Module 3:Evidence-based Prevention: Applying the USPSTF Guidelines

Developed through the APTR Initiative to Enhance Prevention and Population Health Education in collaboration with the Brody School of Medicine at East Carolina University with funding from the Centers for Disease Control and Prevention

Acknowledgments

APTR wishes to acknowledge the following individual that developed this module:

Suzanne Lazorick, MD, MPHDepartments of Pediatrics and Public HealthBrody School of Medicine at East Carolina University

This education module is made possible through the Centers for Disease Control and Prevention (CDC) and the Association for Prevention Teaching and Research (APTR) Cooperative Agreement, No. 5U50CD300860. The module represents the opinions of the author(s) and does not necessarily represent the views of the Centers for Disease Control and Prevention or the Association for Prevention Teaching and Research.

Presentation Objectives

1. Explain the role of the US Preventive Services Task Force (USPSTF) in improving health outcomes

2. Become familiar with available resources and support tools for evidence-based prevention

1. Online tools including widget2. Applications for mobile devices

Resources

Guide to Clinical Preventive Services http://www.ahrq.gov/clinic/cps3dix.htm

US Preventive Services Task Force http://www.ahrq.gov/clinic/uspstfix.htm

Electronic Preventive Services Selector (ePSS) http://www.ahrq.gov/PDA/index.jsp

US Preventive Services Task Force (USPSTF)Mission

Evaluate the benefits of individual services based on age, gender, and risk factors for disease

Make recommendations about which preventive services should be incorporated routinely into primary medical care and for which populations

Identify a research agenda for clinical preventive care

USPSTFProcess Basics

Conduct scientific evidence reviews of clinical preventive services

Estimate the magnitude of benefits and harms for each preventive service and determines the net benefit

Issue a recommendation

USPSTF Strength of Evidence

The Task Force grades the strength of the evidence: "A" (strongly recommends) "B" (recommends) "C" (no recommendation for or against) "D" (recommends against) "I" (insufficient evidence to recommend for or against).

Obesity in Children and AdolescentsExample of USPSTF Screening Recommendations

In January 2010, the USPSTF issued an update to the July 2005 recommendations on screening and interventions for overweight in children and adolescents.

Recommendation based on targeted systematic review of 13 studies of behavioral intervention in 1258 obese children and adolescents

Current research suggests that behavioral interventions can be effective in managing weight in obese children and adolescents.

Combined behavioral-pharmacological interventions may be useful in very obese adolescents, particularly if research confirms that weight loss is maintained.

Obesity in Children and AdolescentsTargeted Systematic Review for Treatment

Summary of the USPSTF Recommendation

Supporting Article

“Effectiveness of Weight Management Interventions in Children: A Targeted Systematic Review for the USPSTF”

CONCLUSIONS: Over the past several years, research into weight management in obese children and adolescents has improved in quality and quantity. Despite important gaps, available research supports at least short-term benefits of comprehensive medium- to high-intensity behavioral interventions in obese children and adolescents. Pediatrics 2010;125:e396–e418

Additional USPSTF Information

Full Recommendation Statement, Supporting Article, Evidence Synthesis, and Clinical Summary found online:

http://www.ahrq.gov/clinic/uspstf/uspschobes.htm

Electronic Preventive Services Selector (ePSS)

Abraham Flexner, 1910

ePSS Online Form

ePSS Online Form Filled In

Recommendations

Not Recommended

Uncertain

ePSS Widget for Website Use

iPhone/Blackberry Input

iPhone/Blackberry Output

Summary

The USPSTF provides graded recommendations for clinical preventive services based on an extensive review of the evidence.

Support tools to quickly determine an individuals needed services include: Age-Specific Preventive History cards as described in

Module 3A ePSS provided via AHRQ website

▪ All that needs to be entered are: patient’s age, gender and Y/N for use of tobacco and sexual activity

Also available as application for mobile devices

Collaborating Institutions

Center for Public Health Continuing EducationUniversity at Albany School of Public Health

Department of Community & Family MedicineDuke University School of Medicine

Advisory Committee

Mike Barry, CAELorrie Basnight, MDNancy Bennett, MD, MSRuth Gaare Bernheim, JD, MPHAmber Berrian, MPHJames Cawley, MPH, PA-CJack Dillenberg, DDS, MPHKristine Gebbie, RN, DrPHAsim Jani, MD, MPH, FACP

Denise Koo, MD, MPHSuzanne Lazorick, MD, MPHRika Maeshiro, MD, MPHDan Mareck, MDSteve McCurdy, MD, MPHSusan M. Meyer, PhDSallie Rixey, MD, MEdNawraz Shawir, MBBS

APTR

Sharon Hull, MD, MPHPresident

Allison L. LewisExecutive Director

O. Kent Nordvig, MEdProject Representative