title: Use of Decision Models in the Development of Evidence-Based Clinical Preventive Services Recommendations: Methods of the U.S. Preventive Services Task Force.
abstract: The U.S. Preventive Services Task Force (USPSTF) develops evidence-based recommendations about preventive care based on comprehensive systematic reviews of the best available evidence. Decision models provide a complementary, quantitative approach to support the USPSTF as it deliberates about the evidence and develops recommendations for clinical and policy use. This article describes the rationale for using modeling, an approach to selecting topics for modeling, and how modeling may inform recommendations about clinical preventive services. Decision modeling is useful when clinical questions remain about how to target an empirically established clinical preventive service at the individual or program level or when complex determinations of magnitude of net benefit, overall or among important subpopulations, are required. Before deciding whether to use decision modeling, the USPSTF assesses whether the benefits and harms of the preventive service have been established empirically, assesses whether there are key issues about applicability or implementation that modeling could address, and then defines the decision problem and key questions to address through modeling. Decision analyses conducted for the USPSTF are expected to follow best practices for modeling. For chosen topics, the USPSTF assesses the strengths and limitations of the systematically reviewed evidence and the modeling analyses and integrates the results of each to make preventive service recommendations.
authors.affiliation: From Stanford University, Stanford, California; Patient-Centered Outcomes Research Institute, Washington, DC; Kaiser Permanente Center for Health Research, Portland, Oregon; University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; VCU-Fairfax Family Medicine Residency, Fairfax, Virginia; University of California, San Francisco, San Francisco, California; University of Iowa, Iowa City, Iowa; Columbia University and Icahn School of Medicine at Mount Sinai, New York, New York; University of Georgia, Athens, Georgia; Harvard Medical School, Boston, Massachusetts; Group Health Research Institute, Seattle, Washington; Duke University, Durham, North Carolina; Yale University, New Haven, Connecticut; Health Partners Institute, Minneapolis, Minnesota; and University of Missouri, Columbia, Missouri.
authors.forename: Douglas K
authors.initials: DK
authors.lastname: Owens
authors.affiliation: From Stanford University, Stanford, California; Patient-Centered Outcomes Research Institute, Washington, DC; Kaiser Permanente Center for Health Research, Portland, Oregon; University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; VCU-Fairfax Family Medicine Residency, Fairfax, Virginia; University of California, San Francisco, San Francisco, California; University of Iowa, Iowa City, Iowa; Columbia University and Icahn School of Medicine at Mount Sinai, New York, New York; University of Georgia, Athens, Georgia; Harvard Medical School, Boston, Massachusetts; Group Health Research Institute, Seattle, Washington; Duke University, Durham, North Carolina; Yale University, New Haven, Connecticut; Health Partners Institute, Minneapolis, Minnesota; and University of Missouri, Columbia, Missouri.
authors.forename: Evelyn P
authors.initials: EP
authors.lastname: Whitlock
authors.affiliation: From Stanford University, Stanford, California; Patient-Centered Outcomes Research Institute, Washington, DC; Kaiser Permanente Center for Health Research, Portland, Oregon; University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; VCU-Fairfax Family Medicine Residency, Fairfax, Virginia; University of California, San Francisco, San Francisco, California; University of Iowa, Iowa City, Iowa; Columbia University and Icahn School of Medicine at Mount Sinai, New York, New York; University of Georgia, Athens, Georgia; Harvard Medical School, Boston, Massachusetts; Group Health Research Institute, Seattle, Washington; Duke University, Durham, North Carolina; Yale University, New Haven, Connecticut; Health Partners Institute, Minneapolis, Minnesota; and University of Missouri, Columbia, Missouri.
authors.forename: Jillian
authors.initials: J
authors.lastname: Henderson
authors.affiliation: From Stanford University, Stanford, California; Patient-Centered Outcomes Research Institute, Washington, DC; Kaiser Permanente Center for Health Research, Portland, Oregon; University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; VCU-Fairfax Family Medicine Residency, Fairfax, Virginia; University of California, San Francisco, San Francisco, California; University of Iowa, Iowa City, Iowa; Columbia University and Icahn School of Medicine at Mount Sinai, New York, New York; University of Georgia, Athens, Georgia; Harvard Medical School, Boston, Massachusetts; Group Health Research Institute, Seattle, Washington; Duke University, Durham, North Carolina; Yale University, New Haven, Connecticut; Health Partners Institute, Minneapolis, Minnesota; and University of Missouri, Columbia, Missouri.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Pignone
authors.affiliation: From Stanford University, Stanford, California; Patient-Centered Outcomes Research Institute, Washington, DC; Kaiser Permanente Center for Health Research, Portland, Oregon; University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; VCU-Fairfax Family Medicine Residency, Fairfax, Virginia; University of California, San Francisco, San Francisco, California; University of Iowa, Iowa City, Iowa; Columbia University and Icahn School of Medicine at Mount Sinai, New York, New York; University of Georgia, Athens, Georgia; Harvard Medical School, Boston, Massachusetts; Group Health Research Institute, Seattle, Washington; Duke University, Durham, North Carolina; Yale University, New Haven, Connecticut; Health Partners Institute, Minneapolis, Minnesota; and University of Missouri, Columbia, Missouri.
