health outcomes, but the strength of the evidence is limited by the number, quality, or consistency of the individual studies, generalizability to routine practice, or indirect nature of the evidence on health outcomes.
Poor: Evidence is insufficient to assess the effects on health outcomes because of limited number or power of studies, important flaws in their design or conduct, gaps in the chain of evidence, or lack of information on important health outcomes.
| Strength of Overall Evidence and Estimate of Net Benefit Determine the Grade | |||||
|---|---|---|---|---|---|
| Strength of Overall Evidence of Effectiveness |
Estimate of Net Benefit (Benefits Minus Harms) | ||||
| Substantial | Moderate | Small | Zero/Negative | ||
| Good | A | B | C | D | |
| Fair | B | B | C | D | |
| Poor | I—Insufficient Evidence | ||||
Janet D. Allan, Ph.D., R.N., C.S. School of Nursing, University of Maryland, Baltimore County; Baltimore, MD
Alfred O. Berg, M.D., M.P.H. Department of Family Medicine, University of Washington; Seattle, WA
Ned Calonge, M.D., M.P.H. Colorado Department of Public Health and Environment; Denver, CO
Thomas G. DeWitt, M.D., Director of the Division of General and Community Pediatrics; Department of Pediatrics, Children's Hospital Medical Center Cincinnati, OH
Paul S. Frame, M.D. Tri-County Family Medicine; Cohocton, NY
Joxel Garcia, M.D., M.B.A. Pan American Health Organization; Washington, DC
Leon Gordis, M.D., M.P.H., Dr. P.H. Epidemiology Department, Johns Hopkins Bloomberg School of Public Health; Baltimore, MD
Kimberly D. Gregory, M.D., M.P.H. Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center; Los Angeles, CA
Russell Harris, M.D., M.P.H. University of North Carolina School of Medicine; Chapel Hill, NC
Charles J. Homer, M.D., M.P.H. National Initiative for Children's Healthcare Quality; Boston, MA
Mark S. Johnson, M.D., M.P.H. Department of Family Medicine, New Jersey Medical School; University of Medicine and Dentistry of New Jersey; Newark, NJ
Kenneth Kizer, M.D., M.P.H., National Quality Forum, Washington, DC
Jonathan D. Klein, M.D., M.P.H. Department of Pediatrics, University of Rochester; Rochester, NY
Tracy A. Lieu, M.D., M.P.H. Department of Ambulatory Care and Prevention, Harvard Pilgrim Health Care and
Harvard Medical School; Boston, MA
Michael L. LeFevre, M.D., M.S.P.H., University of Missouri, School of Medicine, Columbia, MO
Carol Loveland-Cherry, Ph.D., R.N. Office of Academic Affairs, University of Michigan School of Nursing; Ann Arbor, MI
Lucy N. Marion, Ph.D., R.N., School of Nursing, Medical College of Georgia, Augusta, GA
Virginia A. Moyer, M.D., M.P.H. Department of Pediatrics, University of Texas Health Science Center; Houston, TX
Cynthia D. Mulrow, M.D., M.Sc. University of Texas Health Science Center; Audie L. Murphy Memorial Veterans Hospital; San Antonio, TX
Judith K. Ockene, Ph.D., M.Ed. Division of Preventive and Behavioral Medicine, University of Massachusetts
Medical School; Worcester, MA
C. Tracy Orleans, Ph.D. Department of Research and Evaluation, The Robert Wood Johnson Foundation; Princeton, NJ
Jeffrey F. Peipert, M.D., M.P.H. Women and Infants' Hospital; Providence, RI
Nola J. Pender, Ph.D., R.N. School of Nursing, University of Michigan; Ann Arbor, MI
