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

1. 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

2. Acknowledgments 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. APTR wishes to acknowledge the following individual that developed this module: Suzanne Lazorick, MD, MPH Departments of Pediatrics and Public Health Brody School of Medicine at East Carolina University

3. Presentation Objectives • Explain the role of the US Preventive Services Task Force (USPSTF) in improving health outcomes • Become familiar with available resources and support tools for evidence-based prevention • Online tools including widget • Applications for mobile devices

4. 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

5. 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

6. 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

7. 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).

8. 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

9. Obesity in Children and AdolescentsTargeted Systematic Review for Treatment 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.

10. Summary of the USPSTF Recommendation

11. 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

12. Additional USPSTF Information Full Recommendation Statement, Supporting Article, Evidence Synthesis, and Clinical Summary found online: http://www.ahrq.gov/clinic/uspstf/uspschobes.htm

13. Abraham Flexner, 1910 Electronic Preventive Services Selector (ePSS)

14. ePSS Online Form

15. ePSS Online Form Filled In

16. Recommendations

17. Not Recommended

18. Uncertain

19. ePSS Widget for Website Use

20. iPhone/Blackberry Input

21. iPhone/Blackberry Output

22. 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

23. Collaborating Institutions Center for Public Health Continuing Education University at Albany School of Public Health Department of Community & Family Medicine Duke University School of Medicine

24. Advisory Committee Mike Barry, CAE Lorrie Basnight, MD Nancy Bennett, MD, MS Ruth Gaare Bernheim, JD, MPH Amber Berrian, MPH James Cawley, MPH, PA-C Jack Dillenberg, DDS, MPH Kristine Gebbie, RN, DrPH Asim Jani, MD, MPH, FACP Denise Koo, MD, MPH Suzanne Lazorick, MD, MPH Rika Maeshiro, MD, MPH Dan Mareck, MD Steve McCurdy, MD, MPH Susan M. Meyer, PhD Sallie Rixey, MD, MEd Nawraz Shawir, MBBS

25. APTR • Sharon Hull, MD, MPH President • Allison L. Lewis Executive Director • O. Kent Nordvig, MEd Project Representative