Update on the Methods of the U.S. Preventive Services Task Force: Linking Intermediate Outcomes and Health Outcomes in Prevention

Affiliations

¹ Agency for Healthcare Research and Quality, Rockville, Maryland. Electronic address: tracy.wolff@ahrq.hhs.gov.
² Virginia Commonwealth University, Richmond, Virginia.
³ Department of Family and Community Medicine, University of Missouri, Columbia, Missouri.
⁴ Department of Medicine, University of North Carolina Chapel Hill, Chapel Hill, North Carolina; Cecil G. Sheps Center for Health Services Research, University of North Carolina Chapel Hill, Chapel Hill, North Carolina.
⁵ Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine, Mount Sinai Health System, New York, New York.
⁶ Veterans Affairs Palo Alto Health Care System, Palo Alto, California; Department of Medicine, School of Medicine, Center for Primary Care and Outcomes Research, Stanford University, Stanford, California.
⁷ Division of Chronic Disease Across the Lifecourse, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Massachusetts; Environmental Influences on Child Health Outcomes Program, Office of the Director, NIH, Rockville, Maryland.
⁸ College of Public Health, University of Georgia, Athens, Georgia.
⁹ Milken Institute School of Public Health, George Washington University, Washington, District of Columbia.
¹⁰ Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland, Oregon.
¹¹ Patient-Centered Outcomes Research Institute, Washington, District of Columbia.
¹² School of Medicine, University of California, San Francisco, California.

PMID: 29254525
DOI: 10.1016/j.amepre.2017.08.032

Free article

Update on the Methods of the U.S. Preventive Services Task Force: Linking Intermediate Outcomes and Health Outcomes in Prevention

Tracy A Wolff et al. Am J Prev Med. 2018 Jan.

Free article

. 2018 Jan;54(1S1):S4-S10.

doi: 10.1016/j.amepre.2017.08.032.

Authors

Affiliations

¹ Agency for Healthcare Research and Quality, Rockville, Maryland. Electronic address: tracy.wolff@ahrq.hhs.gov.
² Virginia Commonwealth University, Richmond, Virginia.
³ Department of Family and Community Medicine, University of Missouri, Columbia, Missouri.
⁴ Department of Medicine, University of North Carolina Chapel Hill, Chapel Hill, North Carolina; Cecil G. Sheps Center for Health Services Research, University of North Carolina Chapel Hill, Chapel Hill, North Carolina.
⁵ Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine, Mount Sinai Health System, New York, New York.
⁶ Veterans Affairs Palo Alto Health Care System, Palo Alto, California; Department of Medicine, School of Medicine, Center for Primary Care and Outcomes Research, Stanford University, Stanford, California.
⁷ Division of Chronic Disease Across the Lifecourse, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Massachusetts; Environmental Influences on Child Health Outcomes Program, Office of the Director, NIH, Rockville, Maryland.
⁸ College of Public Health, University of Georgia, Athens, Georgia.
⁹ Milken Institute School of Public Health, George Washington University, Washington, District of Columbia.
¹⁰ Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland, Oregon.
¹¹ Patient-Centered Outcomes Research Institute, Washington, District of Columbia.
¹² School of Medicine, University of California, San Francisco, California.

PMID: 29254525
DOI: 10.1016/j.amepre.2017.08.032

Abstract

The U.S. Preventive Services Task Force (USPSTF) is an independent body of experts who make evidence-based recommendations about clinical preventive services using a transparent and objective process. Developing recommendations on a clinical preventive service requires evidence of its effect on health outcomes. Health outcomes are symptoms, functional levels, and conditions that affect a patient's quantity or quality of life and are measured by assessments of physical or psychologic well-being. Intermediate outcomes are pathologic, physiologic, psychologic, social, or behavioral measures related to a preventive service. Given the frequent lack of evidence on health outcomes, the USPSTF uses evidence on intermediate outcomes when appropriate. The ultimate goal is to determine precisely a consistent relationship between the direction and magnitude of change in an intermediate outcome with a predictable resultant direction and magnitude of change in the health outcomes. The USPSTF reviewed its historical use of intermediate outcomes, reviewed methods of other evidence-based guideline-making bodies, consulted with other experts, and reviewed scientific literature. Most important were the established criteria for causation, tenets of evidence-based medicine, and consistency with its current standards. Studies that follow participants over time following early treatment, stratify patients according to treatment response, and adjust for important confounders can provide useful information about the association between intermediate and health outcomes. However, such studies remain susceptible to residual confounding. The USPSTF will exercise great caution when making a recommendation that depends on the evidence linking intermediate and health outcomes because of inherent evidence limitations.

Published by Elsevier Inc.

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Update on the Methods of the U.S. Preventive Services Task Force: Linking Intermediate Outcomes and Health Outcomes in Prevention

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Update on the Methods of the U.S. Preventive Services Task Force: Linking Intermediate Outcomes and Health Outcomes in Prevention

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