Chapter 1: The Program

AHRQ

AHRQ is the health services research arm of the U.S. Department of Health and Human Services (HHS).  AHRQ's mission is to improve the quality, safety, efficiency, and effectiveness of health care for all Americans. AHRQ sponsors and conducts research that provides evidence-based information on health care outcomes, quality, cost, and access for use by health care decisionmakers, including patients, clinicians, health system leaders, policymakers, and others.

AHRQ's activities are driven by the needs of health care decisionmakers. Through the Evidence-based Practice Center (EPC) program, AHRQ applies the analytical capabilities of the EPCs to high-priority topics nominated by its partner organizations. Partners benefit from receiving high-quality systematic reviews from a recognized and credible source. They use EPC report findings to inform or develop evidence-based products and services, including clinical practice guidelines, performance/quality measures, educational materials, and knowledge transfer strategies. This relationship allows AHRQ and partner organizations, through focused use of complementary resources, to pursue measurable improvements in health care.

AHRQ expects that partners whose topics are selected for EPC reports will translate the report findings into evidence-based products for their members or other target audiences. Furthermore, they are expected to track the use, outcomes, or other impacts of these products. This information supports the accountability of AHRQ and partner efforts and provides feedback for ongoing program improvement.

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The Evidence-based Practice Centers Program

AHRQ launched the EPC program in 1997 as an initiative to promote evidence-based practice in everyday care.  The EPC program is a user-driven research partnership with private- and public-sector organizations to facilitate the translation and dissemination of research findings to the memberships and other target audiences of the partner organizations. These organizations  include Federal and State agencies, private sector professional societies, health delivery systems, providers, payers, and others committed to evidence-based health care.  Topics of interest identified by these partners may address clinical, social science/behavioral, economic, and other health care organization and delivery issues.  The topics generally relate to widespread, expensive, and otherwise significant diseases or health problems for Medicare or Medicaid beneficiaries or other special populations.

Since the start of the program in 1997, the EPCs have conducted more than 170 systematic reviews and analyses of the scientific literature on a wide spectrum of topics.  The major products of the program are evidence reports, including comprehensive and more focused systematic reviews, technology assessments, technical briefs, and comparative effectiveness reviews.  These are based on rigorous syntheses and analyses of scientific literature and may include meta-analyses or cost analyses.  The reports emphasize explicit and detailed documentation of methods, rationale, and assumptions.  EPCs draw upon the expertise and experience of other diverse and representative health care and research organizations to gain the insight needed for well-founded, credible, and practical evidence products.  The reports do not make clinical recommendations or recommendations related to coverage and reimbursement policies.

In 2007, AHRQ announced the award of a third round of five-year contracts to the following 14 EPCs:

• Blue Cross and Blue Shield Association Technical Evaluation Center (TEC); Chicago, IL
• Duke University; Durham, NC
• ECRI; Plymouth Meeting, PA
• Johns Hopkins University; Baltimore, MD
• McMaster University; Hamilton, Ontario, Canada
• Oregon Health & Science University; Portland, OR
• RTI International-University of North Carolina; Chapel Hill, NC
• Southern California Evidence-based Practice Center—RAND; Santa Monica , CA
• Tufts-New England Medical Center; Boston, MA
• University of Alberta; Edmonton, Alberta, Canada
• University of Connecticut, Hartford, CT
• University of Minnesota; Minneapolis, MN
• University of Ottawa; Ottawa, Canada
• Vanderbilt University; Nashville, TN

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What Is a Systematic Review and How Are Reviews from the EPC Program Used?

Systematic reviews are conducted to determine whether an intervention for a specific disease or health problem works.  The topics of systematic reviews typically are framed by a set of evidence questions.  Reviewers must locate, synthesize, and evaluate evidence from available scientific studies that meet predetermined inclusion criteria.  Systematic reviews differ from traditional review papers because they adhere to established, transparent, methodologies designed to minimize bias, account for variations in study design, allow consideration of data from multiple studies, and maintain objective analysis and interpretation of available evidence.  In answering well-refined evidence questions in a rigorous scientific manner, systematic reviews can be valuable sources of information for diverse groups of healthcare stakeholders.

Systematic reviews are useful in multiple scenarios, including, but not limited to, instances in which:

• Conflicting evidence exists.
• Data from only a few studies are available.
• Comparison of different interventions is necessary.
• Assessment of the net balance of benefits and harms is warranted.
• Review of the existing evidence base is essential to informing a research agenda or health policy or coverage decision.

EPC evidence reports can help answer questions regarding clinical and behavioral health interventions or organizational, financial and economic mechanisms that are poised to significantly influence the quality, effectiveness, and/or cost of health care.  EPC reports typically are not conducted where evidence on particular interventions is clearly established in practice.

Systematic reviews are only as complete and useful as the evidence that exists on a particular topic or the scope and nature of the evidence questions that guide the review.  To the extent that the body of evidence relevant to a particular topic is limited, the topic may not be appropriate for an effectiveness review, a comparative effectiveness review, or a technology assessment.   In some cases the topic may be appropriate for a Technical Brief.  A Technical Brief is an overview of key issues related to an intervention or issue. It provides an early and objective depiction of the state of science and a summary of ongoing research and information on future research needs.

The determination of the type of review to be performed is made at the topic refinement stage of the EPC review.  It is important to remember that a systematic review that identifies only limited relevant evidence pertaining to a topic can be useful in setting research agendas to extend or fill gaps in the relevant body of evidence.

Users of AHRQ Evidence reports include clinicians, health professional associations, health system managers, researchers, consumer organizations, policymakers, and other health stakeholders. Public and private sector organizations use EPC reports as a basis for developing a broad range of products, services and tools, including clinical guidelines, performance measures, quality or operational improvement tools and strategies, and educational or knowledge transfer vehicles. These reports often are used in formulating coverage policies of managed care organizations, insurers, and other payers.

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