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AHRQ--Agency for Healthcare Research and Quality: Advancing Excellence in Health Care

How Are Evidence-based Practice Center Systematic Reviews Updated?

Many factors influence the decision to update systematic reviews. In the face of limited resources, organizations must prioritize which reports are assessed for the currency of their content and which reports are updated when appropriate.

The AHRQ Evidence-based Practice Center (EPC) program has instituted a process to select systematic reviews for assessing the currency and updating. The stakeholder impact of each active report is assessed annually and categorized as high, moderate, or low (see diagram). The stakeholder impact is determined by the utility and uptake of the report. This is measured by frequency of download of the report or related products, interest from stakeholder partners, and citation in other scientific literature, including clinical practice guidelines.

For reports with the highest stakeholder impact, the AHRQ EPC program commits resources to regularly updating these reports. These reports do not undergo currency surveillance, as described below.

For reports of moderate stakeholder impact, the AHRQ EPC program conducts currency surveillance. Methods have been previously published.1-4 For currency surveillance, the Scientific Resource Center gathers data on relevant new research relevant for a report topic and assesses whether the report’s conclusions are outdated. The AHRQ EPC program then posts this information on the EHC Program Web site.

Reports in the lowest tier of stakeholder impact are assessed annually for stakeholder impact for three years and may be moved to a higher tier based on this assessment. These reports do not undergo currency surveillance. Reports that remain in the lowest tier for 3 years are archived.

This process will be reviewed and revised on an ongoing basis.

This schematic shows the process for review of EPC reports. The narrative expains this process in detail.


  1. Tsertsvadze A, Maglione M, Chou, R, Garritty C, Coleman C, Lux L, Bass E, Balshem H, Moher D. Updating Comparative Effectiveness Reviews: Current Efforts in AHRQ’s Effective Health Care Program. Methods Guide for Comparative Effectiveness Reviews. (Prepared by the University of Ottawa EPC, RAND Corporation–Southern California EPC, Oregon EPC, University of Connecticut EPC, RTI–University of North Carolina EPC, Johns Hopkins Bloomberg School of Public Health EPC under Contract No. 290-02-0021 EPC2). AHRQ Publication No. 11-EHC057-EF. Rockville, MD: Agency for Healthcare Research and Quality. July 2011. Available at:
  2. Shekelle PG, Newberry SJ, Wu H, Suttorp M, Motala A, Lim Y-W, Balk EM, Chung M, Yu WW, Lee J, Gaylor JM, Moher D, Ansari MT, Skidmore R, Garritty C. Identifying Signals for Updating Systematic Reviews: A Comparison of Two Methods. Rockville (MD): Agency for Healthcare Research and Quality. June 2011. Methods Research Report. AHRQ Publication No. 11-EHC042-EF. Available at:
  3. Newberry SJ, Ahmadzai N, Motala A, Tsertsvadze A, Maglione M, Ansari MT, Hempel S, Tsouros S, Schneider Chafen J, Shanman R, Skidmore B, Moher D, Shekelle PG. Surveillance and Identification of Signals for Updating Systematic Review: Implementation and Early Experience. Methods Research Report (Prepared by the RAND Corporation, Southern California Evidence-based Practice Center under Contract No. 290-2007-10062-I and University of Ottawa Evidence-based Practice Center 290-2007-10059-I). AHRQ Publication No. 13-EHC088-EF. Rockville, MD: Agency for Healthcare Research and Quality; June 2013. Available at:
  4. Shekelle PG, Motala A, Johnsen B. Assessment of a Method To Detect Signals for Updating Systematic Reviews. Research White Paper (Prepared by the Southern California Evidence-based Practice Center under Contract No. 290-2007-10062-I). AHRQ Publication No. 14-EHC015. Rockville, MD: Agency for Healthcare Research and Quality. March 2014. Available at: