Glen B. Taksler, PhD; Melanie Keshner, MSN, FNP; Angela Fagerlin, PhD; Negin Hajizadeh, MD, MPH; R. Scott Braithwaite, MD, MSc
Grant Support: By seed funds from New York University School of Medicine.
Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M12-2938.
Reproducible Research Statement: Study protocol: Available in Supplement 1. Statistical code: Template available from Dr. Taksler (e-mail, firstname.lastname@example.org). Nonacademic researchers may be required to sign a written use agreement. Data set: Not available.
Requests for Single Reprints: Glen B. Taksler, PhD, Departments of Population Health and Medicine, New York University School of Medicine, 550 First Avenue, Translational Research Building, 6th Floor, New York, NY 10016; e-mail, email@example.com.
Current Author Addresses: Drs. Taksler, Hajizadeh, and Braithwaite and Ms. Keshner: Departments of Population Health and Medicine, New York University School of Medicine, 550 First Avenue, Translational Research Building, 6th Floor, New York, NY 10016.
Dr. Fagerlin: Division of General Internal Medicine, University of Michigan, 2800 Plymouth Road, Building 16, Room 421W, Ann Arbor, MI 48109.
Author Contributions: Conception and design: G.B. Taksler, M. Keshner, N. Hajizadeh, R.S. Braithwaite.
Analysis and interpretation of the data: G.B. Taksler, M. Keshner, N. Hajizadeh, R.S. Braithwaite.
Drafting of the article: G.B. Taksler, N. Hajizadeh, R.S. Braithwaite.
Critical revision of the article for important intellectual content: G.B. Taksler, A. Fagerlin, R.S. Braithwaite.
Final approval of the article: G.B. Taksler, M. Keshner, A. Fagerlin, R.S. Braithwaite.
Provision of study materials or patients: M. Keshner.
Statistical expertise: G.B. Taksler.
Administrative, technical, or logistic support: G.B. Taksler.
Collection and assembly of data: G.B. Taksler, M. Keshner.
Taksler GB, Keshner M, Fagerlin A, Hajizadeh N, Braithwaite RS. Personalized Estimates of Benefit From Preventive Care Guidelines: A Proof of Concept. Ann Intern Med. 2013;159:161-168. doi: 10.7326/0003-4819-159-3-201308060-00005
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Published: Ann Intern Med. 2013;159(3):161-168.
The U.S. Preventive Services Task Force (USPSTF) makes recommendations for 60 distinct clinical services, but clinicians rarely have time to fully evaluate and implement the recommendations.
To complete a proof of concept for prioritization and personalization of USPSTF recommendations, using patient-specific clinical characteristics.
USPSTF recommendations and supporting evidence and National Vital Statistics Reports.
USPSTF grade A and B recommendations.
Personalized gain in life expectancy associated with each recommendation.
Increases in life expectancy varied more than 100-fold across USPSTF recommendations, and the rank order of benefits varied considerably among patients. For an obese man aged 62 years who smoked and had hypercholesterolemia, hypertension, and a family history of colorectal cancer, the model's top 3 recommendations (from most to least gain in life expectancy) were tobacco cessation (adding 2.8 life-years), weight loss (adding 1.6 life-years), and blood pressure control (adding 0.8 life-year). Lower-ranked recommendations were a healthier diet, aspirin use, cholesterol reduction, colonoscopy, screening for abdominal aortic aneurysm, and HIV testing (each adding 0.1 to 0.3 life-years). For a person with the same characteristics plus uncontrolled type 2 diabetes mellitus, the model's top 3 recommendations were diabetes control, tobacco cessation, and weight loss (each adding 1.4 to 1.8 life-years).
Robust to variation of model inputs and satisfied face validity criteria.
Expected adherence rates and quality of life were not considered.
Models of personalized preventive care may illustrate how magnitude and rank order of benefit associated with preventive guidelines vary across recommendations and patients. These predictions may help clinicians to prioritize USPSTF recommendations at the patient level.
New York University School of Medicine.
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