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What kinds of topics are included in the recommendations?
The U.S. Preventive Services Task Force (USPSTF) reviews the evidence of effectiveness and develops recommendations for clinical preventive services, including screening tests, counseling, and preventive medications.
What process is used to decide which topics are reviewed by the USPSTF?
The Task Force solicits topic nominations from primary care organizations. The Task Force members then decide the topics it reviews. Topics are ranked based on criteria such as burden of disease and potential impact of Task Force recommendations.
What topics are currently under consideration by the Task Force?
Abdominal Aortic Aneurysm, Screening
Alcohol Misuse, Screening and Counseling
Asymptomatic Bacteriuria, Screening
Bladder Cancer, Screening
BRCA 1 & 2, Genetic Testing
Coronary Heart Disease, Screening
Dental Caries, Childhood, Screening
Family Violence, Screening
Hepatitis B, Screening
Hepatitis C, Screening
Low Back Pain, Counseling
Lung Cancer, Screening
Obesity, Childhood, Screening and Counseling
Oral Cancer, Screening
Ovarian Cancer, Screening
Pancreatic Cancer, Screening
Suicide Risk, Screening
Testicular Cancer, Screening
Thyroid Disorder, Screening
Tuberculosis, Screening
Who uses the recommendations?
Over time, the audience for the work of the USPSTF has expanded well beyond the original target of primary care physicians and nurses. USPSTF recommendations have informed the recommendations developed by professional societies, have helped inform the coverage policies of many health plans and insurers, and have figured prominently in the development of health care quality measures and national health objectives.
Who sponsors the USPSTF?
The U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality sponsors the USPSTF.
Who are the members of the USPSTF?
The USPSTF consists of experts from the specialties of family medicine, pediatrics, internal medicine, obstetrics and gynecology, geriatrics, preventive medicine, public health, behavioral medicine, and nursing.
For a list of members, go to: About USPSTF.
Who nominates the USPSTF members?
The Agency for Healthcare Research and Quality solicits nominations for members of the Task Force. Members of the Task Force are selected based on recognized expertise in prevention, evidence-based medicine, and primary care.
How does the USPSTF arrive at its recommendations?
Once the evidence is assembled based on specific analytic frameworks, admissible evidence is reviewed at three strata:
1. The individual study.
2. The body of evidence concerning a single linkage in the analytic framework.
3. The body of evidence concerning the entire preventive service.
For each stratum, the Task Force uses explicit criteria as general guidelines to assign one of three grades of evidence: good, fair, or poor.
Good or fair quality evidence for the entire preventive service must include studies of sufficient design and quality to provide an unbroken chain of evidence-supported linkages, generalizable to the general primary care population, that connect the preventive service with health outcomes.
Poor evidence contains a formidable break in the evidence chain such that the connection between the preventive service and health outcomes is uncertain.
For services supported by overall good or fair evidence, the Task Force uses outcomes tables to help categorize the magnitude of benefits, harms, and net benefit from implementation of the preventive service into one of four categories: substantial, moderate, small, or zero/negative.
The Task Force uses its assessment of the evidence and magnitude of net benefit to make a recommendation, coded as a letter: from A (strongly recommended) to D (recommend against). It gives an I recommendation in situations in which the evidence is insufficient to determine net benefit.
For additional detail, go to: Methods and Background.
How does the USPSTF grade its recommendations?
The USPSTF uses standard recommendation language and grades its recommendations according to one of five classifications (A, B, C, D, I) reflecting the strength of evidence and magnitude of net benefit (benefits minus harms) from implementing the service. The USPSTF grades the quality of the overall evidence for a service on a 3-point scale (good, fair, poor).
All statements specify the population for which the recommendation is intended and are followed by a rationale statement providing information about the overall grade of evidence.
For definitions of these grades, go to: Task Force Ratings: Strength of Recommendations and Quality of Evidence.
I notice that many of the recommendations are “I recommendations.” What does this mean?
An ‘I’ recommendation means that the USPSTF has concluded that the evidence is insufficient to recommend for or against routinely providing the service. The USPSTF recognizes that there are inevitable tensions in translating conclusions about the evidence into recommendations that may be widely applied by clinicians in a variety of settings.
