Author: Larry Chapman
The U.S. Preventive Services Task Force (USPSTF) is an independent body of experts who make evidence-based recommendations about clinical preventive services using a transparent and objective process. Developing recommendations on a clinical preventive service requires evidence of its effect on health outcomes. Health outcomes are symptoms, functional levels, and conditions that affect a patient’s quantity or quality of life and are measured by assessments of physical or psychologic well-being. Intermediate outcomes are pathologic, physiologic, psychologic, social, or behavioral measures related to a preventive service. Given the frequent lack of evidence on health outcomes, the USPSTF uses evidence on intermediate outcomes when appropriate.
The ultimate goal is to determine precisely a consistent relationship between the direction and magnitude of change in an intermediate outcome with a predictable resultant direction and magnitude of change in the health outcomes. The USPSTF reviewed its historical use of intermediate outcomes, reviewed methods of other evidence-based guideline-making bodies, consulted with other experts, and reviewed scientiﬁc literature. Most important were the established criteria for causation, tenets of evidence-based medicine, and consistency with its current standards. Studies that follow participants over time following early treatment, stratify patients according to treatment response, and adjust for important confounders can provide useful information about the association between intermediate and health outcomes. However, such studies remain susceptible to residual confounding. The USPSTF will exercise great caution when making a recommendation that depends on the evidence linking intermediate and health outcomes because of inherent evidence limitations.
This compendium of 9 peer review articles published in this month’s edition of the American Journal of Preventive Medicine (January 2018) provides an in-depth look at the USPSTF. The 9 articles include: methodology they use, net benefits, rapid review procedures, use of risk stratification, group implications, communication issues, organized system uses, and research priorities.
The types of issues addressed in this article includes:
- Methodology used by the USPSTF in relation to intermediate outcomes and health outcomes.
- Use of USPSTF recommendations by employers.
- Nature of the net benefits associated with the use of USPSTF recommendations.
- Communication to individuals and groups of USPSTF recommendations.
- Current research priorities and future initiatives.
Worksite Wellness professionals can use this information to:
- Compare their own preventive medical benefits coverage adequacy and alignment with USPSTF recommendations.
- Educate management and employees about these authoritative recommendations.
- Enhance some selected elements of health literacy regarding the use of preventive care.
- Augment planning around preventive care interventions and employee benefit design choices.
In summary, this is an authoritative and recent source of information about the role and methods of the United States Preventive Services Task Force (USPSTF) and the use of their recommendations by employers.
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