Trends in the allocation of U.S. Preventive Services Task Force recommendation grades and the directionality of topic updates over time
Public Deposited- Last Modified
- January 25, 2020
- Creator
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Thompson, Garrett
- Affiliation: Gillings School of Global Public Health, Public Health Leadership Program
- Abstract
- Background: The U.S. Preventive Services Task Force has provided evidence-based recommendations to primary care clinicians on the use of preventive services for almost 30 years. In the past, the Task Force has been criticized for being too conservative in issuing recommendations in favor of the use of preventive services. Several recent criticisms, however, have focused on recommendations considered too liberal in the promotion of services. Objective: To identify trends in the overall allocation of recommendation grades and in the frequency of positive changes (i.e. the issuance of more favorable recommendations) and negative changes (i.e. the issuance of less favorable recommendations) made to recommendations when updating topics. Methods: All recommendations issued by the Task Force from January 1996 to June 2017 were collected. Point-based and categorization-based methods were used to evaluate the directionality of change for recommendations issued on updated topics. Results: The proportion of negative recommendations issued over the past several years has substantially decreased (to 10.1% of recommendations issued from 2013 to 2017 compared to 22.4% from 2006 to 2012 and 23.8% from 2001 to 2005), while the proportion of “I” statements has increased (to 46.1% from 2013 to 2017 compared to 33.7% from 2006 to 2012 and 36.6% from 2001 to 2005). The proportion of recommendations assigned positive letter grades has slightly increased over time (to 38.2% of recommendations issued from 2013 to 2017 compared to 36.7% from 2006 to 2012 and 33.7% from 2001 to 2005). Furthermore, negative changes (resulting in the decreased promotion and/or increased discouragement of preventive services) made to recommendations issued on updated topics have become less common over time (as assessed by two different methods). Conversely, positive changes (resulting in the increased promotion and/or decreased discouragement of preventive services) have become more common over the past several years. Finally, the Task Force has increasingly chosen not to update negative recommendations for previously evaluated interventions or populations (6 out of 8 of these dropped negative recommendations have occurred since 2013). Conclusions: Several potential factors may have contributed to the longitudinal changes in the issuance of Task Force recommendations observed in this study. These factors include changes in evidence for evaluated services, changes in the methodology for assigning recommendations, political pressures, the link between coverage policy and recommendations, and changes in the thresholds used to delineate recommendation grades. Further research is needed to assess the extent to which each of these factors has influenced the overall issuance of recommendations.
- Date of publication
- August 2017
- Keyword
- DOI
- Resource type
- Rights statement
- In Copyright
- Note
- Paper type: Other
- Track: HC&P
- Advisor
- Jonas, Daniel
- Reviewer
- Harris, Russell
- Degree
- Master of Public Health
- Academic concentration
- Public Health
- Degree granting institution
- University of North Carolina at Chapel Hill
- Graduation year
- 2017
- Language
- Deposit record
- 3406070d-2a57-429d-869c-e7ae838c66f3
Relations
- Parents:
This work has no parents.
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Garrett_Thompson_-_MPH_paper_-_20Jul2017.pdf | 2020-01-25 | Public | Download |
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agreements.txt | 2019-05-11 | Public | Download |
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PREMIS_Events_Metadata_0_d210c44c-b19e-419b-9da2-94be3ef37552.txt | 2019-05-11 | Public | Download |
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original_metadata_file_d210c44c-b19e-419b-9da2-94be3ef37552.xml | 2019-05-11 | Public | Download |