An important challenge is what position to take for the many for which available evidence is inadequate to assess the net benefits or harms. Some say the USPSTF should take a neutral position and offer no advice until better evidence becomes available. Others say it should be more permissive, offering such services as "clinical options," especially if the potential harms or costs are minimal. Doing so recognizes that science is only one consideration in judging appropriateness and that clinicians cannot always await better data to make a decision. Some argue the opposite: In an era in which preventive services of proven benefit are not delivered because of limited time and resources, the USPSTF should actively recommend against use of interventions that have not been adequately studied. This determination is ultimately left to the clinician’s discretion.
How often does the USPSTF update their recommendations?
Depending on the topic priority and availability of new evidence, the Task Force decides how often recommendations are updated.
How are the USPSTF recommendations different from those of other professional organizations?
The Task Force is a multidisciplinary team of primary care experts that uses a systematic evidence-based approach to focus on the role of clinicians in areas of prevention.
Who supports the research needs of the USPSTF?
The Task Force is supported by outside experts and one of AHRQ's Evidence-based Practice Centers (EPCs). This EPC helps to identify high-priority topics for USPSTF assessment and produce systematic reviews of relevant research on each topic.
Where can I find the most recent recommendations?
The most up-to-date recommendations are available immediately on the USPSTF Web site. Go to: New Releases in Preventive Services.
You may also review available recommendations and their supporting documents through an A-Z Topic Index or a listing by Clinical Categories.
What are the supporting documents provided with the recommendations and how do they differ?
The Recommendations and Rationale statement is the official Task Force statement containing the clinical conclusions derived by the USPSTF.
The Summary of the Evidence is an abridged manuscript of the Evidence-based Practice Center’s (EPC) review of the literature.
The Systematic Evidence Review is the comprehensive systematic review of the evidence produced by the EPC with input from the USPSTF.
I have the 1996 Second Edition of the Guide to Clinical Preventive Services, but I can’t find the Third Edition of the handbook. Where is it?
There have been three editions of the Clinical Guide. The First and Second Editions were published in 1994 and 1996, respectively, in the form of a book.
The print form of the Third Edition is being released incrementally (approximately every 6 months) as periodic updates that can be inserted into a notebook binder.
How do I order the most recent Guide to Clinical Preventive Services?
The Third Edition of the Guide to Clinical Preventive Services is the most recent guide. Recommendations are being released incrementally, as they become available, in the form of 8x11 inch pages that can be inserted into a notebook binder. You can subscribe to receive the binder and inserts for $60: Order Guide to Clinical Preventive Services: Periodic Updates.
What topics are included in the Third Edition of the Clinical Guide?
The first installment includes recommendations on:
The second installment includes recommendations on:
How can I get e-mail updates when a new recommendation is released?
You can sign-up to get e-mail updates when a new recommendation is released: Join AHRQ's Prevention Program LISTSERV®
How can I contact the USPSTF?
Address correspondence to the contact below or send a message by e-mail:
Project Officer, USPSTF
Agency for Healthcare Research and Quality
540 Gaither Road, Suite 6000
Rockville, MD 20850
E-mail: uspstf@ahrq.gov
Can other health care organizations provide a link to the USPSTF Web site or specific electronic documents on their Web sites?
Yes, other health organization Web sites can provide a link to content on the USPSTF Web site because the USPSTF publications are federally funded and therefore are available to the public. However, such links cannot be displayed in such a way as to imply endorsement by the Task Force, the Agency for Healthcare Research and Quality, or the U.S. Department of Health and Human Services of a commercial service or product.
For additional information on use of content or to request permission
to incorporate USPSTF content in other electronic resources, use the
Web site
inquiry mailbox: info@ahrq.gov.
Internet Citation:
Questions and Answers. U.S. Preventive Services Task
Force. Agency for Healthcare Research and Quality, Rockville, MD. September
2003. http://www.ahrq.gov/clinic/uspstf/uspsfaqs.htm
U.S. Preventive Services Task Force (USPSTF)
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