Mary Barton, MD, MPP Vice President, Performance Measures

1. “Balancing scientific and social dimensions of guidelines” Mary Barton, MD, MPPVice President, Performance Measures

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] • 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