Diana B. Petitti, M.D., M.P.H. Kaiser Permanente Southern California; Pasadena, CA
George F. Sawaya, M.D., Department of Obstetrics, Gynecology, and Reproductive Sciences; Department of Epidemiology and Biostatistics; University of California, San Francisco, San Francisco, CA
Harold C. Sox, Jr., M.D. Department of Medicine, Dartmouth-Hitchcock Medical Center; Lebanon, NH
Albert L. Siu, M.D., M.S.P.H. Brookdale Department of Geriatrics and Adult Development, Mount Sinai Medical
Center; New York, NY
Steven M. Teutsch, M.D., M.P.H. Merck and Company, Inc. West Point, PA
Carolyn Westhoff, M.D., M.Sc. Department of Obstetrics and Gynecology, Columbia University; New York, NY
Steven H. Woolf, M.D., M.P.H. Department of Family Practice, Preventive Medicine, and Community Health, Virginia Commonwealth University; Fairfax, VA
Barbara P. Yawn, M.D., M.Sc. Olmstead Research Center; Rochester, MN
David Atkins, M.D., M.P.H.; Dana Best, M.D., M.P.H.; Joel Boches; Helen Burstin, M.D., M.P.H.; Mackenzie Cross; Sandra K. Cummings; Elizabeth Edgerton, M.D., M.P.H.; Farah Englert; Kenneth Fink, M.D., M.G.A., M.P.H.; Janice L. Genevro, Ph.D., M.S.W.; Barbara Gordon; Margi Grady; Janelle Guirguis-Blake, M.D.; Patrik Johansson, M.D.; Heather Johnson; Douglas Kamerow, M.D., M.P.H.; Hazel Keimowitz, M.A.; Claire Kendrick, M.S.Ed.; David Lanier, M.D.; Iris Mabry, M.D., M.P.H.; David Meyers, M.D.; Tess Miller, Dr.P.H.; Kevin Murray; Barbara Najar, M.P.H.; Bridget O'Connell; Nilam Patel, M.P.H.; Amy Pfeiffer; Gurvaneet Randhawa, M.D., M.P.H.; Stacia Sanvick; Eve Shapiro; Randie Siegel, M.S.; Jean Slutsky, P.A., M.S.P.H.; Kristie Smith; Tricia Trinité, M.S.P.H., A.P.R.N.; Tracy Wolff, M.D., M.P.H.
Evidence-Based Practice Centers Supporting the USPSTF 2001-2005
The following researchers working through two AHRQ Evidence-Based Practice Centers prepared systematic evidence reviews and evidence summaries as resources on topics under consideration by the USPSTF.
Mikel Aickin, Ph.D.; Tracy Beil, M.S.; Christina Bougatsos, B.S.; Jessica Burnett; David Buckley, M.D.; Benjamin K.S. Chan, M.S.; Roger Chou, M.D.; Elizabeth Clark, M.D., M.P.H.; Robert Davis, M.D., M.P.H.; Stephanie Detlefsen, M.D.; Karen B. Eden, Ph.D.; Craig Fleming, M.D.; Michele Freeman, M.P.H.; Rochele Fu, Ph.D.; Nancy Glass, Ph.D., M.P.H., R.N.; Rachel Gold, Ph.D., M.P.H; Carla A. Green, Ph.D., M.P.H.; Jeanne-Marie Guise, M.D., M.P.H.; Andrew Hamilton, M.S., M.L.S.; Elizabeth Haney, M.D; Emily Harris, Ph.D., M.P.H.; Mark Helfand, M.D., M.P.H.; Charles J. Homer, M.D., M.P.H; Laurie Huffman, M.S.; Linda Humphrey, M.D., M.P.H.; Todd Karthuis, M.D., M.P.H; Kathryn Pyle Krages, M.A.; Greg Larson, M.D.; Erin Leblanc, M.D., M.P.H.; Susan Mahon, M.P.H.; Heather McPhillips, M.D., M.P.H.; Jill Miller, M.D.; Cynthia D. Morris, Ph.D., M.P.H.; Heidi D. Nelson, M.D., M.P.H.; Peggy Nygren, M.S.; Valerie Palda, M.D., M.P.H.; Rita Panosca, M.D.; Daphne Plaut, M.L.S.; Michael R. Polen, Ph.D.; Cheryl Ritenbaugh, Ph.D., M.P.H.; Somnath Saha, M.D., M.P.H.; Scott A. Shipman, M.D., M.P.H.; Paula R. Smith, R.N., B.S.N.; Ariel K. Smits, M.D., M.P.H.; Lina M.A. Takano, M.D., M.S.; Diane Thompson, M.S.; Kim Villemyer; Miranda Walker, B.S.; David Wheeler, M.D.; Evelyn P. Whitlock, M.D., M.P.H.; Selvi B.Williams, M.D., M.P.H.
