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Primary care clinicians juggling dozens of preventive recommendations may now have a value-based framework for sequencing them, according to a poster presented at the Society of General Internal Medicine (SGIM) 2026 Annual Meeting in Washington, DC, and reported by Medscape. Investigators at the University of Chicago evaluated 42 recommendations from the US Preventive Services Task Force (USPSTF) and the Advisory Committee on Immunization Practices, ranking each by quality-adjusted life years (QALYs) gained and by quality years per hour of physician time.
The top six interventions by patient quality years gained were preexposure prophylaxis for patients with high-risk sexual activity (0.41 QALYs) and for those with intravenous drug use (0.13). Medications to reduce the risk for breast cancer ranked next (0.21), followed by statins for primary cardiovascular prevention in adults aged 40 to 75 years at high risk (0.12), alcohol screening with brief behavioral counseling for hazardous drinking (0.11), and weight-loss counseling with referral to a dietician for adults with obesity (0.07).
When physician time was factored in, the top four remained unchanged, while hepatitis B screening for high-risk patients (1.19 quality years per physician hour) and hypertension screening (0.74) rose substantially. Respiratory syncytial virus, influenza, and tetanus-diphtheria-acellular pertussis (TDAP) vaccinations ranked lowest in QALYs per intervention. Breast cancer screening, folic acid supplementation, and TDAP ranked lowest after physician time was included.
The rankings drew on roughly 55 published time- and cost-effectiveness analyses that estimated QALYs for each service. Lead investigator Justin Porter, MD, said that without prioritization, much-needed services are often delayed or omitted entirely. Porter offered the example of a 65-year-old woman with obesity who would qualify for statins as primary prevention; if she declined, clinicians could move down the list to behavioral weight-loss support and then colorectal cancer screening, which ranked ninth for QALYs gained. Jeffrey A. Linder, MD, MPH, of Northwestern University Feinberg School of Medicine, who was not involved in the research, said the framework offers a counterweight to undifferentiated electronic health record alerts and may prompt frontline care teams to focus on higher-yield interventions. The authors reported no disclosures or funding sources.
