The USPSTF is an independent advisory panel of experts who make evidence-based recommendations about clinical preventive services.
In the last few weeks, the little known agency called the U.S. Preventive Services Task Force (USPSTF) has made the news. The Secretary of the Department of Health and Human Services (HHS) has discussed removing all of the USPSTF members, similar to what was done to the Advisory Committee on Immunization Practices (ACIP). Just what is the USPSTF and why is it so important to protect health?
The United States Preventive Services Task Force (USPSTF) [archived link] is an independent advisory panel of experts who make evidence-based recommendations about clinical preventive services. This panel was first created in 1984 and the Agency for HealthCare Research and Quality (AHRQ) provides the panel with needed scientific, administrative, and dissemination support. The USPSTF makes important recommendations about ways to stay healthy, prevent disease, and identify diseases early when they can be best treated. They make recommendations [archived link] about a lot of different things: from cancer screening to tests to identify infectious diseases like HIV to early identification of mental health disorders like depression or unhealthy substance use. Each recommendation applies only to people who have no signs or symptoms of that specific condition. Primary care and other healthcare professionals rely heavily on the USPSTF recommendations to make sure you are staying healthy and catching potentially treatable conditions early. Importantly, the Affordable Care Act [archived link] requires insurance companies to cover USPSTF recommended services without out of pocket costs. This means that people can get their recommended preventive healthcare without having to pay more money and more people are able to access these critical and lifesaving healthcare services.
The USPSTF is made up of 16 volunteer members [archived link] appointed the Secretary of HHS and serve 4 year terms. These members are experts in prevention, family medicine, internal medicine, pediatrics, evidence-based medicine, behavioral health, geriatrics, obstetrics and gynecology, and nursing. Members must disclose any potential conflicts of interest. They are carefully vetted to ensure that they do not have significant conflicts of interest that could harm the scientific integrity of the work and recommendations. Any member that has a potentially significant conflict of interest is not allowed to participate in the discussion or vote on that topic. It is also important to note that USPSTF members are volunteers! They are not paid for their work.They do this hard and time consuming work because they are passionate about disease prevention and public health.
The USPSTF recommendations are widely considered to be among the most rigorous and trustworthy recommendations available. They are top notch. This is because the USPSTF operates with a strict scientific process [archived link] . This process is also very transparent, so all people accessing these guidelines can understand exactly why the recommendation is being made. There are multiple steps [archived link] to making a recommendation.
- Topics for consideration are nominated to the task force. Anyone can nominate [archived link] a topic at any time! The USPSTF reviews the nominated topic to see how relevant the topic is and the impact the topic may have on primary care, prevention, and public health. Topics can be things like “should we screen for breast cancer with mammograms?” or “should we screen older adults for caregiver abuse?”
- Once a topic is selected, the Task Force puts together teams of experts to begin to tackle those clinical questions. These teams are called Evidence-based Practice Centers (EPCs). The EPC will develop a research plan which is posted on the USPSTF website for public comment and suggestion. The public is included throughout the entire process!
- When the research plan is finalized, the EPC reviews all the available literature and data about that topic and puts together an evidence review. The evidence review includes information about benefit, harms, and alternatives. This report is also available on the website for public review.
- The USPSTF reviews the data in the evidence report to make a draft recommendation. Each recommendation is assigned a letter [archived link] grade. Grade A and B recommendations means that there is a good certainty that implementing that recommendation is beneficial to most people. Grade A and B recommendations are the ones that are required to be covered by insurance. Grade C recommendations mean that clinicians can selectively offer this service to some folks because the benefit is small and people might make different choices depending on their circumstances. Grade D stands for “Don’t.” The USPSTF recommends against Grade D topics because there is no evidence of benefit or the harms outweigh the benefits. Grade I means there is insufficient evidence to make a recommendation one way or another. The I recommendations essentially mean we don’t really know the answer yet and need more information and research.
- The draft recommendation is posted for public comments. All the public comments are reviewed and considered by the USPSTF.
- The USPSTF finalizes the recommendation and publishes on the website. Each recommendation is accompanied by a clear description of the potential benefits and harms, a summary of the available evidence and any gaps in knowledge about the topic, explanations of values and opinions that the USPSTF may have used in developing the recommendation, and rating of how confident they are in the evidence used to make this recommendation.
- The recommendations are routinely reassessed and new evidence is incorporated to update recommendations.
The USPSTF is a non-partisan group. They use this structured, meticulous process to make sure they are making good, science-based recommendations. They are independent from the Department of Health and Human Services and do not consider cost when making their recommendations. It was designed this way in part to ensure that recommendations are based solely on scientific evidence and to reduce direct influence from the agency or lobbying groups. The goal is to have unbiased decision-making on prevention services in the United States to promote public and individual health.
In short, the USPSTF is a critical group to provide prevention and screening recommendations based on science and not political ideology. The USPSTF uses rigorous methodology to reduce conflict of interest and recuse members if a conflict arises and to use the best available evidence to make recommendations. They help keep us healthy and ensure that we have access to cost-free prevention services.
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