October 19, 2007

VUMC named to evidence-based medicine initiative

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Katherine Hartmann, M.D., Ph.D.

VUMC named to evidence-based medicine initiative

Vanderbilt University Medical Center has been chosen as one of 14 Evidence-based Practice Centers (EPCs) in the United States and Canada, the Agency for Healthcare Research and Quality (AHRQ) announced today.

For a decade AHRQ has systematically reviewed and reported on the content and quality of the medical literature on specific topics like choice of depression treatments, prostate cancer screening options and surgical outcomes for knee replacement.

The groups that conduct the reviews and summarize the implications are called the Evidence-based Practice Centers.

EPCs evaluate the state of the science of specified topics by performing rigorous reviews and analyses of scientific literature, making options more clear for patients with complex or life-threatening diagnoses who face a bewildering array of information and treatment options, for doctors who must consider new reports of possible harms for treatments that have been mainstays, and for payers who have to weigh the potential benefits and costs of coverage of new drugs, procedures and diagnostic tests.

EPC topics encompass clinical, preventive, behavioral, organizational and financial aspects of health care.

Ancillary analyses, such as claims data analyses or use of advanced models to demonstrate potential outcomes of alternatives, are also performed by EPCs.

The end result is a combination of existing knowledge termed an Evidence Report. These reports, which Vanderbilt will now play a leading role in writing, are used by groups including federal and state agencies, private sector professional societies, health delivery systems, providers and payers.

This five-year designation as an EPC recognizes the unique strengths of VUMC — few other academic medical centers have systems as strong for linking medical care, informatics, training and evidence-based medicine resources to rapidly move best evidence into clinical practice.

VUMC is well-known for sophisticated tools including electronic order sets, decision tools in the patient chart, quality “dash boards” and one of the most sophisticated electronic medical record programs in the country.

Notably, VUMC is one of a very few centers that evaluates the effects of such tools on health outcomes. The combined strength of this infrastructure with a large group of clinical and research faculty members working in evidence translation secured VUMC's designation as an EPC.

“Our faculty's strength was clearly endorsed in this competitive process,” said Katherine Hartmann, M.D., Ph.D., director of the EPC. “This selection says that the AHRQ believes we have top-notch scientists and a strong infrastructure to produce scientifically rigorous reports and materials to help inform care. Vanderbilt is on the leading edge of moving evidence into practice.

“Being designated an EPC is an accomplishment for us all to celebrate.”

VUMC's EPC will participate in two key aspects of the Evidence-based Practice Program: Generalist Reviews and Comparative Evidence Reviews. Generalist topics are broad and typically handle management of specific conditions.

Comparative Effectiveness Reviews are more targeted reviews of specific drugs or devices that have an explicit focus on the development of broadly accessible materials for patients, physicians and policy makers.

“AHRQ is the federal agency that studies quality of care and use of evidence in health care. They are mandated to determine what the best evidence is, so that health care providers and payers can put the best evidence into practice for patients. It is exciting to be part of that process,” said Melissa McPheeters, Ph.D., M.P.H., of the Institute for Medicine and Public Health at VUMC and associate director for operations for Vanderbilt's EPC.

Other center locations include Johns Hopkins University, Duke University and the Research Triangle Institute and University of North Carolina.

“The designation as an EPC is testament to our strong public health and health care efforts at VUMC,” said Jeffrey Balser, M.D., Ph.D., associate vice chancellor for Research.

“Sharing with the larger community our strengths in putting evidence-based medicine into practice and evaluating the resulting health outcomes is a major goal of Vanderbilt. This will truly help us to impact the health of the public both locally and nationally,” Balser said.

An additional major benefit of EPC reports is showing where more research is needed, McPheeters added.

“It's great to know what to do when the answer is clear and well researched, but knowing what you don't know is also really important — and critical for guiding our future clinical and biomedical research,” she said.