Alumni of Robert Wood Johnson Foundation (RWJF) scholar and fellow programs have a long and distinguished history of serving on the United States Preventive Services Task Force (USPSTF). More than 40 grantees have served on the Task Force since 2000. The USPSTF is a panel of independent experts who review the best, available medical evidence on the diagnosis, prevention and treatment of a wide range of health conditions and make recommendations on the most effective methods of care.
Since its inception in 1984, USPSTF guidelines have also played a crucial role in shaping policies on insurance coverage and research funding. Recent examples include their recommendations on breast and prostate cancer screening. As the USPSTF enters 2012, RWJF grantees are leading its efforts to move forward.
Expanding USPSTF’s Reach
“This is my second term on the Task Force,” says Albert L. Siu, MD, MPH, a 1983-1985 RWJF Clinical Scholar, who is also co-vice chair of the USPSTF this year. A geriatrician by training, Siu says, “I returned because the Task Force has gone through several eras and is now targeting a very different audience. We began with a book of recommendations [first published in 1989], shared mostly with academics and primary care physicians. We are now working with a website that is very public.” Task Force recommendations are also released through peer-reviewed journals. “Over time, we’ve also added people to the audience who develop quality measures and make coverage decisions.”
“One of the things I’m working on is helping to update the language of our recommendations so that these new audiences—including the general public—will be able to better understand the recommendations,” explains Siu, who is also chair of the department of geriatric medicine at Mount Sinai School of Medicine in New York. “During my first term on the Task Force, in 2001-2005, I chaired the Geriatrics Workgroup,” he adds, noting that “were it not for my time in the RWJF Clinical Scholars Program, I would not have developed the skills or the network that eventually led to this work.”
Making Better Use of Evidence
While USPSTF members strive to adhere to the highest standards when selecting research on which to base their recommendations, there’s also a need to find more effective ways to work with available data. “We generally use clinical trials, but they have some problems,” explains USPSTF member Sandy Schwartz, MD, MBA, a 1976-1979 RWJF Clinical Scholar. “Trials often use a highly selective patient population; they are conducted over limited time frames and may have limited research questions.”
“In order to strengthen the way we assess data that’s already in existence, I am exploring the use of decision models. When the questions posed require more analysis, we construct rigorous models to assess a broader range of factors,” says Schwartz, a professor of medicine, health management and economics at the School of Medicine and The Wharton School at the University of Pennsylvania.
Improving the quality of data used is also part of the work of USPSTF member Glenn Flores, MD, a 2001-2005 RWJF Physician Faculty Scholar and 1993-1995 RWJF Clinical Scholar. “In the coming year, I am going to chair the Task Force’s Child Health Workgroup. The first step will be to think about how to get better evidence. There’s not as much data out there about children, especially when we look at conditions such as hypertension that cross the age spectrum. There’s also inadequate evidence on child abuse,” says Flores, who is also a professor and director of general pediatrics at the University of Texas Southwestern Medical Center.
“As current chair for the Topic Prioritization Workgroup, I also work with other members on keeping our library of topics current and relevant for primary care clinicians,” says David Grossman, MD, MPH, a 1988-1990 RWJF Clinical Scholar and pediatrician at the Group Health Cooperative in Seattle. “I’m very excited about this work. As the evidence changes, our recommendations need to stay current and our Workgroup monitors this process. One of the recommendation’s we’ve changed recently was our statement on physician screening of childhood obesity. It was changed from an I grade, for insufficient evidence, to a B grade supporting screening, based on the new evidence that had accumulated since the time of the last review.”
“In addition, I work on racial and ethnic disparities in health care and there’s an increasing push to do better work for these populations,” says Flores, noting that in cases where evidence is particularly inadequate, the USPSTF’s “insufficient evidence” grade can serve as a message to people in the field that more research needs to be done. “We have to ask better questions and be sure that we have evidence that’s relevant for everyone,” advises Flores, who is also a member of the National Advisory Committee for the RWJF Harold Amos Medical Faculty Development Program. “One of the gifts that I received from my RWJF grantee background is the ability to look at evidence and translate that research into practice. All Robert Wood Johnson Foundation Clinical Scholars are given this training,” Flores adds.
An alumni of the RWJF Harold Amos Medical Faculty Development Program (2004-2007), Task Force member Kirsten Bibbins-Domingo, PhD, MD, brings the skills of a grantee experienced in investigating disparities. “I’m a general internist, but my research focuses on the prevention of cardiovascular disease, with a focus on minority populations,” Bibbins-Domingo says. “Right now, the USPSTF is interested in how the evidence and our recommendations pertain to specific populations—racial and ethnic minorities, as well as the young and the elderly. I’m working on the Methods Workgroup focused on these subgroups.”
“Many are concerned about the rising rates of cardiovascular disease in young people, as well as analyzing the evidence to see how we can make recommendations to prevent these trends. How, for example, do we screen people without symptoms so that they can avoid developing the disease?” says Bibbins-Domingo, whose Harold Amos research project focused on heart failure in young African Americans.
Broadening the Task Force’s work on disparities, RWJF Clinical Scholar (1994-1996), Wanda Nicholson, MD, MPH, MBA, an associate professor of obstetrics and gynecology at the University of North Carolina at Chapel Hill School of Medicine says, “I have a far-reaching focus on women’s health, with an emphasis on diabetes, obesity and pregnancy. I’m currently working on the cervical cancer guidelines. The best strategy is to ensure that all women are screened since most cases of cervical cancer occur in women who have not been screened.”
“We are also examining new screening data for gestational diabetes to see if there’s more to learn about when to screen in pregnancy and the effects of screening on mother and infant,” she adds. Like other grantees who are USPSTF members, Nicholson says, “my RWJF Clinical Scholars experience really provided the tools for me to conduct evidence-based reviews. In addition, my term as an RWJF Harold Amos Medical Faculty Development Program scholar [2000-2005] gave me dedicated time to pursue my research on reducing disparities in gestational diabetes.”
A Natural Connection
This year, and for many years to come, RWJF scholars stand to play a significant role in the work of the USPSTF, as they do in other pivotal venues in the world of medical research and policy. “What we see on the USPSTF,” Flores says, “is a reflection of—and tremendous tribute to the Robert Wood Johnson Foundation grantee training. It’s the translation of that training into leadership, how we practice medicine and how we’re transforming medicine.”