Putting Evidence Into Practice: An Update on the US Preventive Services Task Force Methods for Developing Recommendations for Preventive Services.

Clinical Preventive Medicine in Primary Care: Background and Practice: 1. Rationale and Current Preventive Practices

Data Needs for Economic Evaluations of Screening in Pediatric Primary Care: A Research Framework.

Clinical practice guidelines can play an important role in mitigating health inequities. The US Preventive Services Task Force (USPSTF) has prioritized addressing health equity and racism in its recommendations. To develop a framework that would allow the USPSTF to incorporate a health equity lens that spans the entirety of its recommendation-making process. Key guidance, policy, and explanatory frameworks related to health equity were identified, and their recommendations and findings were mapped to current USPSTF methods. USPSTF members as well as staff from multiple entities supporting the USPSTF portfolio were consulted. Based on all the gathered information, a draft health equity framework and checklist were developed; they were then circulated to the USPSTF's key partners for input and review. An equity framework was developed that could be applied to all phases of the recommendation process: (1) topic nomination, selection, and prioritization; (2) development of the work plan; (3) evidence review; (4) evidence deliberation; (5) development of the recommendation statement; and (6) dissemination of recommendations. For each phase, several considerations and checklist items to address are presented. These items include using health equity as a prioritization criterion and engaging a diverse group of stakeholders at the earliest phases in identifying topics for recommendations; developing necessary equity-relevant questions (eg, beyond effectiveness and harms) to address during the protocol phase; using methods in synthesizing the evidence and contextual issues in the evidence review related to specific populations experiencing a disproportionate burden of disease; and examining the magnitude and certainty of net benefit, implementation considerations, risk assessment, and evidence gaps through an equity lens when developing evidence-based recommendations. Executing this entire framework and checklist as described will be challenging and will take additional time and resources. Nonetheless, whether adopted in its entirety or in parts, this framework offers guidance to the USPSTF, as well as other evidence-based guideline entities, in its mission to develop a more transparent, consistent, and intentional approach to addressing health equity in its recommendations.

Prevalence of preeclampsia risk factors: implications for low-dose aspirin prophylaxis

* Abbreviation: USPSTF — : US Preventive Services Task Force In this issue of Pediatrics , Smith et al1 describe the challenges with implementing the US Preventive Services Task Force (USPSTF) recommendation for obesity screening in children and adolescents and offering or referring patients and families to behavioral interventions to promote weight improvement. The authors posit that effective behavioral interventions are not feasible to routinely deliver, and this challenge further exacerbates existing health inequities. The mission of the USPSTF is to make recommendations about clinical preventive services using a transparent, rigorous, and objective methodology. This approach ensures that clinicians and patients understand the evidence. On the basis of the certainty of the evidence and the magnitude of net benefits (eg, benefits minus harms), the USPSTF issues an A, B, C, or D grade or I statement. For clinicians, A and B grades mean to offer routinely, C means to selectively offer, D means to not routinely offer, and I is insufficient evidence to recommend … Address correspondence to Alex H. Krist, MD, MPH, 3825 Charles Stewart Dr, Fairfax, VA 22033. E-mail: alexander.krist{at}vcuhealth.org, 703-391-2020

Importance: US life expectancy and health outcomes for preventable causes of disease have continued to lag in many populations that experience racism. Objective: To propose iterative changes to US Preventive Services Task Force (USPSTF) processes, methods, and recommendations and enact a commitment to eliminate health inequities for people affected by systemic racism. Design and Evidence: In February 2021, the USPSTF began operational steps in its work to create preventive care recommendations to address the harmful effects of racism. A commissioned methods report was conducted to inform this process. Key findings of the report informed proposed updates to the USPSTF methods to address populations adversely affected by systemic racism and proposed pilots on implementation of the proposed changes. Findings: The USPSTF proposes to consider the opportunity to reduce health inequities when selecting new preventive care topics and prioritizing current topics; seek evidence about the effects of systemic racism and health inequities in all research plans and public comments requested, and integrate available evidence into evidence reviews; and summarize the likely effects of systemic racism and health inequities on clinical preventive services in USPSTF recommendations. The USPSTF will elicit feedback from its partners and experts and proposed changes will be piloted on selected USPSTF topics. Conclusions and Relevance: The USPSTF has developed strategies intended to mitigate the influence of systemic racism in its recommendations. The USPSTF seeks to reduce health inequities and other effects of systemic racism through iterative changes in methods of developing evidence-based recommendations, with partner and public input in the activities to implement the advancements.

ImportanceUS life expectancy and health outcomes for preventable causes of disease have continued to lag in many populations that experience racism.ObjectiveTo propose iterative changes to US Preventive Services Task Force (USPSTF) processes, methods, and recommendations and enact a commitment to eliminate health inequities for people affected by systemic racism.Design and EvidenceIn February 2021, the USPSTF began operational steps in its work to create preventive care recommendations to address the harmful effects of racism. A commissioned methods report was conducted to inform this process. Key findings of the report informed proposed updates to the USPSTF methods to address populations adversely affected by systemic racism and proposed pilots on implementation of the proposed changes.FindingsThe USPSTF proposes to consider the opportunity to reduce health inequities when selecting new preventive care topics and prioritizing current topics; seek evidence about the effects of systemic racism and health inequities in all research plans and public comments requested, and integrate available evidence into evidence reviews; and summarize the likely effects of systemic racism and health inequities on clinical preventive services in USPSTF recommendations. The USPSTF will elicit feedback from its partners and experts and proposed changes will be piloted on selected USPSTF topics.Conclusions and RelevanceThe USPSTF has developed strategies intended to mitigate the influence of systemic racism in its recommendations. The USPSTF seeks to reduce health inequities and other effects of systemic racism through iterative changes in methods of developing evidence-based recommendations, with partner and public input in the activities to implement the advancements.

