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Evolution and Reform of Healthcare in the US: Clinical Practice Guidelines & USPSTF Grades

This lecture explores the definition and purpose of clinical practice guidelines, as well as the grading system used by the US Preventive Services Task Force (USPSTF) to evaluate healthcare services.

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Evolution and Reform of Healthcare in the US: Clinical Practice Guidelines & USPSTF Grades

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  1. Introduction to Healthcare and Public Health in the US The Evolution and Reform of Healthcare in the US Lecture b This material (Comp1_Unit9b) was developed by Oregon Health & Science University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC000015.

  2. The Evolution and Reform of Healthcare in the USLearning Objectives • Describe evidence-based medicine, clinical practice guidelines, and quality indicators in medicine (Lecture a, b, c) • Describe the patient-centered medical home model (Lecture d) • Discuss the key issues driving healthcare reform in the US (Lecture e) Introduction to Healthcare and Public Health in the US The Evolution and Reform of Healthcare in the US Lecture b

  3. Clinical Practice Guidelines: Definition • Systematically developed statements • Assist practitioner and patient decision-making • Intended for specific clinical circumstances • Recommendations that are based on evidence obtained by conducting a systematic review • Guidelines define the role of specific diagnostic and treatment modalities in the diagnosis and management of a disease Introduction to Healthcare and Public Health in the US The Evolution and Reform of Healthcare in the US Lecture b

  4. Clinical Practice Guidelines: Purpose • To help clinicians and patients make appropriate decisions about healthcare • How do guidelines achieve this? • By specifying a set of generally accepted approaches • By defining appropriate practices • Example of clinical practice guidelines dissemination website: • National guidelines clearinghouse http://www.guideline.gov/index.aspx Introduction to Healthcare and Public Health in the US The Evolution and Reform of Healthcare in the US Lecture b

  5. US Preventive Services Task Force (USPSTF) • Independent panel of experts in prevention and evidence-based medicine • Composed of primary care providers • Conduct scientific evidence reviews of a broad range of clinical preventive healthcare services • Develop recommendations Introduction to Healthcare and Public Health in the US The Evolution and Reform of Healthcare in the US Lecture b

  6. USPTF Grades • A The USPSTF recommends the service has • High certainty of substantial net benefit Suggestions for practice:Offer or provide this service • B The USPSTF recommends the service has • High certainty of moderate net benefit or moderate certainty of moderate to substantial net benefit Suggestions for practice:Offer or provide this service Introduction to Healthcare and Public Health in the US The Evolution and Reform of Healthcare in the US Lecture b

  7. USPTF Grades (continued) • C: Recommends against routinely providing the service. Tailor recommendations to individual patients • At least moderate certainty that the net benefit is small Suggestions for practice: Offer or provide this service only if other considerations support the offering or providing the service in an individual patient • D: Recommends against the service. • Moderate or high certainty of no net benefit or that harms outweigh benefits Suggestions for practice: Discourage the use of this service Introduction to Healthcare and Public Health in the US The Evolution and Reform of Healthcare in the US Lecture b

  8. USPTF Grades (continued) • I Statement: Current evidence is insufficient to assess the balance of benefits and harms of the service Suggestions for practice: Read the clinical considerations section of USPSTF Recommendation Statement. If the service is offered, patients should understand the uncertainty about the balance of benefits and harms Introduction to Healthcare and Public Health in the US The Evolution and Reform of Healthcare in the US Lecture b

  9. The Evolution and Reform of Healthcare in the USSummary – Lecture b • Defined Clinical Practice Guidelines • Described US Preventive Services Task Force (USPSTF) • Described USPSTF grades of evidence Introduction to Healthcare and Public Health in the US The Evolution and Reform of Healthcare in the US Lecture b

  10. The Evolution and Reform of Healthcare in the US References – Lecture b References Harris, R. P., Helfand, M., & Woolf, S. H., et al. (2001). Current methods of the US Preventive Services Task Force: a review of the process. American Journal of Preventative Medicine, 20 (suppl 3), 21-35. U.S. Preventive Services Task Force (USPSTF). (n.d.). Retrieved December 6, 2011, from U.S. Department of Health & Human Services - Agency for Healthcare Research and Quality website: http://www.ahrq.gov/clinic/uspstfix.htm U.S. Preventive Services Task Force. (n.d.). Retrieved December 6, 2011, from U.S. Preventative Services Task Force website: http://www.uspreventiveservicestaskforce.org/ Introduction to Healthcare and Public Health in the US The Evolution and Reform of Healthcare in the US Lecture b

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