authors.forename: Alex H
authors.initials: AH
authors.lastname: Krist
authors.affiliation: From Stanford University, Stanford, California; Patient-Centered Outcomes Research Institute, Washington, DC; Kaiser Permanente Center for Health Research, Portland, Oregon; University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; VCU-Fairfax Family Medicine Residency, Fairfax, Virginia; University of California, San Francisco, San Francisco, California; University of Iowa, Iowa City, Iowa; Columbia University and Icahn School of Medicine at Mount Sinai, New York, New York; University of Georgia, Athens, Georgia; Harvard Medical School, Boston, Massachusetts; Group Health Research Institute, Seattle, Washington; Duke University, Durham, North Carolina; Yale University, New Haven, Connecticut; Health Partners Institute, Minneapolis, Minnesota; and University of Missouri, Columbia, Missouri.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Bibbins-Domingo
authors.affiliation: From Stanford University, Stanford, California; Patient-Centered Outcomes Research Institute, Washington, DC; Kaiser Permanente Center for Health Research, Portland, Oregon; University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; VCU-Fairfax Family Medicine Residency, Fairfax, Virginia; University of California, San Francisco, San Francisco, California; University of Iowa, Iowa City, Iowa; Columbia University and Icahn School of Medicine at Mount Sinai, New York, New York; University of Georgia, Athens, Georgia; Harvard Medical School, Boston, Massachusetts; Group Health Research Institute, Seattle, Washington; Duke University, Durham, North Carolina; Yale University, New Haven, Connecticut; Health Partners Institute, Minneapolis, Minnesota; and University of Missouri, Columbia, Missouri.
authors.forename: Susan J
authors.initials: SJ
authors.lastname: Curry
authors.affiliation: From Stanford University, Stanford, California; Patient-Centered Outcomes Research Institute, Washington, DC; Kaiser Permanente Center for Health Research, Portland, Oregon; University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; VCU-Fairfax Family Medicine Residency, Fairfax, Virginia; University of California, San Francisco, San Francisco, California; University of Iowa, Iowa City, Iowa; Columbia University and Icahn School of Medicine at Mount Sinai, New York, New York; University of Georgia, Athens, Georgia; Harvard Medical School, Boston, Massachusetts; Group Health Research Institute, Seattle, Washington; Duke University, Durham, North Carolina; Yale University, New Haven, Connecticut; Health Partners Institute, Minneapolis, Minnesota; and University of Missouri, Columbia, Missouri.
authors.forename: Karina W
authors.initials: KW
authors.lastname: Davidson
authors.affiliation: From Stanford University, Stanford, California; Patient-Centered Outcomes Research Institute, Washington, DC; Kaiser Permanente Center for Health Research, Portland, Oregon; University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; VCU-Fairfax Family Medicine Residency, Fairfax, Virginia; University of California, San Francisco, San Francisco, California; University of Iowa, Iowa City, Iowa; Columbia University and Icahn School of Medicine at Mount Sinai, New York, New York; University of Georgia, Athens, Georgia; Harvard Medical School, Boston, Massachusetts; Group Health Research Institute, Seattle, Washington; Duke University, Durham, North Carolina; Yale University, New Haven, Connecticut; Health Partners Institute, Minneapolis, Minnesota; and University of Missouri, Columbia, Missouri.
authors.forename: Mark
authors.initials: M
authors.lastname: Ebell
authors.affiliation: From Stanford University, Stanford, California; Patient-Centered Outcomes Research Institute, Washington, DC; Kaiser Permanente Center for Health Research, Portland, Oregon; University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; VCU-Fairfax Family Medicine Residency, Fairfax, Virginia; University of California, San Francisco, San Francisco, California; University of Iowa, Iowa City, Iowa; Columbia University and Icahn School of Medicine at Mount Sinai, New York, New York; University of Georgia, Athens, Georgia; Harvard Medical School, Boston, Massachusetts; Group Health Research Institute, Seattle, Washington; Duke University, Durham, North Carolina; Yale University, New Haven, Connecticut; Health Partners Institute, Minneapolis, Minnesota; and University of Missouri, Columbia, Missouri.