In 2016, the US Preventive Services Task Force concluded that there was "insufficient" ("I" statement) evidence to support universal primary care screening for autism spectrum disorder. The statement led to controversy among research and clinical communities. Although a number of papers have since been published arguing for the potential benefit of autism spectrum disorder screening, none adequately address the potential harms of autism spectrum disorder screening. This evidence gap may relate to confusion regarding how the US Preventive Services Task Force conceptualizes and evaluates potential harm. In this commentary, we explore how the US Preventive Services Task Force operationalizes harm and discuss how the potential for harm was described in the "I" statement on autism spectrum disorder screening. This information can serve as a guide for investigators working to study the benefits and harms of autism spectrum disorder screening in order to fill the research gaps cited by the US Preventive Services Task Force report. Finally, we recommend future research directions for exploring harms of autism spectrum disorder screening, filling cited research gaps, and ultimately ensuring that the benefits of autism spectrum disorder screening truly outweigh the harms for all children and their families.

Colon Cancer Screening Models: Lessons and Challenges

Response to Weinstein’s “Reply of Increased risk of vitamin D deficiency and insufficiency in Black patients with central centrifugal cicatricial alopecia.”

In this issue of Pediatrics , readers will find the recommendation of the US Preventive Services Task Force (USPSTF) that all newborns be screened for hearing loss1; readers will also find a concise version of the systematic evidence report that was commissioned to help develop this recommendation.2 Over the last several years, Pediatrics has published 5 recommendations relevant to children from the USPSTF3–7 and plans to publish additional recommendations as they are released. Because many pediatricians know very little about the USPSTF,8 we would like to use this commentary to inform readers about this task force: what it is, who is involved, how it works, and what readers can expect from these publications. The USPSTF is an independent panel charged by the US Congress to review the scientific evidence for clinical preventive services and develop evidence-based recommendations for the health care community. It was first convened by the US Public Health Service in 1984 and, since 1998, has been sponsored by the Agency for Healthcare Research and Quality (AHRQ). The USPSTF comprises 16 private-sector experts in prevention and primary care, representing primary care specialties and nursing, who serve for terms of 4 to 6 years. Members of the USPSTF are nominated by federal agencies, partner organizations (such as the American Academy of Pediatrics [AAP]), and individuals in response to an announcement in the Federal Register . Members are chosen for their ability to make rigorous, impartial assessments of the scientific evidence for the effectiveness of a broad range of clinical preventive services, including screening, counseling, and preventive medications, and synthesize these assessments into recommendations. Throughout its existence, the task force has had at least 2 pediatricians, as well as other pediatric health care providers, among its members. Currently, 3 of its 16 … Address correspondence to Virginia A. Moyer, MD, MPH, Baylor College of Medicine, Department of Pediatrics, 6621 Fannin St, #1540, Houston, TX 77030. E-mail: moyer{at}bcm.edu

The prevalence of childhood and adolescent overweight has tripled over the past 2 decades, and associations have been identified between dietary patterns, physical activity, sedentary behaviors, and overweight. Some believe that pediatricians can easily recognize an overweight or obese child or adolescent and that there are sufficient therapeutic options to offer these patients and their families.1 However, primary care clinicians face obese and overweight children, adolescents, and parents every day, and most clinicians rarely document overweight. The American Academy of Pediatrics and American Academy of Family Physicians endorse universal screening using body mass index (BMI) and use of BMI growth curves to identify obese and overweight children. Physicians also seem to take high BMI more seriously than weight and height measures2; when documentation of high BMI occurs, screening, counseling, and referral rates for obese and overweight children and adolescents increase.3 Why then, does the US Preventive Services Task Force (USPSTF), in this issue of Pediatrics ,4 find insufficient evidence to recommend for or against formally screening children and adolescents for obesity or overweight in the primary care setting? The answer is: the USPSTF adheres strongly to a policy of making recommendations (either for or against delivery of preventive services) only in the presence of sufficient evidence of adequate quality. The USPSTF cannot make a recommendation for or against screening even for a practice that may be supported by expert consensus or less rigorous evidence. It is important to note that the USPSTF did not recommend that primary care clinicians not weigh and measure children or ignore … Address correspondence to Program Director, USPSTF, Agency for Healthcare Research and Quality, 540 Gaither Rd, Rockville, MD 20850. E-mail: uspstf{at}ahrq.gov

News in Brief

The US Preventive Services Task Force (USPSTF) is an independent body comprised of national experts in prevention and evidence-based medicine. The primary audience for the USPSTF's work is primary care clinicians, and many consider the Task Force's recommendations to be definitive standards for preventive services.

This is an update of the 2002 US Preventive Services Task Force recommendation on screening for child and adolescent major depressive disorder. The US Preventive Services Task Force weighed the benefits and harms of screening and treatment for major depressive disorder in children and adolescents, incorporating new evidence addressing gaps in the 2002 recommendation statement. Evidence examined included the benefits and harms of screening, the accuracy of primary care-feasible screening tests, and the benefits and risks of treating depression by using psychotherapy and/or medications in patients aged 7 to 18 years. Screen adolescents (12-18 years of age) for major depressive disorder when systems are in place to ensure accurate diagnosis, psychotherapy (cognitive-behavioral or interpersonal), and follow-up (B recommendation). Evidence is insufficient to warrant a recommendation to screen children (7-11 years of age) for major depressive disorder (I statement).