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EPC Pilot Project: A Dual Approach To Facilitate Health Systems Uptake of Evidence Synthesis Reports. Anxiety in Children

Research Report
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This report is from AHRQ's series on Health Systems Partnership Pilot Project Reports. These reports describe the efforts of Evidence-based Practice Centers (EPCs) to work with health care decisionmakers and facilitate the use of information from AHRQ EPC evidence reports.

Key Messages

  • Findings: A health system decision aid and an encounter decision aid were shown to be feasible and effective tools that can provide health systems with contextual and implementation information on the treatment of anxiety in children.
  • Lessons learned for EPC Program: Comparative effectiveness evidence syntheses often do not have sufficient information that allows decision-making and implementation of evidence. This includes information on costs, resources, patients' values, acceptability and feasibility of interventions. Additional synthesis of study characteristics and intervention components is often needed.
  • Utility for health systems: A dual approach that caters to the needs of both health system decision-makers and the clinician-patient dyad may facilitate uptake of evidence synthesis reports by health systems.

Structured Abstract

Objective. To develop tools that can facilitate uptake of evidence synthesis reports by health systems.

Data Source. We used a published evidence report on anxiety in children. We conducted a non-systematic review of Pubmed, searched the Internet and interviewed experts and other stakeholders for literature on factors essential for treatment decision-making.

Methods. We followed a dual approach in which we developed two tools, one for the health system (based on the Evidence to Decision Framework) and the second for the clinical encounter (a shared decision-making tool). The tools provided contextual and implementation information for stakeholders.

Results. A health system decision aid (DA) was produced as a hard copy and provided information on which patients are candidate for treatment, values and preferences, costs and resources, acceptability, impact on health equity, feasibility, drug dosing, psychotherapies other than cognitive behavioral therapy, remission rates and prognosis of anxiety in children. Health system stakeholders found the DA useful and generalizable to other conditions. The encounter DA was produced as cards containing information on issues that drive treatment decisions (effect on symptoms, effect on function, treatment burden, side effects and cost). Patients and parents prioritized the cards and chose the order in which these issues were discussed with clinician. The encounter DA was found to be helpful by patients, parents and clinicians.

Conclusion. A dual approach addressing health system stakeholders as well as clinicians and patients can provide practical information beyond what is traditionally contained in evidence synthesis reports. This approach is likely feasible and may facilitate uptake of evidence reports by health systems.

Citation

Suggested citation: Morrow A.S., Whiteside, S.P., Sim, L., Brito, J.P., Wang, Z., Murad, M.H., EPC Pilot Project: A Dual Approach to Facilitate Health Systems Uptake of Evidence Synthesis Reports. Anxiety in Children. Methods Research Report. (Prepared by the Mayo Clinic Evidence-based Practice Center under Contract No. 290-2015-00013-I.) AHRQ Publication No.No. 18(19)-EHC021-EF. Rockville, MD: Agency for Healthcare Research and Quality. October 2018. Posted final reports are located on the Effective Health Care Program search page. DOI: https://doi.org/10.23970/AHRQEPCMETHENGAGEANXIETY