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Editorial
January 26, 2016

JAMA Welcomes the US Preventive Services Task Force

Author Affiliations
  • 1Dr Bauchner is Editor in Chief, Dr Fontanarosa is Executive Deputy Editor, and Dr Golub is Deputy Editor, JAMA
JAMA. 2016;315(4):351-352. doi:10.1001/jama.2015.18448

The US Preventive Services Task Force (USPSTF) was created in 1984 by congressional authorization and “is an independent group of national experts in prevention and evidence-based medicine.”1 The intent of the USPSTF is “to improve the health of all Americans by making evidence-based recommendations about clinical preventive services such as: screenings, counseling services, and preventive medications.”1

For more than 3 decades, the USPSTF has developed numerous evidence-based recommendations and reports, with many of the initial reports published in JAMA, from 19872 to 1993. These reports, and other subsequent reports from the USPSTF, have likely had a profound influence on clinical practice and delivery of preventive services in the United States and around the world. For example, after the 2012 USPSTF recommendation against routine prostate-specific antigen (PSA) screening for all men, the overall rates of PSA screening declined substantially.3

Most physicians are familiar with the Recommendation Statements from the USPSTF. Although there have been some changes in the USPSTF processes over the years, most Recommendation Statements are supported by and primarily based on Evidence Reports conducted by the evidence-based practice centers (EPCs), which are academic or research organizations with expertise in conducting evidence reviews, and are commissioned by and supported by the Agency for Healthcare Research and Quality (AHRQ), the sponsoring agency for the USPSTF.

The Recommendation Statements are accompanied by the familiar grades of A, B, C, D, and I—ranging from A recommendations, indicating that “The USPSTF recommends the service. There is high certainty that the net benefit is substantial,” to D recommendations, indicating that “The USPSTF recommends against the service. There is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits,” to I recommendations, indicating that, “The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of the service. Evidence is lacking, of poor quality, or conflicting, and the balance of benefits and harms cannot be determined.”4

The importance of these designations changed in 2012 with the passing of the Affordable Care Act (ACA). Recommendations that receive an A or B grade must be offered or provided to patients and must be supported by health insurance policies. As recently described by the current leaders of the USPSTF, “The ACA specifies that commercial and individual or family plans must, at a minimum, provide coverage and not impose cost sharing for any evidence-based preventive services that receive a grade of A or B from the USPSTF. Medicare and Medicaid are excluded from this provision of the ACA.”5 For services that are graded as non-A and non-B by the USPSTF, the ACA grants discretion about coverage decisions to the payers. However, there are some concerns that linking recommendation grades to first-dollar coverage policies may potentially place the USPSTF’s “analytic rigor at risk by preventing members from concentrating on the science” because of the awareness that the recommendations constitute statutory mandates.6

In this issue of JAMA, we are pleased to again be publishing these clinically influential reports from the USPSTF in JAMA and the JAMA Network Journals. The 2 articles in this issue are the first of numerous forthcoming USPSTF Recommendation Statements and accompanying Evidence Reports and address the important issue of screening for depression. In the Recommendation Statement, Siu and colleagues7 from the USPSTF recommend “screening for depression in the general adult population, including pregnant and postpartum women,” and indicate that “screening should be implemented with adequate systems in place to ensure accurate diagnosis, effective treatment, and appropriate follow-up (B recommendation).” In the full Evidence Report prepared for the USPSTF, O’Connor and colleagues8 reviewed the evidence for the benefits and harms of depression screening in adults. In their article in this issue of JAMA,9 the authors focus on the evidence on screening for depression in pregnant and postpartum women and conclude that “Direct and indirect evidence suggested that screening pregnant and postpartum women for depression may reduce depressive symptoms in women with depression and reduce the prevalence of depression in a given population.”

The development process for the Recommendation Statements and Evidence Reports that accompany most statements is detailed and elaborate and largely is governed by legislative requirements. For instance, these processes require that these reports undergo a period of public comment and peer review by individuals and various federal agencies and professional societies. Accordingly, because of these review processes, these manuscripts will not undergo further external peer review after submission to JAMA. Rather, both documents are being published as a service to physicians, other health care professionals, and the public, with the Evidence Report article serving as a focused representation of the full evidence that was provided to the USPSTF when the Recommendation Statement was developed. We have worked closely with the EPCs to ensure transparency and consistency in the way in which the Evidence Reports are presented.

