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Evidence-based Practice Centers

Synthesizing scientific evidence to improve
quality and effectiveness in health care

Under the Evidence-based Practice Program of the Agency for Healthcare Research and Quality (formerly the Agency for Health Care Policy and Research—AHCPR), 5-year contracts are awarded to institutions in the United States and Canada to serve as Evidence-based Practice Centers (EPCs). The EPCs review all relevant scientific literature on clinical, behavioral, and organization and financing topics to produce evidence reports and technology assessments. The EPCs also conduct research on methodologies and the effectiveness of their implementation, and provide technical assistance in translating the reports and assessments into quality improvement tools and in helping to inform coverage policies.

Overview / Report Development / Centers and Topics / Potential Users /
Topic Nomination Procedure / Available Evidence Reports / Additional Information


In 1997 the Agency for Health Care Policy and Research (AHCPR), now known as the Agency for Healthcare Research and Quality (AHRQ), launched its initiative to promote evidence-based practice in everyday care through establishment of 12 Evidence-based Practice Centers (EPCs). The EPCs develop evidence reports and technology assessments on topics relevant to clinical, social science/behavioral, economic, and other health care organization and delivery issues—specifically those that are common, expensive, and/or significant for the Medicare and Medicaid populations. With this program, AHRQ became a "science partner" with private and public organizations in their efforts to improve the quality, effectiveness, and appropriateness of clinical care by facilitating the translation of evidence-based research findings into clinical practice.

In June 2002, AHRQ announced the award of new 5-year contracts for EPC-II to 13 Evidence-based Practice Centers to continue and expand the work performed by the original group of EPCs. Most of the second group of EPCs were part of the initial set. However, EPC-II brings in three new institutions to the program—the Universities of Alberta, Minnesota, and Ottawa—while MetaWorks and the University of Texas-San Antonio have concluded their respective contracts as two of the original EPCs.

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Report Development

The EPCs develop evidence reports and technology assessments based on rigorous, comprehensive syntheses and analyses of the scientific literature on topics relevant to clinical, social science/behavioral, economic, and other health care organization and delivery issues. EPC reports and assessments emphasize explicit and detailed documentation of methods, rationale, and assumptions. These scientific syntheses may include meta-analyses and cost analyses. All EPCs collaborate with other medical and research organizations so that a broad range of experts is included in the development process. (For details, go to Centers and Topics.)

The resulting evidence reports and technology assessments are used by Federal and State agencies, private sector professional societies, health delivery systems, providers, payers, and others committed to evidence-based health care.

In addition, the EPCs will:

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Centers and Topics

Following are the Evidence-based Practice Centers from both the initial award and EPC II award with a list of their assigned topics by title and year assigned. MetaWorks and University of Texas are no longer EPCs, but their listings are retained for historical and information purposes. You may review a profile for each active Center, if available, by selecting the name of the Center.

Blue Cross and Blue Shield Association, Technology Evaluation Center (TEC), Chicago, IL
Wound healing: laser treatment and vacuum assisted closure—2003
Islet cell transplantation for diabetes—2002
Role of endoscopic retrograde cholangiopancreatopography (ERCP) in clinical practice—2001
Management of chronic asthma—1999
Use of erythropoietin in hematology and oncology—1998
Testosterone suppression treatment for prostatic cancer—1997

Duke University, Durham, NC
Multiple sclerosis, criteria to determine disability—2003
Effect of seasonal allergies on working populations—2001
Management of post-term pregnancy—2000
Treatment of pulmonary disease following spinal cord injury—1999
Treatment of fibroids—1999
Management of acute chronic obstructive pulmonary disease—1998
Evaluation of cervical cytology—1997

ECRI, Plymouth Meeting, PA
Treatment-resistant epilepsy—2001
Repetitive motion disorders, diagnosis, and treatment—2000
Treatment of degenerative lumbar spinal stenosis—1999
Criteria for determining disability in patients with end-stage renal disease (ESRD)—1998
Diagnosis and treatment of dysphagia/swallowing problems in the elderly—1997

