Advancing the Methods of the U.S. Preventive Services Task Force

Advancing the Methods of the U.S. Preventive Services Task Force (Article in Advancing the U.S. Preventive Services Task Force Methods: Important Considerations in Making Evidence-Based Guidelines, Special Issue of The American Journal of Preventive Medicine).
Krist, Alex H. Bibbins-Domingo, Kirsten. Wolff, Tracy A. Mabry-Hernandez, Iris R.
American Journal of Preventive Medicine
54(1 sp. 1)S1-S3


Clinicians and patients need a trusted source for high-quality recommendations about preventive services. Preventive services are for people who are not suffering from a condition and may be healthy and well. They are intended for those without signs or symptoms of a disease to improve the quality and/or length of life. Although many recommended services are highly beneficial, prevention also has a potential for harm—a chance for making a healthy and well individual sick or anxious through false positives, overdiagnosis, and overtreatment. Making recommendations based on the most up-to-date evidence must consider this important balance. If a recommendation is made too soon, before evidence truly demonstrates effectiveness, people could be harmed; and if a recommendation is not made quickly in response to new evidence, the delivery of lifesaving preventive care may be delayed. Accordingly, it is critical for preventive service recommendations to assess the balance of benefits and harms rigorously and accurately based on the evidence and to do so in a timely and efficient manner.

The mission of the U.S. Preventive Services Task Force (USPSTF) is to provide evidence-based recommendations on preventive services to primary care clinicians who deliver preventive care. Recommendations are based on a systematic review of all evidence, assessment of both benefits and harms, determination of the certainty and magnitude of net benefit, and assignment of a letter grade. This process is rigorous, objective, and transparent; and it is well documented and continually updated.1–8 Foundational methods principles of the USPSTF include that recommendations are based solely on existing evidence and expert opinion is not used as a substitute for evidence; interpretation of the literature uses the tenets of evidence-based medicine, Bradford Hill criteria for causation,9and concepts described in the National Academy of Medicine’s report—Clinical Practice Guidelines We Can Trust,10 and the potential conflicts of interest are minimized.11

Although grounded in foundational principles of evidence-based medicine, the USPSTF’s methods are not static. The USPSTF routinely faces methods challenges and has a process for methods review and advancement. Much of this work occurs as the USPSTF weighs the evidence for specific topics, but recurring issues arise that span topics. These issues are addressed by the USPSTF’s Methods Workgroup, which includes all members of the USPSTF, evidence-based practice centers, scientific research centers, and Agency for Healthcare Research and Quality medical officers. This workgroup has a diverse and robust set of prevention and methods skills. Tasks that the workgroup may undertake include assessing the consistency of the USPSTF’s methods, reviewing how other guideline-making bodies and methods leaders handle issues, and deciding whether to update the USPSTF’s methods. Several methods domains that the USPSTF is currently advancing include determining the applicability of evidence to primary care; making subpopulation- and risk-stratified recommendations; incorporating new forms of evidence (e.g., modeling, big data); weighing benefits and harms; using indirect evidence; and linking intermediate outcomes to health outcomes.

The purpose of this journal supplement issue is to present and discuss some of these key methodologic concepts and questions that the USPSTF is currently addressing.