As with these 2 articles, most of the USPSTF Recommendation Statements that appear in JAMA or in the JAMA Network Journals will be accompanied by an editorial to provide context for the implications of the Recommendation Statements and objective perspective about the Evidence Reports. As with all editorials in JAMA, the authors of editorials accompanying the USPSTF reports will be selected by the editors of JAMA, and these editorials will not be subject to review by the USPSTF, the EPC authors, or AHRQ staff and therefore should be interpreted as independent commentary about the Recommendation Statements.

In this issue of JAMA, Thase10 provides a scholarly editorial that emphasizes and supports the recommendations of the USPSTF. In addition, because of the interest in and importance of the topic of depression screening, several of the JAMA Network Journals, including JAMA Psychiatry, JAMA Internal Medicine, and JAMA Neurology,1113 also are publishing editorials presenting independent comments and perspectives about the screening for depression Recommendation Statement.

We are pleased to welcome the USPSTF back to JAMA and the JAMA Network. By providing wide dissemination of these important and highly influential Recommendation Statements, we hope to help the USPSTF guide the use of preventive services in the United States and around the world and fulfill its mission of “improving the health of all Americans.”

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Article Information
Editorials represent the opinions of the authors and JAMA and not those of the American Medical Association.

Corresponding Author: Howard Bauchner, MD, JAMA (howard.bauchner@jamanetwork.org).

Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.

References
1.
US Preventive Services Task Force (USPSTF): an introduction. Agency for Healthcare Research and Quality. http://www.ahrq.gov/professionals/clinicians-providers/guidelines-recommendations/uspstf/index.html. Accessed January 5, 2016.
2.
O’Malley  MS, Fletcher  SW.  US Preventive Services Task Force: screening for breast cancer with breast self-examination: a critical review . JAMA. 1987;257(16):2196-2203.
PubMedArticle
3.
Jemal  A, Fedewa  SA, Ma  J,  et al.  Prostate cancer incidence and PSA testing patterns in relation to USPSTF screening recommendations . JAMA. 2015;314(19):2054-2061.
PubMedArticle
4.
Guide to Clinical Preventive Services, 2014: Appendix A: how the US Preventive Services Task Force grades its recommendations. Agency for Healthcare Research and Quality. http://www.ahrq.gov/professionals/clinicians-providers/guidelines-recommendations/guide/appendix-a.html. Accessed January 5, 2016.
5.
Siu  AL, Bibbins-Domingo  K, Grossman  D.  Evidence-based clinical prevention in the era of the Patient Protection and Affordable Care Act: the role of the US Preventive Services Task Force . JAMA. 2015;314(19):2021-2022.
PubMedArticle
6.
Woolf  SH, Campos-Outcalt  D.  Severing the link between coverage policy and the US Preventive Services Task Force . JAMA. 2013;309(18):1899-1900.
PubMedArticle
7.
Siu  AL; US Preventive Services Task Force.  Screening for depression in adults: US Preventive Services Task Force Recommendation Statement . JAMA. doi:10.1001/jama.2015.18392.
8.
O’Connor  E, Rossom  RC, Henninger  M,  et al. Screening for Depression in Adults: An Updated Systematic Evidence Review for the US Preventive Services Task Force: Evidence Synthesis No. 128 [AHRQ Publication No. 14-05208-EF-1]. Rockville, MD: Agency for Healthcare Research and Quality; 2016.
9.
O’Connor  E, Rossom  RC, Henninger  M, Groom  HC, Burda  BU.  Primary care screening for and treatment of depression in pregnant and postpartum women: evidence report and systematic review for the US Preventive Services Task Force . JAMA. doi:10.1001/jama.2015.18948.
10.
Thase  ME.  Recommendations for screening for depression in adults. JAMA. doi:10.1001/jama.2015.18406.
11.
Reynolds  CF  III, Frank  E.  US Preventive Services Task Force Recommendation Statement on screening for depression in adults: not good enough. JAMA Psychiatry. doi:10.1001/jamapsychiatry.2015.3281.
12.
Whooley  MA.  Screening for depression: a tale of two questions. JAMA Intern Med. doi:10.1001/jamainternmed.2015.8493.
13.
Mayberg  HS.  Implementing recommendations for depression screening of adults: how can neurology contribute to the dialogue? JAMA Neurology. doi:10.1001/jamaneurol.2015.5048.
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