Evidence-based health care 2004: AHRQ moves research to translation and implementation.

Abstract

Since its inception, the Agency for Healthcare Research and Quality (AHRQ) has worked to promote the use of state-of-the-science evidence to improve health care and decisionmaking. Evidence-based health care has been variously defined. Sackett et al. (2000) defines it as “the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence-based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research.”Muir Gray (1997) goes further to say the practice of evidence-based health care “enables those managing health services to determine the mix of services and procedures that will give greatest benefit to the population served.” AHRQ extends its efforts and these definitions to promote the use of evidence to inform health care policymaking. The role of evidence-based health care in promoting better health outcomes and more value in the care we purchase and provide is only beginning to be realized. Much of the focus over the last two decades has been on perfecting the techniques of evaluating and interpreting evidence through rigorous systematic reviews and the development of guidelines and measures. Less attention has been paid to the usability of these products, although the difficulty in getting them used in practice has been well-documented (Grimshaw et al. 2004). Thus, it continues to be a challenge to get the best available evidence to decisionmakers at the point that they need it and in a form that is useful. As a promoter and generator of evidence, AHRQ has seen its mission and role naturally evolve since it was created as the Agency for Health Care Policy and Research. AHCPR was established by Congress in 1989 “for the purpose of enhancing the quality, appropriateness, and effectiveness of health care services and access to care.” The U.S. Congress and other health care decisionmakers and policymakers, increasingly alarmed over the variation of health care practices across the United States, were looking for scientific evidence on which to base health care decisions (Wennberg 1984). Accordingly, AHCPR's mission was “to support, conduct, and disseminate research that improves access to care and the outcomes, quality, cost, and utilization of health care services.” Over the last 12 years, AHRQ-sponsored research has helped build the foundation of evidence used by health care decisionmakers at all levels. In 1999, Congress reauthorized the Agency and renamed it the Agency for Healthcare Research and Quality. The reauthorization legislation removed a mandate that AHRQ develop clinical practice guidelines and directed the Agency to be a “science partner” with public and private health care organizations. As a science partner, AHRQ would assist the health care system in translating evidence and research into improved practice and policy. Consequently, AHRQ's new mision is “to improve the quality, safety, efficiency, and effectiveness of health care for all Americans.” The goal of this mission is to work with the public and private sector to translate scientific evidence into improved health care, outcomes, and policy. Details on AHRQ's new mission can be found in the June 2004 issue of HSR. A clear direction for AHRQ under the new mission is the explicit focus on moving beyond discovery to decisionmaking. While it is always important to make sure that the quality of scientific information is high, it is equally important to ensure that it is relevant and usable.There are numerous lost opportunities for evidence to inform decisionmaking, oftentimes because decisionmakers simply cannot access or use the information when and where they need it. A major component of AHRQ's new mission is a concentration on increasing the visibility and usability of scientific findings for decisionmakers at all levels—clinical practice, health systems, and policy making. This is a shift from a major focus on the generation of new knowledge to a focus on the production of information that is not only needed by decisionmakers but delivered in a format that is practical, accessible, and useful—actionable and solution oriented.