"Evidence based" task force - read for answers

[StephN]

By wading around in the rather large USPSTF site, most of our questions about the way the panel came to their conclusions can be answered.

"The USPSTF is supported by an Evidence-based Practice Center (EPC). Under contract to AHRQ, the EPC conducts systematic reviews of the evidence on specific topics in clinical prevention that serve as the scientific basis for USPSTF recommendations"

If you click the link to the EPC mentioned above you get this list of contracted "centers" that provide various types if information:

You Are Here: AHRQ Home > Clinical Information > Evidence-based Practice > EPC Program



Evidence-based Practice Centers


Synthesizing scientific evidence to improve
quality and effectiveness in health care



Under the Evidence-based Practice Centers (EPC) Program of the Agency for Healthcare Research and Quality (formerly the Agency for Health Care Policy and Research—AHCPR), 5-year contracts are awarded to institutions in the United States and Canada to serve as EPCs. The EPCs review all relevant scientific literature on clinical, behavioral, and organization and financing topics to produce evidence reports and technology assessments. These reports are used for informing and developing coverage decisions, quality measures, educational materials and tools, guidelines, and research agendas. The EPCs also conduct research on methodology of systematic reviews.

Overview / Centers / Report Development / Additional Information

Overview

In 1997 the Agency for Health Care Policy and Research (AHCPR), now known as the Agency for Healthcare Research and Quality (AHRQ), launched its initiative to promote evidence-based practice in everyday care through establishment of 12 Evidence-based Practice Centers (EPCs). The EPCs develop evidence reports and technology assessments on topics relevant to clinical, social science/behavioral, economic, and other health care organization and delivery issues—specifically those that are common, expensive, and/or significant for the Medicare and Medicaid populations. With this program, AHRQ became a "science partner" with private and public organizations in their efforts to improve the quality, effectiveness, and appropriateness of health care by synthesizing the evidence and facilitating the translation of evidence-based research findings. Topics are nominated by non-federal partners such as professional societies, health plans, insurers, employers, and patient groups. Go to http://www.ahrq.gov/clinic/epc/epctopicn.htm for topic nomination procedures. Federal partners often request evidence reports and should contact the EPC Program Director for more information.
For details on the EPC program for current and potential partner organizations, go to the EPC Partner's Guide.
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Centers

In October 2007, AHRQ announced the third award of 5-year contracts for EPC-III to 14 Evidence-based Practice Centers to continue and expand the work performed by the previous group of EPCs. Most of the third group of EPCs were part of the initial set. However, EPC-III brings in two new institutions to the program-the University of Connecticut and Vanderbilt University--while Stanford has concluded its contract as one of the original EPCs.
Five of the EPCs specialize in conducting technology assessments for the Centers for Medicare & Medicaid Services (CMS). Go to: http://www.ahrq.gov/clinic/techix.htm for more information.
One EPC concentrates on supporting the work of the U.S. Preventive Services Task Force (USPSTF). Go to: http://www.ahrq.gov/clinic/uspstfix.htm for more information.

The current EPCs are located at:

• Blue Cross and Blue Shield Association, Technology Evaluation Center. .
• Duke University.1
• ECRI Institute.1
• Johns Hopkins University.
• McMaster University.
• Minnesota Evidence-based Practice Center.
• Oregon Evidence-based Practice Center.2
• RTI International—University of North Carolina.
• Southern California.
• Tufts—New England Medical Center.1
• University of Alberta.1
• University of Connecticut.
• University of Ottawa.
• Vanderbilt University."

You can further read about "report development.

MOST IMPORTANT is the at the end of that section, is this statement on what will be done with the findings (emphasis mine):

"The resulting evidence reports and technology assessments are used by Federal and State agencies, private sector professional societies, health delivery systems, providers, payers, and others committed to evidence-based health care."

[vlcarr]

I don't understand how all this works but find it interesting that Vanderbilt, which is where I'm being treated, publicly disagreed with the new mammo guidelines.

[Jackie07]

I read it on our paper last Thursday that the spokesperson for HHS had clarified that it was just a 'recommendation' by the task force, not a law or rule. According to that statement, women are continued to have the 'coverage' as long as it is prescribed by their doctors.

The urgent need now is to educate young (and older) women to be 'assertive' and to pay attention to their overall health. (My opinion)

[Carolyns]

Hi Jackie,

The challenge with these types of recommendations is that young women's doctors will read these guidelines and follow them... hide behind them for cover if things go wrong. I was put off of a mamo for over a year due to an OB/GYN who said that I was too young for a mammo according to the "guidelines". Well what young woman doesn't want to hear that she does not need a mammogram (myself included). Anyway a year later when I changed doctors and got a mammogram it was found that I did in fact have breast cancer that had spread to the nodes.

Later I found that he was writing in my file that I had an obsessive fear of breast disease. It seemed that he thought that doing self breast exams and feeling a lump made me obsessive.

Thanks, Carolyn

[Jackie07]

Same thing happened to me in the diagnosis of my first brain tumor. Our then family doctor told us that he could give me a referral to a 'psychiatrist' if we wanted to. We changed doctor and then persisted for 7 months requesting for all kinds of tests before the huge brain tumor was found.

Just 5 minutes ago, I saw on CNN that even though the Secretary of HHS had said the task force report is just a guideline, the actual wording in the congressional bill had stated that future laws will have to adhere to the guideline.

Now the former head of NIH, Dr. Bernardine Healy, is voicing her concern on CNN - "It is not wise," she says. Carly Fiorina (former CEO of Hewett-Packer and recent breast cancer survivor who is running for a Senate seat) also just stated that the bill does not solve any of the problems it aimed to solve. Gloria Stainen just joked about what the Congress might do if there's a study report on men's low sperm count.

[hutchibk]

One danger is that of the slippery slope. Recommendations by commissioned task forces can easily get slipped into the lexicon as accepted theories (because many want to be on the leading end of what they perceive to be a trend, they will buy into it instead of questioning the purpose and methodolgy with due diligence), much along the lines of misleading gossip about someone that becomes accepted as truth. Supposed accepted theories can then take on a life of their own and often by the time the more reasonable masses and experts take the time to slow down and drill down into the theory bit by pit, piece by piece, the theory has gained steam and more and more followers. Once that happens, you start to see official Govt. agencies and Councils for Comparative Effectiveness, etc, turning these types of recommendations into mandates. Hey ho, here we go.

[Jean]

All so True Brenda....all to often especially in big business (and lets face it bc is a business to many)
I well remember in those corp. meetings how long before it hit the fan... decisons were made long before they were relesed.. it was just a matter of getting the situaion in place then - up and running.

ugh...