AHRQ Evidence-based Practice Center Program--Applying the Knowledge to Practice to Data Cycle to Strengthen the Value of Patient Care
For more than 20 years, the Agency for Healthcare Research and Quality (AHRQ) Evidence-based Practice Center (EPC) Program has been identifying and synthesizing evidence to inform evidence-based healthcare. Recognizing that many healthcare settings continue to face challenges in disseminating and implementing evidence into practice, AHRQ’s EPC program has also embarked on initiatives to facilitate the translation of evidence into practice and to measure and monitor how practice changes impact health outcomes. The program has structured its efforts around the three phases of the Learning Healthcare System cycle: knowledge, practice, and data. Here, we use a topic relevant to the field of hospital medicine—Clostridium difficile colitis prevention and treatment—as an exemplar of how the EPC program has used this framework to move evidence into practice and develop systems to facilitate continuous learning in healthcare systems.
©2019 Society of Hospital Medicine
Research evidence is critical for strengthening the value, quality, and safety of patient care. Learning healthcare systems (LHS) can support the delivery of evidence-based healthcare by establishing organizational processes that support three activities (Figure).1-3
- Knowledge: Identifying and synthesizing evidence to address clinical challenges
- Practice: Applying knowledge in the process of care delivery
- Data: Assessing performance and creating a feedback cycle for learning and improvement
The systematic implementation of evidence into practice continues to be a challenge for many healthcare organizations4-7 due to limited resources, expertise, and culture.5,8-12 Missing opportunities for translating knowledge into practice not only results in low-value care (ie, waste) but also in harm.1
The AHRQ (Agency for Healthcare Research and Quality) Evidence-based Practice Center (EPC) Program was established in 1997, with the goal of synthesizing research to inform evidence-based healthcare. The national impact of this program has been significant. Since the American Recovery and Reinvestment Act of 2009, EPC program reports have been used to inform over 95 clinical practice guidelines from societies such as the American College of Physicians, 16 health coverage decisions from payers such as the Centers for Medicare & Medicaid Services, and 24 government policies and program planning efforts, such as the National Institutes of Health Pathways to Prevention Program.13
The EPC program recognizes that evidence awareness is not sufficient to change practice and improve clinical outcomes. As such, the EPC program also embarked on initiatives to facilitate the translation of evidence into clinical practice and to measure and monitor how changes in practice impact health outcomes. AHRQ has historically worked with professional organizations to translate systematic reviews into clinical practice guidelines as well as federal agencies to inform payer decisions and program planning. Recently, the EPC program has increased collaborative efforts with hospitals and healthcare systems to understand how they use evidence and to partner with them to identify methods to improve the uptake of evidence into practice.9,12
In this perspective, we describe the AHRQ EPC Program’s work to address the three phases of the LHS cycle (knowledge, practice, and data) to support high-value care, using the topic of preventing and treating Clostridium difficile colitis as a relevant example to the hospital medicine field (Figure 2). By sharing this work, we hope it can serve as a model to illustrate how partnerships between organizations and AHRQ can lead to improvements in healthcare.
