Guide to Clinical Preventive Services, 2014
Appendix D. About the U.S. Preventive Services Task Force
Created in 1984, the U.S. Preventive Services Task Force (USPSTF) is an independent group of national experts in prevention and evidence-based medicine that works to improve the health of all Americans by making evidence-based recommendations about clinical preventive services such as:
- Counseling services
- Preventive medications
The Task Force is made up of 16 volunteer members who serve 4-year terms. Members come from the fields of preventive medicine and primary care, including internal medicine, family medicine, pediatrics, behavioral health, obstetrics and gynecology, and nursing. The Task Force is led by a chair and two vice-chairs. Members are appointed by the Director of AHRQ. Members must have no substantial conflicts of interest that could impair the integrity of the work of the Task Force. A list of current USPSTF members, including their biographical information, can be found on the USPSTF Web site (www.USPreventiveServicesTaskForce.org).
Since 1998, through acts of the U.S. Congress, the Agency for Healthcare Research and Quality (AHRQ) has been authorized to convene the Task Force and to provide ongoing scientific, administrative, and dissemination support to the Task Force.
The Task Force makes recommendations to help primary care clinicians and patients decide together whether a preventive service is right for a patient's needs. Its recommendations apply to people who have no signs or symptoms of the specific disease or condition to which a recommendation applies and are for services prescribed, ordered, or delivered in the primary care setting.
Task Force recommendations are based on a rigorous review of existing peer-reviewed evidence. The Task Force assesses the effectiveness of a clinical preventive service by evaluating and balancing the potential benefits and harms of the service. The potential benefits include early identification of disease and improvement in health. The potential harms can include adverse effects of the service itself or inaccurate test results that may lead to additional testing, additional risks or unneeded treatment. The Task Force does not explicitly consider costs in its assessment of the effectiveness of a service. The Task Force assigns each recommendation a letter grade (A, B, C, or D grade or an I statement) based on the strength of the evidence and on the balance of benefits and harms of the preventive service. More information on USPSTF recommendation grades and a list of all current USPSTF recommendations can be found on the USPSTF Web site.
The Recommendation Making Process
The USPSTF is committed to making its work as transparent as possible. As part of this commitment, the Task Force provides opportunities for the public to provide input during each phase of the recommendation process.
The phases of the topic development process are described below and illustrated in “Steps the USPSTF Takes to Make a Recommendation” at the end of this appendix.
The USPSTF considers a broad range of clinical preventive services for its recommendations, focusing on screenings, counseling, and preventive medications. Anyone can nominate a topic for consideration by the Task Force.
Research Plan Development
Once the USPSTF selects a topic for review, it works with an Evidence-based Practice Center (EPC) to develop a draft research plan, which guides the recommendation process and includes key questions and target populations. A draft research plan is posted for public comment, and feedback is incorporated into a final research plan.
Evidence Report and Recommendation Statement Development
Using the final research plan as a guide, the EPC researchers independently gather, review, and analyze evidence on the topic and summarize their findings in a systematic evidence report. The evidence report is sent to subject matter experts for peer review before it is shared with the Task Force.
Then, the entire Task Force discusses and deliberates the evidence, weighs the benefits and harms, and uses the information to determine the effectiveness of a service. The Task Force revises and finalizes a draft recommendation statement based on this discussion.
The draft evidence report and draft recommendation statement are typically posted together on the Task Force Web site for a period of 4 weeks. During the comment period, any member of the public may submit comments on either or both of the documents.
Upon receiving all comments from experts, partners, and the public, the EPC researchers revise the draft evidence report. Once final, the EPC begins to prepare a summary of the evidence report for submission to a peer-reviewed journal.
Final Recommendation Statement
Then, Task Force members review all the comments received and use them to inform the development of the final recommendation statement. The recommendation statement is sent to all Task Force members for final ratification.
The final recommendation statement and evidence summary are published at the same time in a peer-reviewed journal. All recommendation statements and supporting evidence reports are made available on the Task Force Web site (www.USPreventiveServicesTaskForce.org).
Please visit the Task Force Web site (www.USPreventiveServicesTaskForce.org) to learn how and when to nominate topics for consideration by the Task Force or to comment on topics in development.
Identifying High Priority Research Gaps
In the Patient Protection and Affordable Care Act of 2010, Congress has specifically charged the Task Force with identifying and reporting each year on areas where current evidence is insufficient to make a recommendation on the use of a clinical preventive service, with special attention to those areas where evidence is needed to make recommendations for specific populations and age groups. The USPSTF believes that identifying evidence gaps and highlighting them as priority areas for research will inspire public and private researchers to collaborate and target their efforts to generate new knowledge and address important health priorities. The Annual Report to Congress is available on the Task Force Web site.
On the Task Force Web site, people can:
- View all current USPSTF recommendations, EPC reports, and supporting materials.
- View manuals, slides, videos, and commentaries about the methods and processes the Task Force uses.
- Learn how to interpret recommendations and use them in clinical primary care practice.
- Nominate a new USPSTF member or a topic for a consideration by the Task Force.
- Provide input on specific draft materials during public comment periods.
- Sign up for the USPSTF listserv to receive USPSTF updates.
- Access the Electronic Preventive Services Selector (ePSS), a quick hands-on tool designed to help primary care clinicians and health care teams identify, prioritize, and offer the screening, counseling, and preventive medication services that are appropriate for their patients. The ePSS is available on the Web (epss.ahrq.gov) or as a mobile phone or PDA application.
- Access myhealthfinder. myhealthfinder is a tool for consumers that provides personalized recommendations for preventive services based on the U.S. Preventive Services Task Force; the Bright Futures Guidelines; the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices (ACIP); and the Institute of Medicine's (IOM's) Committee on Preventive Services for Women.
Steps the USPSTF Takes to Make a Recommendation