Johns Hopkins University, Baltimore, MD
Depression and post-myocardial infarction—2003
Recruitment of medically underserved populations to clinical trials, knowledge and access to information—2003
Strategies for improving minority healthcare quality—2002
Training for rare public health events—Update of prior report related to bioterrorism—2002
Management of hepatitis C—2001
Management of venous thrombosis—2001
Use of glycohemoglobin and microalbuminuria in diagnosis and monitoring of diabetes mellitus—2001
Bioterrorism:Training for rare public health event—2000
Blood pressure monitoring, outside of clinic setting—2000
Treatment of coexisting cataract and glaucoma—1999
Treatment of acne—1998
Anesthesia management during cataract surgery—1998
Evaluation and treatment of new onset of atrial fibrillation in the elderly—1997

McMaster University, Hamilton, Ontario, Canada
Impaired glucose tolerance—2003
Dementia treatment—2002
Diffusion and dissemination of evidence-based cancer control interventions—2001
Impact of cancer-related decision aids—2000
Management of neurogenic/neuropathic pain following spinal cord injury—1999
Criteria for weaning from mechanical ventilation—1998
Treatment of attention deficit/hyperactivity disorder—1997

MetaWorks, Inc., Boston, MA (1997-2001)
Medical and scientific research related to disability from chronic fatigue syndrome—2001
Diagnosis and management of Parkinson's disease—2000
Criteria for the referral of patients with epilepsy—1999
Management of breast disease—1999
Diagnosis of sleep apnea—1997

Oregeon Evidence-based Practice Center, Portland, ORa
Food-related health claims—2003
Technical support for U.S. Preventive Services Task Force—2003
Hyperbaric oxygen therapy: treatment for brain injury and stroke—2001
Preventing adolescent criminal and other health-risking social behavior—2001
Vaginal birth following Cesarean—2001
Effect of healthcare working conditions on patient safety—2001
Echocardiography and carotid ultrasound in evaluation and management of stroke—2000
Diagnosis and management of osteoporosis—1999
Medical informatics and telemedicine coverage under the Medicare program—1999
Rehabilitation of persons with traumatic brain injury—1997

RTI International-University of North Carolina at Chapel Hill, NC*a, c
Perinatal depression—2003
Community-based participatory research—2002
Distance learning program (Phase I)—2002
Health literacy: impact on health outcomes—2002
Management of bronchiolitis—2001
Methods to rate strength of scientific evidence—2000
Criteria to determine disability for speech/language disorders—2000
Efficacy of behavioral dietary interventions to reduce cancer risk—1999
Management of pre-term labor—1998
Pharmacotherapy for alcohol dependence—1997

Southern California Evidence-based Practice Center—RAND, Santa Monica, CAb
End of Life care—2004
Health information technology—2003
Omega-3 fatty acids: cancer and neurology—2003
Preventing violence and related health-risking behaviors in adolescents—2003
Omega-3 fatty acids: autoimmune diseases and gastrointestinal/renal diseases—2002
Obesity, pharmacological management—2002
Clinical efficacy and side effects of ephedra—2001
Ayurvedic treatments for diabetes mellitus—2000
Diagnosis and treatment of congestive heart failure—2000
Utilization of physician services—2000
Otitis media with effusion—1999
Mind-body interventions for gastrointestinal conditions—1999
Management of acute otitis media—1998
Prevention of venous thromboembolism after injury—1998
Prevention and management of urinary complications in paralyzed persons—1997

Stanford University, Stanford, and University of California, San Francisco, CA
Best strategies for quality improvement—2003
Effective payment strategies to support quality-based purchasing—2003
Effective payment strategies to support quality-based purchasing (Phase I Feasibility Study)—2002
Regional models for bioterrorism preparedness—2002
Management of coronary heart disease in women—2001
Making health care safer: a critical analysis of patient safety practices—2001
Autopsy as outcome and performance measure—2000
Bioterrorism: decision support systems in disease management—2000
Refinement of HCUP Quality Indicators—1999
Management of unstable angina—1998
Management of stable angina—1997

Tufts-New England Medical Center (formerly New England Medical Center), Boston, MA
Effectiveness of soy—2004
Omega-3 fatty acids: transplantation and immune-mediated diseases—2003
Food-related health claims—2003
Technical support for AHRQ Technology Assessment Program—2003
Omega-3 fatty acids: cardiovascular disease—2002
Management of cancer symptoms—2002
Management of clinically inapparent adrenal mass—2001
Quality of life: management of cancer-associated pain and related symptoms—2001
Neonatal hyperbilirubinemia—2001
Management of allergic rhinitis—2000
Criteria to determine disability for infant/childhood impairments—2000
Evaluation of technologies for identifying acute cardiac ischemia in the emergency department—1999
Management of cancer pain—1998
Diagnosis and treatment of acute bacterial sinusitis—1997