authors.forename: Matthew W
authors.initials: MW
authors.lastname: Gillman
authors.affiliation: From Stanford University, Stanford, California; Patient-Centered Outcomes Research Institute, Washington, DC; Kaiser Permanente Center for Health Research, Portland, Oregon; University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; VCU-Fairfax Family Medicine Residency, Fairfax, Virginia; University of California, San Francisco, San Francisco, California; University of Iowa, Iowa City, Iowa; Columbia University and Icahn School of Medicine at Mount Sinai, New York, New York; University of Georgia, Athens, Georgia; Harvard Medical School, Boston, Massachusetts; Group Health Research Institute, Seattle, Washington; Duke University, Durham, North Carolina; Yale University, New Haven, Connecticut; Health Partners Institute, Minneapolis, Minnesota; and University of Missouri, Columbia, Missouri.
authors.forename: David C
authors.initials: DC
authors.lastname: Grossman
authors.affiliation: From Stanford University, Stanford, California; Patient-Centered Outcomes Research Institute, Washington, DC; Kaiser Permanente Center for Health Research, Portland, Oregon; University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; VCU-Fairfax Family Medicine Residency, Fairfax, Virginia; University of California, San Francisco, San Francisco, California; University of Iowa, Iowa City, Iowa; Columbia University and Icahn School of Medicine at Mount Sinai, New York, New York; University of Georgia, Athens, Georgia; Harvard Medical School, Boston, Massachusetts; Group Health Research Institute, Seattle, Washington; Duke University, Durham, North Carolina; Yale University, New Haven, Connecticut; Health Partners Institute, Minneapolis, Minnesota; and University of Missouri, Columbia, Missouri.
authors.forename: Alex R
authors.initials: AR
authors.lastname: Kemper
authors.affiliation: From Stanford University, Stanford, California; Patient-Centered Outcomes Research Institute, Washington, DC; Kaiser Permanente Center for Health Research, Portland, Oregon; University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; VCU-Fairfax Family Medicine Residency, Fairfax, Virginia; University of California, San Francisco, San Francisco, California; University of Iowa, Iowa City, Iowa; Columbia University and Icahn School of Medicine at Mount Sinai, New York, New York; University of Georgia, Athens, Georgia; Harvard Medical School, Boston, Massachusetts; Group Health Research Institute, Seattle, Washington; Duke University, Durham, North Carolina; Yale University, New Haven, Connecticut; Health Partners Institute, Minneapolis, Minnesota; and University of Missouri, Columbia, Missouri.
authors.forename: Ann E
authors.initials: AE
authors.lastname: Kurth
authors.affiliation: From Stanford University, Stanford, California; Patient-Centered Outcomes Research Institute, Washington, DC; Kaiser Permanente Center for Health Research, Portland, Oregon; University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; VCU-Fairfax Family Medicine Residency, Fairfax, Virginia; University of California, San Francisco, San Francisco, California; University of Iowa, Iowa City, Iowa; Columbia University and Icahn School of Medicine at Mount Sinai, New York, New York; University of Georgia, Athens, Georgia; Harvard Medical School, Boston, Massachusetts; Group Health Research Institute, Seattle, Washington; Duke University, Durham, North Carolina; Yale University, New Haven, Connecticut; Health Partners Institute, Minneapolis, Minnesota; and University of Missouri, Columbia, Missouri.
authors.forename: Michael
authors.initials: M
authors.lastname: Maciosek
authors.affiliation: From Stanford University, Stanford, California; Patient-Centered Outcomes Research Institute, Washington, DC; Kaiser Permanente Center for Health Research, Portland, Oregon; University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; VCU-Fairfax Family Medicine Residency, Fairfax, Virginia; University of California, San Francisco, San Francisco, California; University of Iowa, Iowa City, Iowa; Columbia University and Icahn School of Medicine at Mount Sinai, New York, New York; University of Georgia, Athens, Georgia; Harvard Medical School, Boston, Massachusetts; Group Health Research Institute, Seattle, Washington; Duke University, Durham, North Carolina; Yale University, New Haven, Connecticut; Health Partners Institute, Minneapolis, Minnesota; and University of Missouri, Columbia, Missouri.
authors.forename: Albert L
authors.initials: AL
authors.lastname: Siu
authors.affiliation: From Stanford University, Stanford, California; Patient-Centered Outcomes Research Institute, Washington, DC; Kaiser Permanente Center for Health Research, Portland, Oregon; University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; VCU-Fairfax Family Medicine Residency, Fairfax, Virginia; University of California, San Francisco, San Francisco, California; University of Iowa, Iowa City, Iowa; Columbia University and Icahn School of Medicine at Mount Sinai, New York, New York; University of Georgia, Athens, Georgia; Harvard Medical School, Boston, Massachusetts; Group Health Research Institute, Seattle, Washington; Duke University, Durham, North Carolina; Yale University, New Haven, Connecticut; Health Partners Institute, Minneapolis, Minnesota; and University of Missouri, Columbia, Missouri.
authors.forename: Michael L
authors.initials: ML
authors.lastname: LeFevre
mesh_terms: D026683:Advisory Committees; D003661:Decision Support Techniques; D019317:Evidence-Based Medicine; D006801:Humans; D011314:Preventive Health Services; D014481:United States