The United States Preventive Services Task Force (USPSTF) was first formed in 1984 to assist physicians in making decisions about which preventive services to offer patients. It consists of a 15-member panel of independent scientists picked for their expertise in primary care, clinical prevention, and evidence-based methodology. The first set of recommendations was published in 1989 as the Guide to Clinical Preventive Services, and was revised in 1996 in the second edition. Recommendations are now published on the USPSTF web site (www.ahrq.gov/ clinic/uspstfix.htm).
The USPSTF uses an explicit set of steps and criteria to judge the effectiveness, harms, costs and benefits of preventive interventions: screening, counseling, and chemoprevention. Topics are suggested by outside partners, including the American Academy of Family Physicians, and are then sent to one of 13 evidence-based practice centers, where an extensive review is conducted of the current scientific literature on the topic. The evidence report is then reviewed by the 15-member USPSTF and a recommendation is made using the rating system described in TABLE 1. The current members of the USPSTF arefound at www.ahrq.gov/clinic/uspstfab.htm# Members. The staff for the task force is provided by the Agency for Health Care Quality and Research (AHRQ), one of the agencies in the Public Health Service of the US Department of Health and Human Services.
In addition to listing the recommendations and the rationales behind them, the USPSTF web site also provides the evidence report and a description of recommendations on that topic made by other organizations, with a discussion of clinical implications of the recommendation. During 2004, the USPSTF made or updated 29 recommendations ( TABLE 2 ). There were 5 A recommendations, 4 B recommendations, no C recommendations, 11 recommendations against an intervention (D recommendation), and 9 instances of insufficient evidence to make a recommendation.
TABLE 1
Standard recommendation language, USPSTF
| RECOMMENDATION: |
| A Language: The USPSTF strongly recommends that clinicians routinely provide [the service] to eligible patients. (The USPSTF found good evidence that [the service] improves important health outcomes and concludes that benefits substantially outweigh harms.) |
| RECOMMENDATION: |
| B Language: The USPSTF recommends that clinicians routinely provide [the service] to eligible patients. (The USPSTF found at least fair evidence that [the service] improves important health outcomes and concludes that benefits outweigh harms.) |
| RECOMMENDATION: |
| C Language: The USPSTF makes no recommendation for or against routine provision of [the service]. (The USPSTF found at least fair evidence that [the service] can improve health outcomes but concludes that the balance of the benefits and harms is too close to justify a general recommendation.) |
| RECOMMENDATION: |
| D Language: The USPSTF recommends against routinely providing [the service] to asymptomatic patients. (The USPSTF found at least fair evidence that [the service] is ineffective or that harms outweigh benefits.) |
| RECOMMENDATION: |
| I Language: The USPSTF concludes that the evidence is insufficient to recommend for or against routinely providing [the service]. (Evidence that [the service] is effective is lacking, of poor quality, or conflicting and the balance of benefits and harms cannot be determined.) |
TABLE 2
USPSTF recommendations made in 2004
| A Recommendation (strongly recommends) |
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| B Recommendation (recommends) |
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| D Recommendation (recommends against) |
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| I Recommendation (insufficient evidence) |
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