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Effective Health Care Program

AHRQ EPC Pilot Projects Summary: Improving Health Systems Access' to High Quality Evidence

Series Overview

Background: Agency for Healthcare Research and Quality Evidence-based Practice Center (EPC) systematic reviews are used by clinical professional organizations to support the development of clinical practice guidelines and federal agencies to inform program planning and research priorities. In recent years, the AHRQ EPC program has been increasingly interested in advancing the use of EPC systematic reviews by health systems. To support this, the EPCs conducted pilot projects where they engaged with health systems to develop and evaluate a dissemination product based on an existing EPC report.

Methods: EPCs identified healthcare decisionmakers and worked with them to identify their information needs. Interviews were conducted with patients, health system leaders, decisionmakers, and/or frontline staff to understand how evidence is currently obtained, which information is most relevant, and how evidence can be presented to best facilitate incorporation of the findings into practice. A central evaluation form was developed for EPCs to enter data about their projects as they progressed. The Scientific Resource Center, which provides support to the EPC program, performed content analysis of evaluation forms, pilot project reports, and discussions about recommendations at the in-person EPC meeting to summarize lessons learned across projects.

Results: Nine pilot projects were conducted (Table 1). Projects piloted a variety of methods and tools across a wide range of clinical topics to facilitate the dissemination or implementation of information from evidence syntheses. Methods tested included: informational videos, cyberseminars, decision aids, clinical pathways, and interactive tools to explore the underlying evidence. Preliminary findings from these pilots suggest that developing dissemination products often requires additional expertise beyond that of a typical systematic review team and that examination of other bodies of literature such as cost and patient preferences may be required to meet the needs of health systems. The additional amount of time required to develop these dissemination products ranged from 27 to 2,850 additional hours.

Conclusions: These pilots produced a wide range of products. In general, adaptations were appreciated by the health systems and two or three were implemented in the clinical system during the short project timeline. The majority required additional skills and information. The findings of this study suggest that concise summaries of evidence are well received by health systems, but require proper context and engagement by health system. Tailoring products to a specific health system increases usability in that health system. Further research is needed to understand which formats are most effective.

Table 1. Description of piloted products.

EPC Program 2017-2018 Methods Workgroup

Piloted Dissemination Product

Pilot Report Title

Clinical Topic and EPC Report

Brown, Duke, Minnesota EPC

Thomas A. Trikalinos, MD
Mary Butler, Ph.D., MBA
Gillian Sanders-Schmidler, Ph.D.

Interactive Presentation

Web Interactive Presentation of EPC Reports and Mapping to Quality Measures

Nonsurgical Treatments for Urinary Incontinence in Adult Women: A Systematic Review Update

ECRI Institute – Penn Medicine (ECRI-Penn)

Emilia Flores, Ph.D., RN

EMR Clinical Practice Pathway

Use of a Clinical Pathway to Facilitate the Translation and Utilization of AHRQ EPC Report Findings

Early Diagnosis, Prevention, and Treatment of Clostridium difficile

Johns Hopkins University

Karen A. Robinson, Ph.D.

Key messages, newsletters, evidence to decision framework

Disseminating Findings from EPC Reports: Pilot Project of Three Products

Contrast-Induced Nephropathy: Comparative Effects of Different Contrast Media

Kaiser Permanente Research Affiliates (KPRA), Southern California EPC (SCEPC)

Jennifer S. Lin, M.D., MCR
Lisa Rubenstein, M.D., MS

Clinical Operations Evidence Review (COER) Cyberseminar

Linking Evidence Reviews to Organizational Guideline Planning

Screening for Abnormal Glucose and Type 2 Diabetes Mellitus: A Systematic Review to Update the 2008 U.S. Preventive Services Task Force Recommendation

Mayo Clinic EPC

M. Hassan Murad, M.D., MPH

Clinical and health system encounter decision aid

Anxiety in Children- A Dual Approach to facilitate health systems uptake of evidence synthesis reports

Anxiety in Children

Pacific Northwest EPC

Annette M. Totten, Ph.D.

MAGICapp and Tableau data visualization

Improving Access to and Usability of Systematic Review Data for Health Systems Guidelines Development

Noninvasive, Nonpharmacological Treatment for Chronic Pain

RTI International—University of North Carolina (RTI-UNC) EPC

Daniel E. Jonas, M.D., MPH

EMR tool Implementation package

Development of a Primary Care Guide for Implementing Evidence-based Screening and Counseling for Unhealthy Alcohol Use with Epic-based Electronic Health Record Tools

Screening, Behavioral Counseling, and Referral in Primary Care to Reduce Alcohol Misuse

University of Alberta EPC

Lisa Hartling, Ph.D.

1 & 3 page summaries

Development and Usability Testing of EPC Evidence Review Dissemination Summaries for Health Systems Decisionmakers

Strategies to improve mental health care for children and adolescents

First and second-generation antipsychotics in children and young adults

University of Connecticut EPC

C. Michael White, Pharm.D., FCP, FCCP

Quality Measure Index

Assessing the Impact of Indexing Performance Measure Codes on the Perceived Value of EPC Reports to Health-Systems

Nonsurgical Treatments for Urinary Incontinence in Adult Women: A Systematic Review Update