Mary Barton, MD, MPP Vice President, Performance Measures “Balancing scientific and social dimensions of guidelines”

2 US Preventive Services Task Force Established 1984 for initial five year project Panel of Non-Federal experts Since 1990 supported by the Agency for Healthcare Research and Quality AHRQ’s predecessor agency in hot water from “Guidelines” USPSTF makes “Recommendations”

3 USPSTF: Simplified M.O. Since 1990, increasing bar of evidence requirements Review of literature Systematic Evidence Review – Key Questions established from the start – Analytic Framework – Exhaustive and complete review of published literature

4 USPSTF: Simplified M.O. Assessment of literature shared between – Evidence review team Quality Eye toward resistance to bias – USPSTF Relevance, applicability Where is it justifiable to extrapolate?

5 USPSTF: Simplified M.O. Not surprised by controversy – Breast Cancer has historically stirred wide, sometimes acrimonious debate – 2002 USPSTF review and recommendation – 1997 NIH Consensus Conference Majority and Minority Statements

6 Policy Advances 2003 Medicare Modernization Act – Evidence-based Practice Center program 2008 Medicare Improvement for Patients and Providers (MIPPA) – Authority for Sec’y HHS to generate Medicare Coverage Decisions Debate around the Affordable Care Act

7 Helpful principles Communicate early, often, and frequently Increase points of engagement Seek public and patient voices

8 New M.O. for USPSTF At start of review process – Post Analytic Framework and Key Questions for Public Comment In review of EPC reports – Seek diverse opinions for formal review Draft form of Recommendations – Posting all Task Force Recommendations as Drafts for Public Comment – Now ~18 months into trial Variety of stakeholder engagements

9 Current tension “The efforts by politicians to reject the committee's scientific findings have been condemned as an example of unwarranted political interference in scientific research.” [ Wikipedia ]political interference in scientific research The Value of Including Patient Voices – AHRQ’s Comparative Effectiveness program work on methods for increasing public involvement – Institute of Medicine report on Trustworthy Clinical Practice Guidelines

10 Discussion Points As scientific research is gathered into Reviews Policy Statements Clinical guidelines or Recommendations Performance Measures Seek out meaningful public input Establish effective routes of communication with key stakeholders