TABLE 2-1 USPSTF Grade Definitions

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 degree of certainty that the net benefit is moderate to substantial. Offer or provide this service.
C The USPSTF recommends against routinely providing the service. There may be considerations that support providing the service in an individual patient. There is at least moderate certainty that the net benefit is small. Offer or provide this service only if other considerations support the offering or providing the service in an individual patient.
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 Statement 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.

SOURCE: USPSTF, 2008a.

The charge of the Task Force is limited in scope: “its recommendations address primary or secondary preventive services targeting conditions that represent a substantial burden in the United States and that are provided in primary care settings or available through primary care referral” (USPSTF, 2008b). These recommendations are intended to inform primary care providers as they care for individual patients in primary care practice. They are not intended to determine which preventive health care services health insurers should be required to cover. The methodology used in developing Task Force clinical recommendations does not take into consideration many nonclinical issues related to health care coverage (USPSTF, 2011). USPSTF uses a grade system, which is described in Table 2-1.

USPSTF Methodology

Task Force recommendations and their accompanying evidence reports are produced through the collaborative efforts of the USPSTF, the Agency



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