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Clinical Preventive Services
Two Federal Initiatives
U.S. Preventive Services Task Force
David Atkins, M.D., M.P.H., Senior Health Policy Analyst, Center for Practice and Technology Assessment, Agency for Healthcare Research and Quality (AHRQ), Rockville, MD.
Recognizing physicians' needs for guidelines on clinical preventive services, in 1984 the Federal Government established the U.S. Preventive Services Task Force (USPSTF). The mission of the Task Force is to:
- Evaluate the scientific evidence of the effectiveness of individual clinical preventive services.
- Build a consensus for effective clinical preventive services.
- Issue age- and risk-factor-specific recommendations.
- Guide the research agenda in the area of preventive care.
The goal of the USPSTF is to promote effective prevention in the primary care setting.
The Task Force is comprised of 14 physicians who receive support from researchers at several Evidence-based Practice Centers across the country. USPSTF products include: The Guide to Clinical Preventive Services, published in 1989, and the Second Edition of the Guide to Clinical Preventive Services, published in 1996, which contains recommendations on more than 200 clinical interventions. Currently, Task Force members are in the process of developing the third edition, which will be available in 2001.
The USPSTF takes an explicit, evidence-based approach to their evaluations. The USPSTF
methodology is to:
- Define clinical endpoints of interest, i.e., fewer deaths from certain diseases.
- Review the evidence in a systematic manner.
- Evaluate the quality of individual studies for fundamental flaws.
- Link recommendations to evidence.
The original purpose of The Guide to Clinical Preventive Services was to educate clinicians.
However, the Task Force audience has expanded to include consumers and the media, provider organizations, health plans, insurers and organizations that work to ensure healthcare quality. Recognizing that implementation needs to go beyond educating individual clinicians, the Task Force has begun to target their recommendations and messages for these different audiences.
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Guide to Community Preventive Services
Emily Kahn, Ph.D., M.P.H., Staff Scientist, Community Guide Branch, Division of Prevention Research and Analytic Methods, Epidemiology Program Office, Centers for Disease Control and Prevention (CDC), U.S. Department of Health and Human Services, Atlanta, GA.
Another preventive care initiative being carried out at the Federal level is the development of
The Community Guide to Preventive Services, by the Centers for Disease Control and
Prevention. The Community Guide and the USPSTF, as part of the Healthy People 2010 public
health program, combine results to determine the Nation's prevention priorities. The Community Guide establishes and disseminates guidelines for community preventive services to be provided by physicians and community-based clinics.
According to Dr. Kahn, the following six risk behaviors are related to the largest burden of
- Tobacco use.
- Alcohol abuse and misuse.
- Other substance abuse.
- Inadequate nutrition.
- Physical inactivity.
- Risky sexual behavior.
The Community Guide recommendations focus on preventing community-based injury and
illness associated with the above risk factors. In addition, environmental reviews—initiatives
focusing on sociocultural issues—will be included.
Examples of environmental review topics include:
- Early childhood development programs.
- Minimum wage job opportunities for working families.
- Access to quality healthcare for all ages.
Recommendations within the Community Guide are reviewed by CDC scientists and finalized by an independent task force. The CDC works with a wide variety of consultants and liaisons, including chapter development teams comprised of subject matter experts and external consultants. Like those of the USPSTF, the recommendations are based on systematic reviews of the evidence. The CDC methodology is to:
- Develop a conceptual framework.
- Search electronic databases for evidence.
- Rate the quality of evidence.
- Summarize evidence for a given intervention.
- Translate the strength of evidence into recommendations.
In addition to recommendations, the Community Guide will include supplementary information for each intervention, such as analyses of cost-effectiveness, statements of applicability of the intervention to different populations, and evidence of potential benefits and harms and possible
barriers to implementation. The final product is due for release in June 2001.
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Atkins D, et al. Developing evidence-based clinical practice guidelines: lessons learned by the U.S.
Preventive Services Task Force. Ann Rev Pub Health 1996;17:511-38.
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