Guide to Clinical Preventive Services, 2014
The U.S. Preventive Services Task Force (USPSTF) is mandated by Congress to conduct rigorous reviews of scientific evidence to create evidence-based recommendations for preventive services that may be provided in the primary care setting.
Since its inception, the USPSTF has made and maintained recommendations on dozens of clinical preventive services that are intended to prevent or reduce the risk for heart disease, cancer, infectious diseases, and other conditions and events that impact the health of children, adolescents, adults, and pregnant women. The Guide to Clinical Preventive Services 2014 includes both new and updated recommendations released from 2004-2014 in a brief, easily usable format meant for use at the point of patient care. The most up-to-date version of the recommendations, as well as the complete USPSTF recommendation statements, are available along with their supporting scientific evidence at www.USPreventiveServicesTaskForce.org.
Recommendations for preventive care have evolved over time as it has become widely recognized that some “preventive” services were not actually beneficial. Individual health care providers, professional organizations, integrated health systems, insurers (both private and public), as well as groups crafting health quality measures and national health objectives, have recognized the need to carefully balance potential benefits and harms using the highest quality of evidence, and have adopted the recommendations of the Task Force. The primary audience for the USPSTF’s work remains primary care clinicians, and the recommendations are now considered by many to provide definitive standards for preventive services. The work of the USPSTF is recognized by the Patient Protection and Affordable Care Act. Under the law, preventive services with a Task Force grade of A or B must be covered without cost-sharing (e.g., copayment or deductible) under new health insurance plans or policies.
In the last several years, the USPSTF has increased the transparency of its work, and these efforts have gained additional momentum in view of the enhanced importance of the recommendations under the new law. Public comments are welcomed at multiple points in the development of each recommendation to encourage additional input from experts, advocates and other stakeholders to help the Task Force craft relevant and clear recommendation statements. However, the USPSTF remains committed to evaluating evidence free from the influence of politics, special interests, and advocacy.
As the science around clinical practice guideline development has evolved, USPSTF methods continue to evolve as well. The Procedure Manual, which can be found on the USPSTF Web site, details the most updated version of the process for evaluating the quality and strength of the evidence for a service, determining the net health benefit (benefit minus harms) associated with the service, and judging the level of certainty that providing these services will be beneficial in primary care. We continue to explore the appropriate use of mathematical modeling to help fill research gaps regarding the ages at which to start and stop providing a service, and at what time intervals. In addition, we are committed to improving the communication of our recommendations to a broader audience, including patients and policymakers.
The letter grade linked to each recommendation reflects both the magnitude of net benefit and the strength and certainty of the evidence supporting the provision of a specific preventive service. These grades translate to practice guidance for clinicians:
- Discuss services with “A” and “B” recommendation grades with eligible patients and offer them as a priority.
- Discourage the use of services with “D” recommendation grades unless there are unusual additional considerations.
- Give lower priority to services with “C” recommendation grades; they need not be provided unless there are individual considerations in favor of providing the service.
Help patients understand the uncertainty surrounding services with “I” (insufficient evidence) statements, which reflect the conclusion that the evidence is insufficient to determine net benefit. The Clinical Considerations section of each full recommendation statement offers additional guidance.
The USPSTF recognizes that clinical decisions about patients involve more complex considerations than the evidence alone; clinicians should always understand the evidence but individualize decisionmaking to the specific patient and situation. The Clinical Considerations section of each USPSTF recommendation statement helps clinicians by offering practical information so they can tailor these recommendations to individual patients.
We strongly encourage clinicians to visit the USPSTF Web site and read the complete recommendation statements for services relevant to their patients. Additional information is available to facilitate the delivery of the highest quality preventive care. For each topic, educational materials have been developed for use with patients and the public. Special materials developed for clinicians are also available on some complex topics, such as prostate and lung cancer screening, along with links to informative Web sites. In addition, the USPSTF Electronic Preventive Services Selector (ePSS), available via PDA, smart phone, or on the Web at epss.ahrq.gov, allows users to search USPSTF recommendations by patient age and other clinical characteristics.
We hope you find the Guide to Clinical Preventive Services 2014 to be a useful tool as you care for patients. Based on the best medical evidence available, we are confident that by implementing these recommended services, you will help your patients live longer and healthier lives.
Michael L. LeFevre, M.D., M.S.P.H., Chair
Albert L. Siu, M.D., M.S.P.H., Co-Vice Chair
Kirsten Bibbins-Domingo, Ph.D., M.D., M.A.S., Co-Vice Chair
U.S. Preventive Services Task Force