Putting the Evidence into Decision Making

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By Stephanie Chang, MD, MPH, Director; Christine Chang, MD, MPH, Deputy Director; and Amanda Borsky, DrPH, MPP, Dissemination & Implementation Advisor
Agency for Healthcare Research and Quality, Evidence-based Practice Center Program

At the Agency for Healthcare Research and Quality (AHRQ) Evidence-based Practice Center (EPC) Program, we place a high priority on helping health care professionals keep pace with today’s ever-increasing abundance of health information. Our mission is to make sure health care decisions are based on the best available evidence for the best possible health outcome.

As part of that effort, we pay close attention to the impact of our program, a trusted source of information that for 20 years has synthesized research to inform evidence-based health care practice, delivery, policy and research.

It has been gratifying, therefore, to learn that between 2009 and 2016, EPC program reports have been used to inform at least 95 clinical guidelines, 16 health coverage decisions, and 24 government policies and program planning efforts. Below are some recent examples of how EPC reports have made a difference.

Stephanie Chang, MD, MPH, Director

Program planning and promotion of care

Setting research agendas

  • Purpose: Working to address the opioid crisis, the National Institutes of Health (NIH) Pathways to Prevention Program commissioned a review to examine the evidence on effectiveness and harms of opioid therapy for chronic pain, focusing on long-term outcomes.
  • Findings: The EPC report The Effectiveness and Risks of Long-Term Opioid Treatment of Chronic Pain, found no studies comparing long-term opioid treatment to non-opioid treatment for chronic pain. But it found that the use of opioids is associated with increased risk of serious harms, including higher risk of abuse, overdose, and heart attacks.
  • Impact: In response, NIH called for more research to identify when opioid use is appropriate, optimal regimens, and alternative regimens for those who are unlikely to benefit from opioids. The Centers for Disease Control and Prevention (CDC) also used the evidence review to develop a guideline for primary care clinicians on prescribing opioids for chronic pain. More than 20 state Medicaid programs have adopted recommendations from this guideline.

Clinical practice guidelines

  • Purpose: Pressure ulcers commonly occur and are associated with significant health burdens, but they are potentially preventable. Existing evidence was unclear on how best to identify people at higher risk and how to prevent pressure ulcers from occurring or getting worse.
  • Findings: The EPC report, Pressure Ulcer Risk Assessment and Prevention: Comparative Effectiveness, found that more advanced static support surfaces are more effective than standard mattresses for preventing pressure ulcers in higher-risk populations. It also found that risk-assessment instruments can identify patients at higher risk for pressure ulcers, but more research is needed to understand how the use of such instruments impacts pressure ulcer incidence compared with clinical judgment.
  • Impact: The American College of Physicians used the evidence review to develop a clinical practice guideline, Risk Assessment and Prevention of Pressure Ulcers.

AHRQ’s EPC reports are unique resources. They are stakeholder driven, as each report is produced in partnership with an external organization committed to using the review for evidence-based decisions. They are scientifically rigorous, with findings that assess the confidence in the conclusions of a report (for example, strength of the evidence). And they are independent and unbiased, with each report adhering to a strict conflict of interest policy to uphold the integrity and accuracy of its reviews.

AHRQ’s EPC reports are publicly available via AHRQ’s Effective Healthcare Program Website. Please note that EPC Program also considers suggestions as we begin to develop new evidence reviews each year — you can use our web form to suggest a topic.

Federal agencies may also contract with AHRQ to conduct a specific evidence report. For more information about contracting with AHRQ or any other questions, please send an email to EPC@ahrq.hhs.gov.

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