Tufts-New England Medical Center

Evidence-based Practice Center

Profile

The Tufts-New England Medical Center Evidence-based Practice Center (EPC) produces evidence reports based on systematic reviews and other analyses such as decision/cost-effectiveness analyses. The analyses critically appraise, summarize, and synthesize the results of all studies that have addressed a similar clinical research question.

The EPC leverages the resources of its parent center, the Center for Clinical Evidence Synthesis with its Cochrane Center designation, to advance the science of evidence synthesis as a tool to guide health care decisions by public and private organizations. The EPC involves a broad range of clinical and methodologic experts from Tufts-New England Medical Center and its collaborating organizations. The EPC's offices are located in Boston, Massachusetts at New England Medical Center, the principal teaching hospital of the Tufts University School of Medicine.

The NEMC EPC will:

• Produce systematic reviews which critically appraise, summarize, and synthesize the best evidence to explain differences among research studies on specific clinical questions.
• Perform methodologic research on quantitative synthesis in systematic reviews. Includes research, which seeks to validate existing methods, develop new or more efficient methods to conduct and interpret meta-analyses.
• Provide technical assistance to partner/user organizations whose efforts to translate findings from evidence reports and technology assessments into practice require training clinicians to become evidence-based practitioners. The EPC will make available training opportunities in preparing systematic reviews, one of its functions as a Cochrane Center within the international Cochrane Collaboration and a training site for the Agency for Healthcare Research and Quality (AHRQ) National Research Service Award Fellowship Training Program.

Capabilities

EPC principals perform and publish numerous meta-analyses each year of a wide range of clinical interventions. Four EPC members, out of the more than 60 EPC clinical and methodology experts, co-chaired Agency for Healthcare Research and Quality PORTs (Patient Outcome Research Teams) or Clinical Practice Guideline Panels. These included the PORTs on variations in the Management and Outcomes of Diabetes and Prostatic Diseases and the Guideline Panels on Heart Failure, Acute Pain, and Cancer Pain. EPC researchers also have broad interests in various methodologic approaches to the problems of clinical evidence synthesis.

EPC Project Director Dr. Joseph Lau formulated the method of synthesizing the results of the National Heart Lung and Blood Institute's National Heart Attack Alert Program Technology Assessment evaluation of technologies for identifying acute cardiac ischemia in the emergency department.

The EPC's recent research focus involves comparison of meta-analyses of small trials with very large trials, generalizability of meta-analyses, and the development and application of the control-rate meta-regression method to interpret discrepant clinical trial results.

EPC members have qualifications and experience in the following disciplines:

• Meta-analysis. The statistical integration of separate studies, and cumulative meta-analysis, a method pioneered by Center Director, Dr. Joseph Lau, whereby the combined point estimate of an effect is sequentially computed by adding one study at a time in a prespecified order.
• Biostatistics. This includes development of new statistical methods and their application to medical research with particular emphasis on Bayesian techniques. (Bayesian hierarchical regression models for meta-analysis).
• Decision analysis. The method of analyzing the benefits and harms systematically so that the tradeoffs between potential interventions are explicit. EPC member Dr. Stephen Pauker developed and applied decision models in guideline formulation for the National Institutes of Health consensus panels for Bone Marrow Transplantation and Breast Cancer Treatment and the American College of Chest Physicians' Consensus Conference on Antithrombotic Therapy. EPC member Dr. Nanda Col developed a decision analytic Markov model which projected the risks and benefits of hormone replacement therapy on an individualized basis.
• Cost-effectiveness analysis. EPC members have published numerous studies analyzing which medical resources produce the most benefit per dollar. Other recent cost-effectiveness analyses by EPC members include ones on antithrombotic therapy in heart disease, interferon alfa-2b treatment for chronic hepatits B, and other pharmacoeconomic studies.
• Predictive modeling. Computer-based models for outcome prediction which can be used for both real-time emergency cardiac care and for retrospective review of care: Time-insensitive Predictive Instruments (TIPIs).
• Consumer education. Collaboration with patients to translate knowledge about effective health care into practice in diverse settings. Recent projects of EPC members from the Education Development Center, Inc. include adoption of cancer pain guidelines in managed care (funded by the Agency for Health Care Policy and Research) and dissemination of effective video-based HIV prevention programs (funded by the Centers for Disease Control and Prevention).
• Managed care decisionmaking. Programs of the Tufts Managed Care Institute, the first venture of its kind between a medical school and an independent practice association (IPA), integrate managed care principles into the full continuum of training from medical school and residency into private practice. EPC member Blue Cross Blue Shield of Massachusetts adapts and implements clinical evidence as guidelines to meet the business and health needs of its insured populations.

Collaboration

The EPC consists of the following components:

New England Medical Center/Tufts University School of Medicine components, Boston, MA: Division of Clinical Care Research (including the Center for Clinical Evidence Synthesis, the New England Cochrane Center, the AHCPR Institutional NRSA Training Program in Health Services Research, the Center for Cardiovascular Health Services Research, and the Biostatistics Research Center); Primary Care Outcomes Research Institute Division of Clinical Decision Making; Informatics and Telemedicine (including the National Library of Medicine Institutional NRSA Training Program in Medical Informatics); the Health Institute; and Tufts Managed Care Institute.

EPC components external to New England Medical Center EPC: Brown University Medical School, Providence, RI (including the Center for Statistical Sciences, the Center for Geriatrics, and the Brown University AHCPR Institutional NRSA Training Program.); Massachusetts General Hospital, Boston, MA (selected clinical experts); Veterans Administration Health Services Research, Boston, MA; Educational Development Corporation, Newton, MA; Blue Cross and Blue Shield of Massachusetts, Boston, MA; and the San Francisco Cochrane Center, San Francisco, CA.

In addition to EPC members themselves, current partners of the EPC include the American Academy of Otolaryngology-Head and Neck Surgery, the American Academy of Pediatrics, the American Academy of Family Physicians, and the American College of Physicians.

Additional Information

Access the Web site at http://www.nemc.org/dccr/Evidence-based%20Practice.htm

Or contact:

Dr. Joseph Lau, Director
Center for Clinical Evidence Synthesis
Division of Clinical Care Research
Tufts-New England Medical Center
750 Washington Street, Box 63
Boston, MA 02111
Phone: (617) 636-7670
Fax: (617) 636-8628
E-mail: jlau1@tufts-nemc.org

Internet Citation:

Tufts-New England Medical Center, Evidence-based Practice Center. Profile, February 2004. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/clinic/epc/nemcepc.htm

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