Tool prioritizes guidance from the Preventive Services Task Force

The mathematical model helps doctors determine the most appropriate recommendations to use from the expert panel to improve a patient's health.

By — Posted Aug. 12, 2013

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Primary care physicians soon may be able to use a tool during patient visits to quickly identify the preventive services most likely to improve an individual's health outcomes, said New York internist Scott Braithwaite, MD.

“It's very challenging to get through the [U.S. Preventive Services Task Force's] list of recommendations,” said Dr. Braithwaite, chief of the Division of Comparative Effectiveness and Decision Sciences at New York University's Langone Medical Center. He said doctors commonly follow the recommendations “that take up the least amount of time, but they're not always the ones that are most important for people's health.”

At the same time, many physicians report having too little time during patient visits to implement all of the recommendations from the U.S. Preventive Services Task Force.

To help resolve the problem, Dr. Braithwaite and NYU colleagues developed a mathematical model to prioritize for individual patients the task force recommendations that would improve life expectancy most effectively. The findings were published in the Aug. 6 issue of Annals of Internal Medicine.

Doctors could use the model with the help of an electronic health records system. The model would work by examining task force recommendations and how they impact life expectancy. That analysis would help a physician determine the most important guidelines to prioritize for a particular patient.

The study found that tobacco cessation, diabetes control, weight loss and blood pressure reduction consistently were among the highest-ranked guidelines across various hypothetical patients. Screenings for abdominal aortic aneurysm, breast cancer and colon cancer typically ranked lower.

“Right now this is just 'proof of concept.' It's not a final framework to be implemented widely in clinical practice,” said lead study author Glen B. Taksler, PhD, an instructor at NYU Langone.

The model is being piloted in a primary care clinic at Bellevue Hospital in New York. The study authors hope it will be implemented through EHRs at practices nationwide in the near future.

Michael L. LeFevre, MD, MSPH, co-vice chair of the USPSTF, is excited by the possibilities of the study's findings.

“We in primary care are all anxious to be able to individualize the care that we provide on the basis of good science. This is a step down that path,” said Dr. LeFevre, a family physician in Columbia, Mo.

But, he added, this is just a start, and there's a lot to be learned from these efforts.

A guideline's impact on life span

The task force has recommendations for 60 distinct clinical services, the study said. Although preventive health care in the U.S. has improved during the past decade, nearly half of U.S. adults were not receiving key preventive health services before 2010, said a study published in the June 15, 2012, issue of the Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report.

For the Annals study, researchers assessed the most recent data on U.S. life expectancy and disease prevalence for conditions that are addressed by task force guidance. They also evaluated each of the expert panel's recommendations that received a grade of A or B.

Preventive services that receive an A grade have a substantial net benefit. Those that get a B grade have a moderate-to-substantial net benefit, the task force said.

Researchers calculated national average life expectancy for patients using age, race and gender. They then adjusted life expectancy for personalized factors, such as body mass index and tobacco use.

Researchers estimated hypothetical patients' change in life expectancy from following each task force recommendation that received a grade A or B.

Based on the model, a 62-year-old obese man who smoked and had high cholesterol, hypertension and a family history of colorectal cancer would benefit most from task force recommendations on tobacco cessation, weight loss and blood pressure control, the study said.

Changing characteristics, including the patient's gender, or adding other factors, such as type 2 diabetes, influences which recommendations became priorities and their rank order.

A key limitation of the mathematical model is that “it's only as good as its input, and many of the inputs are really not known,” Dr. LeFevre said.

One such uncertainty is why black men have a shorter life expectancy than white men, he said.

Still, “it's important research,” Dr. LeFevre said.

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Task force recommendations make headlines

Although preventive health care has improved during the past decade, some physicians say they have too little time to implement all the recommendations issued by the U.S. Preventive Services Task Force. Several task force guidelines have attracted media attention in recent years:

Breast cancer screening

Recommendation: Conduct biennial screening mammography for women age 50-74.
Grade: B
Issued: 2009

Colorectal cancer screening

Recommendation: Screen everyone age 50-75 by fecal occult blood test, sigmoidoscopy or colonoscopy.
Grade: A
Issued: 2008

Depression screening for adults

Recommendation: Screen when staff-assisted depression care supports are in place to ensure accurate diagnosis, effective treatment and follow-up.
Grade: B
Issued: 2009

Diabetes screening

Recommendation: Screen for type 2 diabetes in asymptomatic adults with sustained blood pressure greater than 135/80 mm Hg.
Grade: B
Issued: 2008

Obesity screening and management for adults

Recommendation: Offer or refer patients with a BMI of at least 30 kg/m2 to intensive, multicomponent behavioral interventions.
Grade: B
Issued: 2012

Tobacco use counseling and interventions

Recommendations: Ask all adults about tobacco use and provide cessation interventions for those who use tobacco products.
Grade: A
Issued: 2009

Source: “Personalized Estimates of Benefit from Preventive Care Guidelines,” Annals of Internal Medicine, Aug. 6 (link)

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External links

“Prioritizing Guideline-Recommended Interventions,” Annals of Internal Medicine, Aug. 6 (link)

“Use of Selected Clinical Preventive Services Among Adults — United States, 2007-2010,” Morbidity and Mortality Weekly Report, Centers for Disease Control and Prevention, June 15, 2012 (link)

U.S. Preventive Services Task Force (link)

“Personalized Estimates of Benefit from Preventive Care Guidelines,” Annals of Internal Medicine, Aug. 6 (link)

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