Synthesizing and distilling evidence to shape clinical practice, inform health policy, and drive future research
When we seek care for sickness or injury, we count on doctors and health care professionals to know what treatment will work best for us. The field of evidence-based practice research is devoted to reviewing and analyzing the body of scientific evidence to inform the decisions of health care practitioners.
Since 1997, we have operated as the RTI International-University of North Carolina Evidence-based Practice Center (RTI-UNC EPC), producing a range of products grounded in evidence synthesis methods. Such products include comprehensive systematic evidence reviews, health technology assessments, evidence maps, and others. These products are distillations of evidence in the scientific literature that can be used to inform clinical or public health practice, health policy, and research.
One of 9 EPCs sponsored by the Agency for Healthcare Research and Quality (AHRQ), the RTI-UNC EPC is led by RTI in collaboration with the Cecil G. Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill and faculty at the Ohio State University and the Danube University Krems. Our EPC is also an affiliate of the US Cochrane Network. In addition to AHRQ sponsorship, we conduct evidence syntheses commissioned by other federal agencies, states, health care professional organizations, and other non-commercial entities.
We conduct systematic reviews and related evidence syntheses on drugs, medical devices, and clinical, health care delivery, and public health interventions across a variety of health topics. Patients, health care providers and administrators, insurers, professional societies, advocates, and policymakers use our reviews to inform patient and provider decisions, insurance coverage decisions, clinical practice guidelines, and the direction of future health research.
Conducting Consistent, Transparent, and Rigorous Reviews in Support of the United States Preventive Services Task Force
As a key part of our EPC portfolio, we conduct systematic reviews for the U.S. Preventive Services Task Force (USPSTF) to inform their recommendations for primary care clinicians regarding the effectiveness of preventive clinical services such as screening, behavioral counseling, and preventive interventions.
Under the Affordable Care Act, USPSTF-recommended services must be covered at no cost to patients, meaning our reviews carry significant policy weight. In recognition of the high stakes of applying our review results, we institute and maintain quality processes to ensure consistency, transparency, and rigor across multiple concurrent reviews.
Specifically, we follow national and international standards endorsed by the National Academy of Medicine, the Cochrane Collaboration, the USPSTF, and AHRQ in conducting systematic reviews. For USPSTF and other reviews, we routinely
- Vet investigators conducting the review for financial and nonfinancial conflicts of interest to ensure a well-balanced and unbiased review team.
- Develop review protocols in consultation with methodologists and clinical and content experts and modify based on public comment received.
- Search multiple bibliographic databases and grey literature sources and hand-search references from key citations.
- Develop and test forms for review of studies and publications and data abstraction.
- Use internationally recognized tools and instruments for conducting risk-of-bias assessments of included studies.
- Conduct strength of evidence (GRADE) assessments dually and independently with third-person adjudication for conflicts.
- Post draft reports for public comment, distribute them for expert peer review, and revise reports based on feedback.
Recent USPSTF Reviews
Our 2021 review supported the USPSTF's updated recommendations to screen for prediabetes and type 2 diabetes in individuals who have overweight or obesity. Diabetes affected an estimated 13% of US adults in 2020, and 34.5% met criteria for prediabetes. Diabetes is associated with complications such as increased cardiovascular disease risk and kidney failure, and screening may allow earlier detection and potentially improved outcomes.
Changing Clinical Practice and Policy
Since its founding, the RTI-UNC EPC has delivered evidence to inform health care practice.
Our work on a Cochrane rapid review of the effectiveness of screening for COVID-19 concluded that available evidence on screening tests suggests they may miss infections. This finding underscores the importance of public health measures such as physical distancing and masking in controlling the spread of the virus.
Our recent AHRQ-funded Effective Health Care program review addressing maternal, fetal, and child outcomes of mental health medications in pregnant women identified significant limitations in understanding of the effects of medications in pregnant or postpartum women. Untreated serious mental health problems during and after pregnancy could potentially cause more harm than continuing to take medications to treat the conditions. We worked with the Patient-Centered Outcomes Research Institute (PCORI) to develop an evidence map to visualize information about studies addressing social needs interventions to improve health outcomes. The map distills complex information on study and population characteristics, health outcomes, and study quality in an accessible visual format for researchers, physicians, payers, and purchasers.
Our EPC also conducts reviews for other organizations. For example, our health technology assessment conducted for the Washington State Health Care Authority informed coverage determinations for sacroiliac joint fusion.
Driving Future Health Research
Our efforts have changed and continue to change research in many ways.
Our syntheses help identify gaps in the evidence that can then serve as the basis for future funding initiatives. For example, our PCORI-funded rapid review assessing the effectiveness and harms of video telehealth modalities reported gaps in understanding of effects in underserved and vulnerable populations, especially in relation to health disparities and health equity. Gaps also exist regarding the use of video teleconferencing for collaborative or integrated care and for patients with multiple chronic conditions.
Additional evidence of the influence of EPC systematic reviews and synthesis of methodological approaches include incorporation of reviews into federal requests for applications and the frequency with which reviews are cited in the literature.
Advancing Methods for Conducting Systematic Reviews
The EPC has been in the forefront of several methodological advances for systematic reviews, such as
- Assessing risk of bias
- Establishing and validating standards for assessing strength of evidence
- Reviewing complex interventions
- Conducting network meta-analyses
- Distinguishing efficacy from effectiveness
- Exploring the nature of heterogeneity
- Creating reporting standards for assessing nonfinancial conflicts of interests
- Developing methods for rapid reviews.
We continue to develop and disseminate new methods such as qualitative comparative analysis and guidance for systematic reviews of complex interventions. We are also actively involved in conducting methods work in collaboration with methodologists from international institutions such as the Cochrane Collaboration and GRADE.
Disseminating Findings
To ensure that evidence-based recommendations benefit patients by making their way into clinical practice, we disseminate and translate our findings through multiple venues—including conference presentations, peer-reviewed publications, materials for continuing medical education, and clinical practice guidelines. RTI-UNC publications include:
- AHRQ Evidence Reports
- PCORI Projects and Reports
- Recent Journal Publications from RTI-UNC-affliated Investigators
Collaborate with Our Experts
Our experts collaborate in projects with researchers and agencies across the globe. Collaborative partners have included other EPCs and organizations including the Social Interventions Research & Evaluation Network (SIREN) at the University of California, San Francisco and the State of Washington.
Our services include:
- Evidence identification and assessment
- Evidence synthesis
- Methods consultation
- Methods development
Our expertise spans multiple content areas including health services research, health care quality, epidemiology, knowledge translation, guideline development, prevention research, and program evaluation across primary care, women’s health, and early childhood development, among other therapeutic areas.
Contact us about collaboration at epc@rti.org.
