CHAP ER 8 CLinical Preventive Services (united States Preventive Services Task Force) How many studies have been conducted that address the ey question, and how large are the stuc GRADING SERVICES How consistent are the results Once Task Force members have answered these questions, I Are there additional factors that raise confidence in the the group assigns a grade for the service of A, B, C, D, or I results(e. g, dose-response effects, consistency with bio- (Table 18-2). After assigning a tentative grade, the Task Force logic models)? discusses these recommendations with federal and primary are partners. Federal partners include the Centers for TASK FORCE MEMBERS Disease Control and Prevention( CDC), Center for Medicare and Medicaid Services(CMS), Health Resource and Services Sixteen members serve on the Task Force at any given time. Administration (HRSA), National Institutes of Health About 25% of USPSTF members are replaced each year (NIH), and Food and Drug Administration(FDA) Exam Members are nominated in a public process and are chosen ples of primary care partners include the American Medical their expertise in the subject matter, research Association, American College of Physicians, and American disease prevention, application of synthesized evi College of Preventive Medicine dence to clinical decision making, and clinical expertise in The results of the evidence review and the task force primary health care. They are chosen through a rigorous recommendations are posted for comments by the partners process and serve staggered 4-year terms on the committee. and public, published in reputable journals, and dissemi- KEY QUESTIONS In clinical practice there is little difference between gra A and b recommendations: in both cases the service should Once an evidence review is complete, USPSTF members vote be strongly encouraged. Services with grades of C, D, and I the eight key questions that determine if screening for a should not be routinely used. However, it is important to understand the difference between these grades For grades A through D, USPSTF is reasonably certain it understand I. Does screening for X reduce morbidity and/or mortality? the balance of benefits and harm. For services graded C, 2. Can a group at high risk for X be identified on clinical there is a net benefit, but it is likely small. A service with a C grounds? recommendation is breast cancer screening for women 3. Are accurate screening tests available? younger than 50(see Chapter 16). Decisions about these C 4. Are treatments available that make a difference in inter- services should be individualized. In contrast for services mediate outcomes when the disease is caught early? graded D, there is clear evidence that there is no net benefit, 5. Are treatments available that make a difference in mor- or that there is net harm; an example is screening for ovarian bidity and mortality (patient outcomes) when the disease cancer. These D services should be avoided. is caught earl 2. For services with an I grade, evidence is lacking or con- 6. How strong is the association between the intermediate flicting, and the Task Force has determined that they can outcomes and patient outcomes neither recommend for nor recommend against the service. 7. What are the harms of the screening test As of 2012, services with an I grade include skin cancer 8. What are the harms of treatment? screening, colorectal cancer screening with CT colonography Table 18-2 Grades Assigned to Screening Recommendation and Suggestions for Practice Grade Defnition Net Benefit Suggestions for Practice USPSTF recommends the service High certainty for net Offer/provide this service. USPSTF recommends the service Offer/provide this servi ertainty for net uSpstf does certainty that the other considerations support the net benefit is smal offering or providing the service or symptoms, an In there is likely to be only a small benefit from this service. D USPSTF recommends against the se derate or high Discourage the use of this service. certainty of SPSTF concludes that current evidence is insufficient to No certainty Read Clinical Considerations section the balance of benefits and harms of the servic balance of benefits/ of USPSTF Recommendation Evidence is lacking, of poor quality, or conflicting Statement. If the service is the balance of benefits and harms odifiedfromhttp://www.uspreventiveservicestaskforce.org/uspstto7/ratingsv2.htm. USPSTE U.S. Preventive Services Task Force