Purpose: The United States Preventive Services Task Force (USPSTF) makes recommendations for 60 distinct clinical services, but clinicians rarely have time to fully implement the recommendations. A systematic approach to prioritizing and personalizing guidelines for individual patients may improve outcomes.
Methods: We created a state transition Markov model for each of the 25 USPSTF Grade A and B guidelines for non-pregnant adults. For each guideline, we included factors to personalize the expected benefits and risks at the patient level, based on individual patient characteristics (e.g., smoking status, hypertension, and obesity), medical history, and family history. We personalized national life expectancy curves for a patient’s age, race, and gender, to estimate how much longer an individual would be expected to live from following each preventive care recommendation. We rank-ordered recommendations based on expected number of life-years gained, to help identify the preventive care guidelines with the greatest benefit for each patient.
Results: For a 62 year-old obese (height=68 inches, weight=200 lbs., BMI=30.4) male smoker with high cholesterol (TC=300, LDL=250), hypertension (BP=150/90) and family history of colorectal cancer (≥2 family members), the model's rank order of recommendations would be to quit smoking (3.1 life-years gained), lose weight (16 lbs., +1.6 life-years), lower blood pressure (to 120/80, +0.8 life years), eat a healthier diet (+0.3 life-years), lower cholesterol (to TC=199, LDL=108, +0.3 life-years), use aspirin daily (+0.1 life-years), and undergo colonoscopy (every 10 years, +0.1 life-years). Therefore, quitting smoking would confer about 1.9x the life expectancy gain as losing weight and 3.7x the life expectancy gain as lowering blood pressure. Expected gains from colonoscopy and use of aspirin would be similar, about 0.1x the life expectancy gain as losing weight. For the same individual who also had uncontrolled type II diabetes (HbA1c=8), the model’s top recommendation would be to get diabetes under control (to HbA1c≤7, +1.7 life-years). Quitting smoking would still confer about 1.9x the life expectancy gain as losing weight (+1.6 vs. +0.8 life-years), but now only 1.2x the life expectancy gain as lowering blood pressure (+1.6 vs. +1.3 life-years).
Conclusion: Quantitative models could help generate rank order recommendations of personalized preventive care. Future studies should consider patient adherence to recommendations and determine whether personalized preventive care would improve patient outcomes and save time for providers.