Background article
The evolving role of prevention in health care: Contributions of the U.S. Preventive Services Task Force

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Historical background: the journey of the U.S. preventive services task force

Although major groups had advocated annual physical examinations for decades8 and promoted routine screening tests such as blood and urine chemistry panels, chest radiographs, and electrocardiograms, a comprehensive review of the scientific evidence to support specific preventive services was lacking in the early 1980s. Doubts grew as critical review articles focused attention on the absence of data for many commonly delivered services.9 In 1979, the Canadian Task Force on the Periodic Health

The changing climate of prevention

By the time the second edition of the Guide appeared, the environment for preventive medicine and evidence-based medicine had changed dramatically. Managed care organizations, which had emerged as a dominant paradigm for delivering and paying for health care, included preventive care among basic covered services more commonly than had traditional fee-for-service insurance.4, 19, 20 At the same time, the heightened competition spurred by managed care brought increased attention to costs and

Continuing evolution of guidelines and evidence-based health care

By 1996, the enthusiasm for clinical practice guidelines and for evidence-based medicine had been tempered by a realization of their attendant practical and political challenges.22 At its inception, the U.S. Congress authorized the Agency for Health Care Policy and Research (AHCPR; renamed the Agency for Healthcare Research and Quality [AHRQ] in 1999) to develop practice guidelines as part of its twin goals of improving quality and reducing unnecessary costs. By 1995, however, controversies

The current USPSTF

It is in this context that a third USPSTF was convened in 1998 to update the recommendations of the second Task Force. Following the release of the second edition of the Guide, responsibility for the work of the USPSTF and the related Put Prevention Into Practice28 initiative (www.ahrq.gov/clinic/prevenix.htm) were transferred to AHRQ as part of its commitment to supporting evidence-based practice. Thirteen Task Force members (including four returning members) were selected from a pool of over

Implementation: the final frontier of preventive medicine

The experiences of the first and second USPSTF, as well as that of other evidence-based guideline efforts, have highlighted the importance of identifying effective ways to implement clinical recommendations. Practice guidelines are relatively weak tools for changing clinical practice when used in isolation.29, 30 To effect change, guidelines must be coupled with strategies to improve their acceptance and feasibility. Such strategies include enlisting the support of local opinion leaders, using

Future challenges

The USPSTF faces continuing challenges in its attempts to distill evidence and produce clinical recommendations (see the accompanying paper on USPSTF methods in this issue).44 Increasing explicitness of USPSTF methods cannot completely remove the subjective element involved in making recommendations based on inferences from imperfect evidence on complex issues. Nonetheless, the USPSTF continues to adhere to the general principle that it is appropriate to set a high standard of evidence for

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      Some have advocated that the Task Force provide ‘clinical options’ (especially if the harms and costs with performing a particular service are minimal) or that services, which have not been adequately studied, should not be recommended (Woolf and Atkins, 2001). Some suggest that a neutral stance should be taken (meaning not recommending for or against a service) until better evidence is available or that those who are deemed high-risk should be informed of the benefits of performing regular TSE (Woolf and Atkins, 2001; American Urological Association [AUA], 2014). Others explicitly state (i.e. the Society for Adolescent Health and Medicine, 2012) their support for TCa screening or suggest that identified high-risk males (i.e. Caucasian race, being between the ages of 15–40, family history of the disease, and/or the occurrence of cryptorchidism) should ‘seriously’ consider performing monthly exams (ACS, 2015).

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    Reprints are available from the AHRQ Web site at www.ahrq.gov/clinic/uspstfix.htm, through the National Guideline Clearinghouse (www.guideline.gov), or in print through the AHRQ Clearinghouse (1-800-358-9295).

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