Alice Ammerman, Dr.P.H., R.D.; James D. Bader, D.D.S., M.P.H.; Rainer Beck, M.D.; John F. Boggess, M.D.; Malaz Boustani, M.D., M.P.H.; Seth Brody, M.D.; Audrina J. Bunton; Katrina Donahue, M.D., M.P.H.; Louise Fernandez, PA-C, R.D., M.P.H.; Kenneth Fink, M.D., M.G.A., M.P.H.; Carol Ford, M.D.; Angela Fowler-Brown, M.D.; Bradley N. Gaynes, M.D., M.P.H.; Paul Godley, M.D., M.P.H.; Susan A. Hall, M.S.; Laura Hanson, M.D., M.P.H.; Russell Harris, M.D., M.P.H.; Katherine E.Hartmann, M.D., Ph.D.; Michael Hayden, M.D.; M. Brian Hemphill, M.D.; Alissa Driscoll Jacobs, M.S., R.D.; Jana Johnson; Linda Kinsinger, M.D., M.P.H.; Carol Krasnov; Ramesh Krishnaraj; Carole M. Lannon, M.D., M.P.H.; Carmen Lewis, M.D., M.P.H.; Kathleen N. Lohr, Ph.D.; Linda J. Lux, M.P.A. ; Kathleen McTigue, M.D., M.P.H.; Catherine Mills, M.A.; Kavita Nanda, M.D., M.H.S.; Carla Nester, M.D.; Britt Peterson, M.D., M.P.H.; Christopher J. Phillips, M.D., M.P.H.; Michael Pignone, M.D., M.P.H.; Mark Pletcher, M.D., M.P.H.; Saif S. Rathore; Melissa Rich, M.D.; Gary Rozier, D.D.S.; Jerry L. Rushton, M.D., M.P.H.; Lucy A. Savitz; Joe Scattoloni; Stacey Sheridan, M.D., M.P.H.; Sonya Sutton, B.S.P.H.; Jeffrey A. Tice, M.D.; Suzanne L. West, Ph.D.; B. Lynn Whitener, Dr.P.H., M.S.L.S.; Margaret Wooddell, M.A.; Dennis Zolnoun, M.D.
Liaisons to the USPSTF
American Academy of Family Physicians
American Academy of Nurse Practitioners
American Academy of Pediatrics
American Academy of Physician Assistants
American Cancer Society
American College of Obstetricians and Gynecologists
American College of Physicians
American College of Preventive Medicine
American Medical Association
American Osteopathic Association
America's Health Insurance Plans
National Organization of Nurse Practitioner Faculties
Canadian Task Force on Preventive Health Care
Centers for Disease Control & Prevention
Centers for Medicare & Medicaid Services
Health Resources and Services Administration
Indian Health Services
Military Health System
National Institutes of Health
U.S. Food and Drug Administration
VA National Center for Health Promotion and Disease Prevention
The USPSTF recognizes the importance of immunizations in primary disease prevention. The Task Force refers to recommendations made by the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices (ACIP) for immunization of children and adults. The methods used by ACIP to review evidence on immunizations may differ from the methods used by the USPSTF.
Prevention Dissemination and Implementation (Put Prevention Into Practice) aims to improve delivery of appropriate clinical preventive services. The program disseminates the USPSTF recommendations in multiple formats and facilitates health care delivery systems' implementation of evidence-based preventive services through partnerships, communication, user-driven tools, and outreach. For more information, go to www.ahrq.gov/clinic/ppipix.htm
AHRQ's Electronic Preventive Services Selector for PDAs, and its companion Web-based tool, both allow users to search USPSTF recommendations by patient age, sex, and pregnancy status. Available at http://www.epss.ahrq.gov.
The Guide to Community Preventive Services provides recommendations on population-based interventions to promote health and prevent disease, injury, disability, and premature death. Recommendations are promulgated by the Task Force on Community Preventive Services, an independent group appointed by the Director of the Centers for Disease Control and Prevention. For information, go to http://www.thecommunityguide.org.
The National Guideline Clearinghouse™ (NGC) is a database of evidence-based clinical practice guidelines and related documents. To access, go to www.guideline.gov.
The USPSTF strongly recommends the new Adult Preventive Care Timeline.
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AHRQ Publication No. 06-0588
Current as of June 2006
Internet Citation:
The Guide to Clinical Preventive Services 2006—Recommendations of the U.S. Preventive Services Task Force. Pocket Guide. Agency for Healthcare Research and Quality, Rockville, MD. AHRQ Publication No. 06-0588, June 2006. http://www.ahrq.gov/clinic/pocketgd06/
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