University of Alberta, Edmonton, Alberta, Canada
Melatonin for sleep disorders—2003
Occupational asthma, burden of illness/economic consequences—2003
Biventricular pacing for congestive heart failure—2002

University of Minnesota, Minneapolis, MN
Spirometry/chronic obstructive pulmonary disease—2003
Total knee replacement—2002
Efficacy of behavioral interventions to modify physical activity—2002
Economic incentives: impact on use/outcomes of preventive health services—2002

University of Ottawa, Ottawa, Canada
Omega-3 fatty acids: maternal/child health, mental health, and eye health—2003
Acute stroke, evaluation and treatment—2003
Celiac disease—2003
Sexuality and reproductive health following spinal cord injury—2003
Omega-3 fatty acids: asthma—2002
Quality measures: diagnosis and treatment of breast cancer in women—2002
Sexuality and reproductive health following spinal cord injury (Phase I Feasibility Study)—2002

University of Texas Health Science Center, San Antonio, TX (1997-2001)
Defining and managing chronic fatigue syndrome—2000
Medical harms workshop—2000
Use of garlic for cardiovascular disease—1999
Use of silybum marianum in treatment of liver disease and cirrhosis—1999
Management of chronic hypertension during pregnancy—1998
Depression treatment with new drugs—1997

aTechnical support for U.S. Preventive Services Task Force.
bTechnical support for National Center for Complementary and Alternative Medicine.
cTechnical support for National Institute of Dental and Craniofacial Research.

*RTI International is a tradename of Research Triangle Institute.

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Potential Users

Evidence reports and technology assessments provide a foundation that public and private entities may use to develop and implement their own practice guidelines, performance measures, review criteria, and other health care quality improvement tools. In addition, they may give health plans and payers information needed to make informed decisions about coverage policies for new and changing medical devices and procedures.

Potential users of these evidence reports and technology assessments include clinicians, medical and professional associations, health system managers, researchers, group purchasers, program managers, consumer organizations, and policymakers.

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Topic Nomination Procedure

Topics for evidence reports and technology assessments focus on specific aspects of prevention, diagnosis, treatment, and/or management of a particular condition, or on an individual procedure, treatment, or technology.

Nominations of topics for EPC evidence reports and technology assessments are solicited routinely through notices in the Federal Register. Topic nominations also are accepted on an ongoing basis.

Specific information that should accompany nominations includes the potential questions to be answered by the report or assessment, availability of scientific data, disease prevalence and/or severity, practice variation patterns, and descriptions of plans for using the evidence report or technology assessment to improve quality of care.

Selection criteria for topics include the following:

Select to access the Nominations of Topics for Evidence-based Practice Centers.

Professional associations, health plans, providers, and others that nominate topics may act as partners with EPCs, providing technical expertise and serving as part of a larger group of peer reviewers of the final product. Partners are expected to translate the findings from the evidence reports and technology assessments into practice guidelines or other implementation tools to improve quality of care within their respective organizations. AHRQ expects that future evidence reports and technology assessments will be developed in the following broad topic areas: child and adolescent health, maternal health, geriatrics, dental health, mental health and substance abuse, rehabilitation, preventive care, and health care organization and financing systems.

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Available Evidence Reports

The following list provides complete titles of released reports in numerical order. For a quick menu of evidence report topics or a disease category listing, go to EPC Evidence Reports at: /clinic/epcindex.htm.

