THE FIRST 4 YEARS OF A HOSPITAL-BASED COMPARATIVE EFFECTIVENESS CENTER: TRANSLATING RESEARCH INTO PRACTICE TO IMPROVE THE QUALITY, SAFETY AND COST-EFFECTIVENESS OF PATIENT CARE

Purpose: Most existing centers for health technology assessment (HTA) are associated with payers or government agencies.  They most frequently review and analyze emerging and costly technologies.  But hospitals often have to make decisions about processes of care that have impact not only on cost, but on the quality and safety of patient care.

Method: Our academic medical center created a Center for Evidence-based Practice (CEP) for the purpose of gathering scientific evidence and applying it to decision making about purchasing, formularies, and clinical practice.  CEP was established in July 2006, is funded by the Office of the Chief Medical Officer, and is staffed by two hospitalist co-directors trained in epidemiology, two HTA analysts, primary care and infectious disease physician liaisons, a librarian, a health economist, and an administrator, totaling 4.5 full time equivalents.

Result: Over 100 evidence reports have been completed to date, 42 in the most recent 12 months.  Internal clients requesting reports include clinical and administrative leaders and committees in our medical center, as well as committees established to improve and standardize care.  Topics have included processes of care like the use of heparin versus saline for catheter flushing; and high-cost and emerging technologies like telemedicine in critical care.  Reports review existing guidelines and systematic reviews first, and review primary studies when previously published reviews do not offer sufficient evidence.  Local utilization and cost data are incorporated so reports can be tailored to our medical center's needs. CEP then works with key stakeholders to implement reports, including integrating them into computerized clinical decision support, and measures their impact using administrative and/or clinical data.  Evidence reviews are shared publicly through the National Guideline Clearinghouse, the Cochrane-indexed HTA database, and peer-reviewed publications.  CEP also offers education through workshops, a resident elective, courses for medical and graduate students, and academic detailing. In addition, CEP has developed collaborations with payors, government organizations, and private industry, such as the development of evidence-based infection control guidelines with the CDC.

Conclusion: An evidence-based practice center within an academic medical center can offer systematic evaluations of high impact clinical topics.  Besides informing clinical practice, such evaluations can promote a culture of evidence-based decision-making, offer educational and publishing opportunities, and facilitate constructive relations between the medical center and outside organizations.