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Understanding the Level of Preventative Services (Grades and Suggestions)

July 17th, 2018 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
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It is essential for providers, clinicians, and other users to understand the importance of providing preventative services.  The U.S. Preventative Services Task Force (USPSTF) has recommendations and has applied Grade Definitions as a suggested resource to imply the significance and strength of preventative services.  The following definitions apply to recommendations voted on after July 2012.  The USPSTF states “Determining whether or not the service should be offered or provided to an individual patient will typically require an informed conversation between the clinician and patient.”

Affordable Care Act and U.S. Preventive Services Task Force Recommendations

 Grade Definition  Suggestions for Practice
A  The USPSTF recommends the service. There is high certainty that the net benefit is substantial.   Offer or provide this service.
B The USPSTF recommends the service.    There is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial.  Offer or provide this service.
C The USPSTF recommends selectively offering or providing this service to individual patients based on professional judgment and patient preferences. There is at least moderate certainty that the net benefit is small. Offer or provide this service for selected patients depending on individual circumstances.
D 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. Discourage the use of this service.
I 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.         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.

  

Levels of Certainty Regarding Net Benefit (Per USPSTF)

Level of Certainty* Description
High 
  • The available evidence usually includes consistent results from well-designed, well-conducted studies in representative primary care populations. These studies assess the effects of the preventive service on health outcomes. This conclusion is therefore unlikely to be strongly affected by the results of future studies.
Moderate
  • The available evidence is sufficient to determine the effects of the preventive service on health outcomes, but confidence in the estimate is constrained by such factors as:

    • The number, size, or quality of individual studies.
    • Inconsistency of findings across individual studies.
    • Limited generalizability of findings to routine primary care practice.
    • Lack of coherence in the chain of evidence.
    • As more information becomes available, the magnitude or direction of the observed effect could change, and this change may be large enough to alter the conclusion.
Low
  • The available evidence is insufficient to assess effects on health outcomes. Evidence is insufficient because of:

    • The limited number or size of studies.
    • Important flaws in study design or methods.
    • An inconsistency of findings across individual studies.
    • Gaps in the chain of evidence.
    • Findings not generalizable to routine primary care practice.
               (or Lack of information on important health outcomes)

   

More information may allow estimation of effects on health outcomes.   

 

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