A new National Academies of Sciences, Engineering and Medicine consensus study, headed by Kaiser Permanente Division of Research Director Tracy Lieu, MD, MPH, makes recommendations to accelerate the research needed to fill evidence gaps for clinical preventive services. The National Academies are private, non-profit institutions that provide expert advice to the U.S. to solve problems and inform public policy decisions related to science, technology, and medicine.

Evidence to Support Preventive Care Lacking

An essential part of medical care, research Kaiser Permanente, Division of Research Northern California’s Spotlight recently showcased the importance of generating evidence for preventative disease. Unfortunately, many evidentiary gaps still exist for common preventive services from checking vitamin D levels in adults to common hearing loss or cognitive impairment testing or for that matter, even how to screen young people for substance abuse disorder. But how to fill in those gaps?

Enter the U.S. Preventive Services Task Force (USPSTF)

As it turns out, an organization called the U.S. Preventive Services Task Force (USPSTF) exists to help close that gap. An independent, volunteer group of national experts in prevention and evidence-based medicine, the group helps improve health by making recommendations about clinical preventive services such as screening tests, counseling services, and preventive medications.

Reviewing the evidence for preventive services while assigning letter grade recommendations for those with sufficient evidence, this body issues an “I” statement for services that involve insufficient evidence for example. Kaiser Permanente reports that it takes an average of 8 years to replace an “I’ rating with a letter grade signifying superior evidence. Unfortunately, a good deal of preventive services never become backed with evidence.

The Study Findings & Interview

Now Kaiser Permanente reports that the health system’s own Tracy Lieu heads up a National Academies of Sciences, Engineering, and Medicine consensus study charged with the acceleration needed to fill the evidence gaps for clinical preventive services. How will they do this? This will be accomplished by making recommendations necessary that ultimately lead to the appropriate evidence so vital in the backing and acceptance of prevention.

Led by Lieu, the group produced a viewpoint concerning their most recent findings published in JAMA on January 27th. Lieu shared with Spotlight some important perspectives.  What follows is a TrialSite breakdown of that information.

How much authority does the U.S. Preventive Services Task Force have to close preventive medicine gaps in U.S. health care?

Significant. In fact, according to Dr. Lieu, the Affordable Care Act mandated insurers to pay for services that this body recommends. This task force’s recommendations thus “have the force of law.”

How stringent are the evidentiary standards?

USPSTF’s assessments are “quite meticulous” about what evidence it uses to assess whether preventive care is backed by “robust” evidence.

Why is this a challenge?

Because in the real world of caregiving the burden is then of course on the practitioner to determine if a particular topic is backed by sufficient evidence.  Each individual practitioner (e.g., physician, nurse, etc.) faces the burden to determine if they should recommend a test or screening for a specific patient.  In some cases that can be highly beneficial, in other cases an unsustainable burden.

How does the  USPSTF committee zero in on the appropriate granularity required for sufficient evidence?

Dr. Lieu shared that their committee requires that preventive medicine evidence-focused researchers must “focus on the precise set of questions the task force most needs to be addressed” in order to avoid the problem of producing insufficient medical evidence.

Why did Lieu jump into this role as chair?

According to Kaiser Permanente, Dr. Lieu shared that the chair role involved the “perfect combination of science, policy and clinical practice” and frankly reminded her of the Kaiser Permanente research program framework declaring “Every day we are thinking about how to create a structure that helps researchers and policymakers and clinical practitioners. This National Academies project was something concrete that could help all of these fields collaborate more effectively, and I was pleased to participate.”

What about the process

Lieu shared some key organizations involved in establishing a core stakeholder committee involving first and foremost, the National Institutes of Health (NIH) and the Agency for Healthcare Research and Quality (AHRQ), and what tasks will be accomplished, including public workshops and invited speakers. 

Depending on the topic, select speakers were invited—e.g., experts from the National Cancer Institute would come and present on the topic of colorectal cancer. The group also does systematic literature reviews scanning published and online sources leading to a draft of the evidentiary product—“a taxonomy” representing a “standard list of terms.” The core stakeholders iterate reviews of the taxonomy till they arrive at a final.

What were the main findings?

Lieu reports that the main output was the taxonomy, a sort of roadmap used by clinical guidelines committees, funders and researchers can use “to clearly communicate about the specific areas of research that are needed.”

Below is an example of the committee process

Lead Research/Investigator

Tracy Lieu, MD, MPH, Kaiser Permanente, director of the Division of Research

Call to Action: follow the link to read the entire report in Spotlight.

Link to Article

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