Introduction
The pace of innovation in health care has
never been greater, and this innovation is constantly adding to a broad and
complex array of health care interventions and systems. Accompanying this
growth in the capacity of health care is an expanding body of evidence
regarding safety, effectiveness, appropriate indications, cost-effectiveness,
and other attributes of these interventions and systems. However, achieving
these opportunities to improve health care depends on the ability of
clinicians, patients, and policymakers to interpret and apply this body of
evidence. As documented in a 2003 study of health care quality by RAND, Americans receive, on average, only about half of recommended health care.1
Failure to understand which services work
best, under what circumstances, and for which types of patients contributes to
the increasing cost of care, threats to patient safety, and avoidable loss of
life. Landmark reports of The Institute of Medicine, including To Err is Human2 and Crossing the
Quality Chasm,3 have drawn national attention to shortcomings in quality and patient safety. A
substantial hurdle to improving quality of care remains the effective translation
of research findings into sustainable improvements in patient outcomes. The
Agency for Healthcare Research and Quality (AHRQ) works to bridge this gap, not
only by contributing to the health care knowledge base itself, but also by
identifying priority areas for assembling, interpreting and translating to users
findings from this knowledge base.
In the United States and around the world, AHRQ is recognized as a source of well-founded,
reliable assessments of scientific evidence in health care. Under its Effective
Health Care Program, AHRQ works to improve the quality and effectiveness of
health care by facilitating the translation of evidence-based research findings
into clinical practice and policy. This program of user-driven research is
designed to put information in the hands of the
decisionmakers.
The 14 Evidence-based Practice Centers (EPCs)
under contract to AHRQ produce scientific syntheses—evidence reports,
technology assessments, technical briefs, and comparative effectiveness reviews—that give public and private organizations foundations for developing and
implementing their own practice guidelines, performance measures, educational
programs and other strategies to improve the quality of health care and
decisionmaking. These evidence reports, technology assessments, technical
briefs, and comparative effectiveness reviews also may be used to inform
coverage and reimbursement policies.
By conducting systematic reviews of the available evidence
on a topic, the EPCs serve as resources for partner and stakeholder organizations
that will use the report. The growing number of partners/stakeholders
to the EPC program includes private sector organizations and government
agencies. Non-governmental partners include health professional organizations,
voluntary health (e.g., disease-oriented) organizations, health payers, and
others. Evidence reports prepared by EPCs have been used in the development of
clinical practice guidelines by organizations such as the American Psychiatric
Association, American Academy of Pediatrics (AAP), and the American Heart
Association. The AAP, for example, developed a practice guideline based on an
EPC report on diagnosis of attention-deficit/hyperactivity disorder.
Partners in government to date include the
Centers for Medicare & Medicaid Services (CMS) and the Social Security
Administration. Within the National Institutes of Health (NIH), the Office of
Medical Applications of Research uses EPC reports to support its consensus
development program, the Office of Dietary Supplements uses evidence reports to
assist its research agenda setting, and reports have also been requested by
others including the National Cancer Institute, the National Center for
Complementary and Alternative Medicine, and the Office of Research on Women's
Health. CMS uses technology assessments prepared by the EPCs to inform
decisions about Medicare coverage of new and existing health technologies.
The EPC program can assist the increasing
number of health care organizations who are promoting evidence-based medicine
with systematic reviews on high-priority topics. The EPC program welcomes the
opportunity to expand relationships with partners to support their efforts to
develop clinical practice guidelines, technology assessments, and other
evidence-based products.
This guide
provides detailed information on the EPC program for current and potential
partner organizations. It presents background on the program and the roles and
responsibilities of its key participants, including AHRQ, the partners, and the
EPCs. Also covered are the topic nomination process and specification of
evidence questions, topic selection criteria, strategies and expectations for
report dissemination and resources on evidence-based health care.
1. McGlynn BA, et al. The quality of health care delivered to adults in the United States. N Engl J Med 2003;348:2635-45.
2. Institute of Medicine, Committee on Quality of Health Care in America. To Err Is Human: Building a Safer Health System. Washington, DC: National Academy Press, 2000.
3. Institute of Medicine, Committee on Quality of Health Care in America. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academy Press, 2001.
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