The Effective Health Care Program Stakeholder Guide
Chapter 2: Effective Health Care Program Activities
Core activities contribute to the conduct of comparative effectiveness research/patient-centered outcomes research through the EHC Program and to the continuing development of an infrastructure to sustain and advance these efforts. To ensure the relevance of the research to those making health care decisions, stakeholders are kept involved in all core activities at every stage of the research process. These core EHC activities are described below.
AHRQ’s Healthcare Horizon Scanning System began with funding under the American Recovery and Reinvestment Act of 2009. Its purpose is to conduct horizon scanning of emerging health care technologies and innovations in order to better inform AHRQ’s investments in comparative effectiveness research/patient-center outcomes research through the EHC Program. The Healthcare Horizon Scanning System provides AHRQ a systematic process to identify and monitor target technologies and innovations in health care and to create an inventory of target technologies that have the highest potential for impact on clinical care, the health care system, patient outcomes, and costs. It is a tool for the public to identify and find information on new health care technologies and interventions. Any investigator or funder of research can use the AHRQ Healthcare Horizon Scanning System to select potential research topics.
The health care technologies and innovations of interest for horizon scanning are those that have yet to diffuse into or become part of established health care practice. These health care interventions are still in the early stages of development or adoption, except in the case of new applications of already-diffused technologies. Consistent with the definitions of health care interventions provided by the Institute of Medicine and the Federal Coordinating Council for Comparative Effectiveness Research, AHRQ is interested in innovations in drugs and biologicals, medical devices, screening and diagnostic tests, procedures, services and programs, and care delivery.
Identification of evidence needs is a central recurring activity that drives research and dissemination throughout the EHC Program. In order to gain the widest perspective into what questions need to be answered, all stakeholders—including consumers, clinicians, policymakers, and other decisionmakers—are encouraged to identify and suggest topics for research. Research suggestions from all sources and all topic nominations are posted on the EHC Web site at www.effectivehealthcare.ahrq.gov. The EHC Program reviews these suggestions based on a series of questions:
- How widespread and serious is the disease or problem proposed for study?
- How much controversy exists about treatment?
- What are the potential impacts for improving care and/or reducing costs?
- Would research results be relevant to Federal health care programs such as Medicare, Medicaid, or the Children’s Health Insurance Program (CHIP)?
- Would research results be relevant or helpful for vulnerable and underserved populations: low-income groups; racial/ethnic minorities; women; children; the elderly; individuals with special health care needs, such as those with disabilities; those who need chronic care or end-of-life care; or those who live in inner-city or rural areas?
In addition, evidence synthesis (described below) also identifies future research needs as part of the research process. In the case of systematic reviews, this includes a formal engagement with stakeholders to prioritize gaps identified during the review of research.
Evidence synthesis is a rigorous systematic research process that adheres to explicit scientific methods to analyze and summarize the existing scientific evidence on a specific topic. These methods are designed to reduce bias and allow research investigators to incorporate large amounts of information from different sources, while focusing on objective analysis and interpretation. The EHC Program produces two types of evidence synthesis reports—systematic reviews and Technical Briefs—depending on the nature and amount of evidence available for synthesis.
Systematic reviews. Systematic reviews are summaries of available scientific evidence that compare the benefits and harms of treatment options. They are designed to provide decisionmakers with accurate, independent, scientifically rigorous information for comparing the effectiveness and safety of various health care options. Systematic reviews have become a foundation for decisionmaking in clinical practice and health policy because they provide more reliable and less biased answers than individual studies. The EHC Program updates systematic reviews if new information becomes available and the topic is still of high clinical importance.
Technical Briefs. A Technical Brief explains what is known—and what is not known—about new or emerging health care tests or treatments. Technical Briefs provide an overview of issues related to emerging technologies or clinical interventions. They generally focus on interventions for which there is limited published information or too few studies to support definitive conclusions. Technical Briefs provide objective descriptions of the state of the science, potential frameworks for assessing the applications, implications of the interventions, summaries of ongoing research, and identification of future information needs.
All reports are produced by the EPCs. For more information on the EPCs, go to www.effectivehealthcare.ahrq.gov/index.cfm/who-is-involved-in-the-effective-health-care-program1/about-evidence-based-practice-centers-epcs.
All reports are available on the EHC Web site, www.effectivehealthcare.ahrq.gov. Many reports are available in Spanish and audio formats. Free printed copies are available by calling 1–800–358–9295.
AHRQ has a strong and long-term commitment to bridging the gap between research and practice by translating and disseminating findings on the comparative effectiveness of interventions for different audiences, including consumers, clinicians, and policymakers.
Summary guides translate complex scientific information into short plain-language publications for use by decisionmakers. The information in the summary guides can be used to assess options and help make informed decisions. Summary guides are developed for three targeted groups of decisionmakers—consumers, clinicians, and policymakers. They are designed to assist in evaluating the benefits and risks of health care interventions and services. Summary guides are available in both written and audio formats, and many are available in Spanish. The summary guides present information about—
- Strengths and limits of evidence.
- Which interventions are supported by strong evidence and which options are less certain.
- Tradeoffs between various decisions.
- How to sort through the options.
- Basic wholesale price information on medications (if relevant).
The John M. Eisenberg Clinical Decisions and Communications Science Center translates scientific reports into different summary guides, each tailored for practical use by consumers, clinicians, or policymakers. New types of summary guides are developed as the need is identified. The Eisenberg Center is developing Continuing Medical Education (CME) and Continuing Education (CE) lessons and examinations, slide sets for use by medical faculty, and electronic decision aids for clinicians and patients/consumers. Podcasts are developed to facilitate Web dissemination of EHC information. AHRQ also supports investigator-initiated efforts to translate and disseminate EHC products. All completed reports and summary guides, as well as many reports in progress, are available on the EHC Web site at www.effectivehealthcare.ahrq.gov.
AHRQ builds the capacity for comparative effectiveness research/patient-centered outcomes research by providing support to institutions to boost their intellectual and organizational capacity for larger scale programs, and by providing for fellowship training opportunities. AHRQ funding supports the career development of clinicians and researchers on the doctoral level, who focus their research on the synthesis, generation, and translation of new scientific evidence, and on the development of analytic tools for comparative effectiveness research/patient-centered outcomes research. The goal of this training and development activity is to increase the Nation’s research and methodological capacity for conducting and improving the quality of systematic reviews, retrospective studies, and clinical trials in comparative effectiveness research/patient-centered outcomes research, and to develop data sources and other aspects of the research infrastructure.
The EHC Program offers many opportunities for stakeholders to get involved at all stages in the research process. Stakeholder involvement, covered in Chapter 3, helps ensure that the program responds to the issues that are most pressing for health care decisionmakers in ways that are accessible and useful.
In addition, the AHRQ Community Forum, funded initially under the American Recovery and Reinvestment Act, develops tools and resources to support EHC stakeholder activities and methods to involve stakeholders and the public more broadly. These resources, available on the EHC Web site, address innovative methods for engaging stakeholders in research, supporting the involvement of patients and consumers, and using deliberative methods to obtain informed public input on complex topics (www.effectivehealthcare.ahrq.gov/tools-and-resources/how-to-get-involved-in-the-effective-health-care-program).