Appendixes
Appendix A: How the U.S. Preventive Services Task Force Grades Its Recommendations
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 |
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Appendix B: Members of the U.S. Preventive Services Task Force 2001-2006
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
George Isham, M.D., M.S. Medical Director and Chief Health Officer HealthPartners Minneapolis, MN
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
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Appendix C: Acknowledgments
AHRQ Staff Supporting the USPSTF 2001-2006
David Atkins, M.D., M.P.H.; Mary Barton, M.D., M.P.P.; 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.; Kenneth Lin, M.D.; Iris Mabry, M.D., M.P.H.; Corey Mackson, M.S.A.; 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; Marion Torchia; Tricia Trinité, M.S.P.H., A.P.R.N.; Tracy Wolff, M.D., M.P.H.
Evidence-Based Practice Centers Supporting the USPSTF 2001-2006
The following researchers working through three AHRQ Evidence-Based Practice Centers prepared systematic
evidence reviews and evidence summaries as resources on topics under consideration by the USPSTF.
Oregon Evidence-Based Practice Center
Mikel Aickin, Ph.D.; Sarah Baird, M.S.; Vance Bauer, M.A.; Tracy Beil, M.S.; Christina Bougatsos, B.S.; Jessica Burnett; David Buckley, M.D.; Taryn Cardenas, B.S.; Susan Carson, M.P.H.; 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.; Michelle Eder, 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.; Theresa Hillier, M.D., M.S.; Laurie Huffman, M.S.; Linda Humphrey, M.D., M.P.H.; Devan Kansagara, M.D.; P. Todd Korthuis, M.D., M.P.H;
Kathryn Pyle Krages, M.A.; Erin Leblanc, M.D., M.P.H.; Beth Liles, M.D.; Jennifen Lin, M.D.; Susan Mahon, M.P.H.;
Yasmin McInerney, M.D.; Heather McPhillips, M.D., M.P.H.; Yvonne Michael, Sc.D.; Jill Miller, M.D.; Cynthia D.
Morris, Ph.D., M.P.H.; Cynthia Mulrow, M.D., M.Sc.; Arpana Naik, M.D.; Heidi D. Nelson, M.D., M.P.H.; Rebecca Newton-Thompson, M.D., M.Sc.; Susan Norris, M.D., M.P.H.; Peggy Nygren, M.S.; Tracy Orleans, Ph.D.; Valerie Palda, M.D., M.P.H.; Rita Panosca, M.D.; Nola Pender, Ph.D., R.N., F.A.A.N.; , Jeffrey Piepert, M.D., M.P.H.; Daphne Plaut, M.L.S.; Michael R. Polen, Ph.D.; Elizabeth O’Connor, Ph.D.; Gary Rischitelli, M.D., J.D., M.P.H.; Cheryl Ritenbaugh, Ph.D., M.P.H.; Kevin Rogers, M.D.; 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.; Robert Steiner, M.D.; Kelly Streit, M.S., R.D.; Lina M.A. Takano, M.D., M.S.; Diane Thompson, M.S.; Kari Tyne, M.D.; Kimberly Vesco, M.D., M.P.H.; Kim Villemyer, B.A.; Miranda Walker, B.A.; Carolyn Westoff, M.D., M.Sc.; Evelyn P. Whitlock, M.D., M.P.H.; Selvi B.Williams, M.D., M.P.H.; Jennifer Wisdom, Ph.D., M.P.H.; Sarah Zuber, B.A.
RTI International/University of North Carolina Evidence-Based Practice Center
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.
University of Ottawa Evidence-Based Practice Center
Nicholas Barrowman, Ph.D.; Catherine Code, M.D., F.R.C.P.C.; Catherine Dubé, M.D., M.Sc., F.R.C.P.C.; Gabriela Lewin, M.D.; David Moher, Ph.D.; Alaa Rostom, M.D., M.Sc., F.R.C.P.C.; Margaret Sampson, M.I.L.S.; Alexander Tsertsvadze, M.D., M.Sc.
Liaisons to the USPSTF
Professional Organizations
American Academy of Family Physicians
American Academy of Nurse Practitioners
American Academy of Pediatrics
American Academy of Physician Assistants
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
Government Agencies
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
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Appendix D: Advisory Committee on Immunization Practices (ACIP) Recommended Immunization Schedules
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.
More Resources on Preventive Services
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
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 http://www.guideline.gov.
The Adult Preventive Care Timeline, based on USPSTF recommendations, is an at-a-glance wall poster, showing which preventive services your patients need, and when. To order, call the AHRQ Publications Clearinghouse at 1-800-358-9295 or send an e-mail to ahrqpubs@ahrq.hhs.gov.
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AHRQ Publication No. 07-05100
Current as of September 2007
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. 07-05100, September 2007. http://www.ahrq.gov/clinic/pocketgd07/
540 Gaither Road Rockville, MD 20850