Closing Evidence Gaps in Clinical Prevention (2022) / Chapter Skim
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2 Clinical Practice Guidelines and the U.S. Preventive Services Task Force
2 Clinical Practice Guidelines and the U.S. Preventive Services Task Force
Pages 25-42
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From page 25... ...
and several other guideline developers prefer the former approach. While the committee's statement of task included developing a taxonomy of evidence gaps and suggesting approaches to closing evidence gaps in clinical prevention in general, it explicitly named the USPSTF several times.
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From page 26... ...
There are many types of contextual barriers to implementing clinical guidelines, including but not limited to the health organization system and health professional context; guidelines context; patient context; and legal, social, and political contexts (Correa et al., 2020; Hurwitz, 1999)
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From page 27... ...
Patients may be reluctant to request or accept suggestions for a service for a variety of reasons, including limited language, literacy, or health literacy; limited motivation to follow a certain recommendation; or concerns about affordability. They may also turn down offers of preventive services based on fears of real or perceived harms (Jones et al., 2010)
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From page 28... ...
U.S. PREVENTIVE SERVICES TASK FORCE History and Scope In 1984, the U.S.
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From page 29... ...
. The legislation also states that the USPSTF shall review the scientific evidence related to the effectiveness, appro priateness, and cost-effectiveness of clinical preventive services for the purpose of developing recommendations for the health care community, and updating previous clinical preventive recommendations.2 However, despite having the authority to do so, the USPSTF does not evaluate evidence related to cost-effectiveness when issuing a grade for a topic: [USPSTF]
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From page 30... ...
U.S. Preventive Services Task Force Process The process of selecting a topic for review through publishing the final recommendation statement takes 3 years on average (Borsky, 2021)
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Preventive Services Task Force Magnitude of Net Benefit Certainty of Net Benefit Substantial Moderate Small Zero/Negative High A B C D Moderate B B C D Low Insufficient (I Statement)
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From page 32... ...
Since 1989, USPSTF recommendations have suggested evidence gaps or research needs for various topics in one way or another, but in 2007, the USPSTF introduced a new section of its recommendation statements called "Other Considerations." This section could include cost and dissemination and
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From page 33... ...
New evidence reviewed to update a topic with an I statement may also not be enough to upgrade it to receive a letter grade recommendation. The ACA requires the USPSTF and the Community Preventive Services Task Force (CPSTF)
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From page 34... ...
For example, in 2008, computed tomographic colonography and fecal DNA testing were a type of screening for colorectal cancer given an I statement by the USPSTF. When the USPSTF updated the colorectal cancer screening in 2016, new evidence about the harms and benefits of those screenings had already emerged, and the USPSTF updated its recommendation so that it no longer included an I statement or separate grade for those specific screenings.
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From page 35... ...
U.S. Preventive Services Task Force's Relationship with the Community Preventive Services Task Force HHS established the CPSTF in 1996 to provide findings and recommendations about community preventive services, programs, and other interventions aimed at improving population health, and to complement the work of the USPSTF (CPSTF, n.d.-a)
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From page 36... ...
Preventive Services Task Force and the Community Preventive Services Task Force. SOURCE: Grossman and Elder, 2015.
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From page 37... ...
While no such taxonomy was discovered, the search provided some insights into how other panels address insufficient evidence. For example, the American College of Cardiology and the American Heart Association and the United Kingdom National Screening Committee describe evidence gaps in a manner similar to those of the USPSTF's I statements or the CPSTSF's IEs, though nomenclature varies.
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From page 38... ...
Presented on March 16, 2021, at Meeting 4 of the Committee on Addressing Evidence Gaps in Clinical Prevention. https://www.nationalacademies.org/event/03-16-2021/addressing-evidence-gaps-in clinical-prevention-committee-meeting-session-2 (accessed October 19, 2021)
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From page 39... ...
n.d.-a. About the Community Preventive Services Task Force.
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From page 40... ...
Preven tive Services Task Force insufficient evidence statements. American Journal of Preventive Medicine.
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Preventive Services Task Force recommenda tion statement. Annals of Internal Medicine 164(4)
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From page 42... ...
Preventive Services Task Force works: USPSTF 101. https://www.uspreventiveservicestaskforce.org/Home/GetFile/6/91/uspstf101_ slides/pdf (accessed July 19, 2021)
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