Evidence Reports

1. Systematic Review of the Literature Regarding the Diagnosis of Sleep Apnea
2. Rehabilitation for Traumatic Brain Injury
Rehabilitation for Traumatic Brain Injury in Children and Adolescents (Supplement)
3. Pharmacotherapy for Alcohol Dependence
4. Relative Effectiveness and Cost-Effectiveness of Methods of Androgen Suppression in the Treatment of Advanced Prostatic Cancer
5. Evaluation of Cervical Cytology
6. Prevention and Management of Urinary Tract Infections in Paralyzed Persons
7. Treatment of Depression—Newer Pharmacotherapies
8. Diagnosis and Treatment of Swallowing Disorders (Dysphagia) in Acute-Care Stroke Patients
9. Diagnosis and Treatment of Acute Bacterial Rhinosinusitis
Diagnosis and Treatment of Uncomplicated Acute Sinusitis in Children (Supplement)
10. An Evaluation of Beta-Blockers, Calcium Antagonists, Nitrates, and Alternative Therapies for Stable Angina
11. Treatment of Attention-Deficit/Hyperactivity Disorder
12. Management of New Onset Atrial Fibrillation
13. Determinants of Disability in Patients with Chronic Renal Failure
14. Management of Chronic Hypertension During Pregnancy
15. Management of Acute Otitis Media
16. Anesthesia Management During Cataract Surgery
17. Management of Acne
18. Management of Preterm Labor
19. Management of Acute Exacerbations of Chronic Obstructive Pulmonary Disease
20. Garlic: Effects on Cardiovascular Risks and Disease, Protective Effects Against Cancer, and Clinical Adverse Effects
21. Milk Thistle: Effects on Liver Disease and Cirrhosis and Clinical Adverse Effects
22. Prevention of Venous Thromboembolism After Injury
23. Criteria for Weaning From Mechanical Ventilation
24. Telemedicine for the Medicare Population
Telemedicine for the Medicare Population: Pediatric, Obstetric, and Clinician-Indirect Home Interventions (Supplement)
25. Efficacy of Interventions to Modify Dietary Behavior Related to Cancer Risk
26. Evaluation of Technologies for Identification of Acute Cardiac Ischemia in the Emergency Department
27. Treatment of Pulmonary Disease Following Cervical Spinal Cord Injury
28. Osteoporosis in Postmenopausal Women: Diagnosis and Monitoring
29. Use of Epoetin for Anemia in Chronic Renal Failure
30. Uses of Epoetin for Anemia in Oncology
31. Prediction of Risk for Patients with Unstable Angina
32. Treatment of Degenerative Lumbar Spinal Stenosis
33. Diagnosis and Management of Specific Breast Abnormalities
34. Management of Uterine Fibroids
35. Management of Cancer Pain
36. Diagnosis and Management of Dental Caries
37. Management of Dental Patients Who Are HIV Positive
38. Surgical Treatment of Coexisting Cataract and Glaucoma
39. Management of Newly Diagnosed Patients with Epilepsy: A Systematic Review of the Literature
40. Mind-Body Interventions for Gastrointestinal Conditions
41. Ayurvedic Interventions for Diabetes Mellitus: A Systematic Review
42. Defining and Managing Chronic Fatigue Syndrome
43. Making Health Care Safer: A Critical Analysis of Patient Safety Practices
44. Management of Chronic Asthma
45. Management of Chronic Neuropathic Pain Following Traumatic Spinal Cord Injury
46. Impact of Cancer-Related Decision Aids
47. Systems to Rate the Strength of Scientific Evidence
48. Cardiovascular Effects of Epinephrine in Hypertensive Dental Patients
49. Effectiveness and Cost-Effectiveness of Echocardiography and Carotid Imaging in the Management of Stroke
50. Endoscopic Retrograde Cholangiopancreatography
51. Training Clinicians for Public Health Events Relevant to Bioterrorism Preparedness
52. Criteria for Determining Disability in Speech-Language Disorders
53. Management of Prolonged Pregnancy
54. Management of Allergic and Nonallergic Rhinitis
55. Diagnosis, Natural History, and Late Effects of Otitis Media with Effusion
56. Management of Clinically Inapparent Adrenal Mass
57. Diagnosis and Treatment of Parkinson's Disease: A Systematic Review of the Literature
58. Autopsy as Outcome and Performance Measure
59. Bioterrorism Preparedness and Response: Use of Information Technologies and Decision Support Systems
60. Management of Chronic Hepatitis C
61. Management of Cancer Symptoms: Pain, Depression, and Fatigue
62. Diagnosis and Treatment of Worker-Related Musculoskeletal Disorders of the Upper Extremity
63. Utility of Blood Pressure Monitoring Outside of the Clinic Setting
