Guide to Clinical Preventive Services, 2012
Since being codified by Congress, the U.S. Preventive Services Task Force (USPSTF) has been fulfilling its charge to conduct rigorous reviews of scientific evidence to create evidence-based recommendations for preventive services that should be provided in the primary care setting.
Since its inception, the USPSTF has made and maintained recommendations on more than 100 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 2012 includes new or updated recommendations on 64 clinical preventive services released from 2002-2012 in a brief, easily usable format meant for use at the point of patient care. Recommendations that were being updated while this edition of the Guide was being compiled, 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. The suggestion that it is not beneficial to provide all of the services available for prevention was nearly a heretical concept in U.S. medical practice when the first USPSTF started its work. Over time, individual health care providers, professional organizations, integrated health systems, health plans and insurers, and public programs, including the Centers for Medicare & Medicaid Services as well as groups crafting health quality measures and national health objectives, have adopted the recommendations. 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 central to the preventive benefits covered under the Patient Protection and Affordable Care Act. Under the new law, in new plans and policies preventive services with a Task Force grade of A or B will be covered with no cost sharing requirements. Even prior to national reform activities, the USPSTF had 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 allow for additional input from experts and advocates and to assist us in better crafting messages for the public. However, the USPSTF remains committed to evaluating evidence free from the influence of politics, special interests, and advocacy.
Our methods continue to evolve as well. Our Procedure Manual, which can be found at www.USPreventiveServicesTaskForce.org/uspstf08/methods/procmanual.htm, outlines our updated process for evaluating the quality and strength of the evidence for a service, determining the net health benefit (benefits 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.
As before, the letter grade linked to each recommendation reflects 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” recommendations with eligible patients and offer them as a priority.
- Discourage the use of services with “D” recommendations unless there are unusual additional considerations.
- Give lower priority to services with “C” recommendations; they need not be provided unless there are individual considerations in favor of providing the service.
- Help patients understand the uncertainty surrounding services when the evidence is insufficient to determine net benefit (I statement). Clinicians may read the Clinical Considerations section of the full recommendations for additional guidance.
As is true of all patient care, preventive services have become much more complex in view of ongoing research. The USPSTF realizes 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. While providers and patients look for simple messages and actions, our recommendations reflect the advances in knowledge in this critical area of health services, and, in order to maximize the health benefits and decrease any health harms, we must consider the new complexity as we do for all medical services we provide. 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 those services they provide, as the additional information can help them deliver the highest quality preventive care. In addition, the USPSTF Electronic Preventive Services Selector (ePSS), available via PDA, smart phone, or on the Web at www.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 2012 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.
Virginia A. Moyer, M.D., M.P.H., Chair
Michael L. LeFevre, M.D., M.S.P.H., Co-Vice Chair
Albert L. Siu, M.D., M.S.P.H., Co-Vice Chair
U.S. Preventive Services Task Force