Closing Evidence Gaps in Clinical Prevention (2022) / Chapter Skim
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Pages 1-18
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. The USPSTF is codified in the Healthcare Research and Quality Act, which states that the USPSTF shall review the scientific evidence related to the effectiveness, appro priateness, and cost-effectiveness of clinical preventive services for the 1
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(USPSTF, 2021c) The USPSTF recommendations guide clinical practice and garner broad attention, as evidenced by the coverage in the lay and medical literature of the recent change in guidance regarding aspirin use to prevent cardiovascular disease (Mahase, 2021; Rabin, 2021; USPSTF, 2021a)
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Both I statements and letter grade recommendations include research needs; the details of those sections vary widely in their specificity and scope. Addressing evidence gaps is important for changing an I statement to a letter grade recommendation or, as in the case of the recent change in the draft recommendation regarding aspirin use to prevent cardiovascular disease, changing a letter grade recommendation, in this example from a C recommendation to a D for some populations (USPSTF, 2021a)
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Furthermore, by offering a list of the different classes of evidence gaps that may play a role in analyzing a preventive service, the taxonomy and an accompanying workflow offer a road map for researchers and funders. The USPSTF analytic framework begins with the specification of a population of interest and then examines the evidence for connections between actions (screening, preventive medications, or behavioral interventions)
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Traditionally this has not been something that the USPSTF has concerned itself with, but the committee's discussions led it to conclude that it was crucial to include evidence gaps related to D&I in the taxonomy. Thus, the committee developed a taxonomy that covers three different facets of prevention-related evidence gaps: foundational issues, clinical and epidemiologic evidence as outlined in the USPSTF's analytic framework, and D&I.
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Others, such as funders, might work with a collection of evidence gaps generated by someone else and apply their own prioritization criteria to develop a research agenda that reflects their own interests. RECOMMENDATIONS The committee makes eight recommendations in three categories: using the taxonomy, fostering clinical prevention research, and advancing the work of the USPSTF.
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FIGURE S-2 Workflow for using the evidence gaps taxonomy. Using the Taxonomy The committee has provided a taxonomy for use in systematically describing evidence gaps in three facets: foundational research, the analytic framework used by the USPSTF, and D&I.
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Preventive Services Task Force should use the Clinical Preven tion Research Taxonomy to identify and describe evidence gaps. The USPSTF will likely and understandably be most inclined to focus their efforts on the analytic framework evidence gaps, as it is already a part of their process.
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Recommendation 2: For each recommendation and I statement, the U.S. Preventive Services Task Force (USPSTF)
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Recommendation 4: Funders, in particular the National Institutes of Health and the Patient-Centered Outcomes Research Institute, should set aside funding to address high-priority evidence gaps identified by the U.S. Preventive Services Task Force.
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Recommendation 6: The National Institutes of Health and other funders addressing high-priority clinical prevention evidence gaps identified by the U.S. Preventive Services Task Force should use funding mechanisms and processes that can assure that research is conducted expediently, efficiently, and with fidelity to the speci fied research needs, rather than waiting for such research needs to be addressed predominantly through investigator-initiated grant mechanisms.
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Expanding and establishing trans-NIH prevention interests into networks for clinical prevention research could also contribute to closing high-priority evidence gaps identified by the USPSTF by establishing an infrastructure to conduct prevention research. Such a network would complement the Centers for Disease Control and Prevention's Prevention Research Centers.
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Recommendation 8: The Agency for Healthcare Research and Qual ity should work with relevant government agencies and key stake holders to evaluate how effectively U.S. Preventive Services Task Force recommendations are implemented in real-world settings to identify and address gaps in achieving the intended benefits.
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. The committee approached the taxonomy and recommendations as an important component of a much larger effort for AHRQ, ODP, and USPSTF partners and other stakeholders to improve clinical prevention research and practice.
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Preventive Services Task Force.
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2018. US Preventive Services Task Force priori ties for prevention research.
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