64. S-Adenosyl-L-Methionine (SAMe) for Depression, Osteoarthritis, and Liver Disease
65. Management of Neonatal Hyperbilirubinemia
66. Systematic Review of the Current Literature Related to Disability and Chronic Fatigue Syndrome
67. Management of Allergic Rhinitis in the Working-Age Population
68. Diagnosis and Treatment of Deep Venous Thrombosis and Pulmonary Embolism
69. Management of Bronchiolitis in Infants and Children
70. Criteria for Determining Disability in Infants and Children: Low Birth Weight
71. Vaginal Birth After Cesarean (VBAC)
72. Criteria for Determining Disability in Infants and Children: Failure to Thrive
73. Criteria for Determining Disability in Infants and Children: Short Stature
74. The Effect of Health Care Working Conditions on Patient Safety
75. Effect of the Supplemental Use of Antioxidants Vitamin C, Vitamin E, and the Coenzyme Q10 for the Prevention and Treatment of Cancer
76. Ephedra and Ephedrine for Weight Loss and Athletic Performance Enhancement: Clinical Efficacy and Side Effects
77. Management of Treatment-Resistant Epilepsy
78. Best-Case Series for the Use of Immuno-Augmentation Therapy and Naltrexone for the Treatment of Cancer
79. Diffusion and Dissemination of Evidence-based Cancer Control Interventions
80. Results of Systematic Review of Research on Diagnosis and Treatment of Coronary Heart Disease in Women
81. Diagnosis and Treatment of Coronary Heart Disease in Women: Systematic Reviews of Evidence on Selected Topics
82. Pharmacologic Management of Heart Failure and Left Ventricular Systolic Dysfunction: Effect in Female, Black, and Diabetic Patients, and Cost-Effectiveness
83. Effect of Supplemental Antioxidants Vitamin C, Vitamin E, and Coenzyme Q10 for the Prevention and Treatment of Cardiovascular Disease
84. Use of Glycated Hemoglobin and Microalbuminuria in the Monitoring of Diabetes Mellitus
85. Hyperbaric Oxygen Therapy for Brain Injury, Cerebral Palsy, and Stroke
86. Total Knee Replacement
87. Literacy and Health Outcomes
88. Effectiveness of Antimicrobial Adjuncts to Scaling and Root-Planing Therapy for Periodontitis
89. Effects of Omega-3 Fatty Acids on Lipids and Glycemic Control in Type II Diabetes and the Metabolic Syndrome and on Inflammatory Bowel Disease, Rheumatoid Arthritis, Renal Disease, Systemic Lupus Erythematosus, and Osteoporosis
90. Strategies for Improving Minority Healthcare Quality
91. Health Effects of Omega-3 Fatty Acids on Asthma
92. Effects of Omega-3 Fatty Acids on Arrhythmogenic Mechanisms in Animal and Isolated Organ/Cell Culture Studies
93. Effects of Omega-3 Fatty Acids on Cardiovascular Risk Factors and Intermediate Markers of Cardiovascular Disease
94. Effects of Omega-3 Fatty Acids on Cardiovascular Disease
95. Training of Hospital Staff To Respond to a Mass Casualty Incident
96. Regionalization of Bioterrorism Preparedness and Response
97. Pharmacological Treatment of Dementia
98. Islet Transplantation in Patients with Type 1 Diabetes Mellitus
99. Community-Based Participatory Research
100. Criteria to Determine Disability Related to Multiple Sclerosis
101. Economic Incentives for Preventive Care
102. Effectiveness of Behavioral Interventions to Modify Physical Activity Behaviors in General Populations and Cancer Patients and Survivors
103. Pharmacological and Surgical Treatment of Obesity
104. Celiac Disease
105. Measuring the Quality of Breast Cancer Care in Women
107. Preventing Violence and Related Health-Risking Social Behaviors in Adolescents

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Additional Information

AHRQ's Center for Outcomes and Evidence (COE) oversees the evidence-based practice program. For more information about the program, EPCs, and topic nominations, contact:

Kenneth Fink, M.D., M.G.A., M.P.H.
Director, EPC Program
Center for Outcomes and Evidence
Agency for Healthcare Research and Quality
540 Gaither Road, Suite 6000
Rockville, MD 20850
Phone: (301) 427-1617
Fax: (301) 427-1639
E-mail: KFink@ahrq.gov

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AHRQ Publication No. 03-P006
Current as of March 2003

Internet Citation:

Evidence-based Practice Centers. Overview. AHRQ Publication No. 03-P006, March 2003. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/clinic/epc/

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