Center for Practice and Technology Assessment

Mission and Programs

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Through the Center for Practice and Technology Assessment, the Agency for Healthcare Research and Quality helps to narrow the gap between what is known from research about effective and efficient clinical care and what is practiced in health care settings. To carry out its mission, the Center supports Evidence-based Practice Centers, the National Guideline Clearinghouse™, the U.S. Preventive Services Task Force, and research and evaluation.

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In response to significant changes in the health care industry, the Agency for Healthcare Research and Quality (AHRQ) established the Center for Practice and Technology Assessment (CPTA) in November 1997. CPTA was established to serve as a single contact for organizations and individuals searching for comprehensive evidence reviews on health conditions, treatments, and technologies.

The Center continues to carry out AHRQ's mission to help narrow the gap between what is known from research about effective and efficient clinical care and what is practiced in health care settings.

Historically, this mission was operationalized by facilitating the development of clinical practice guidelines and conducting inhouse technology assessments. These documents were requested by the Health Care Financing Administration and the Civilian Health and Medical Program of the Uniformed Services to inform coverage policy decisions.

By establishing CPTA, AHRQ has become a "science partner" with private and public organizations in their efforts to improve the quality, effectiveness, and appropriateness of clinical practice by improving the evidence base that serves as its foundation. In carrying out its mission, CPTA supports four major programmatic activities as described below.

Evidence-based Practice Centers (EPCs)

The EPCs develop evidence reports and technology assessments on clinical topics that are common, expensive, and/or significant for the Medicare and Medicaid populations. Evidence reports and technology assessments are based on rigorous review of all relevant scientific literature and include specific analyses, such as meta-analyses and cost analyses, as warranted. Use of these reports and assessments will help reduce inappropriate variations in medical care and improve the overall quality and efficiency of the health care system.

These reports are being released so that private-sector organizations may use them as a basis for developing clinical guidelines, performance measures, and other quality improvement tools. In addition, the evidence reports and technology assessments will give health plans and payers the information necessary to make informed coverage policy decisions about new and changing medical devices and procedures.

Topics for each evidence report or technology assessment are nominated by entities such as Federal agencies, provider societies, and health plans. The nominator works with the EPC to help define the questions to be answered and review the draft product. Nominators also share responsibility with AHRQ for rapid dissemination and implementation of the report or assessment into quality measurement and improvement tools.

AHRQ's Evidence-based Practice Centers are:

• Blue Cross/Blue Shield Association Technology Evaluation Center, Chicago, IL.
• Duke University, Durham, NC.
• ECRI, Plymouth Meeting, PA.
• Johns Hopkins University, Baltimore, MD.
• McMaster University, Hamilton, Ontario, Canada.
• MetaWorks, Inc., Boston, MA.
• New England Medical Center, Boston, MA.
• Oregon Health & Science University, Portland, OR.
• Southern California Evidence-based Practice Center-RAND, Santa Monica, CA.
• Research Triangle Institute and University of North Carolina at Chapel Hill, NC.
• University of California, San Francisco/Stanford University, Stanford, CA.
• University of Texas Health Sciences Center, San Antonio, TX.

National Guideline Clearinghouse™ (NGC)

The National Guideline Clearinghouse™ is a public/private collaboration of AHRQ, the American Medical Association, and the American Association of Health Plans. As a comprehensive, Internet-based source for clinical practice guidelines, it provides access to the widest selection of guidelines and related materials available from public and private organizations. The NGC:

• Contains standardized information for guidelines such as title, sponsoring organization, author(s), and developmental methodology used.
• Provides abstracts and, where possible, full text of guidelines.
• Compares and contrasts the recommendations of guidelines on similar topics with summaries covering major areas of agreement and disagreement.
• Has topic-specific electronic mailing lists to enable registered users to communicate with one another on guideline development, dissemination, implementation, and use.

The National Guideline Clearinghouse™ was developed by ECRI under contract with AHRQ. The NGC has its own World Wide Web site (www.guideline.gov).

U.S. Preventive Services Task Force (USPSTF)

The mission of the USPSTF is to evaluate the scientific evidence for effectiveness of a range of clinical preventive services—screening tests, counseling, immunizations, and chemoprophylaxis—to produce age- and risk-factor specific recommendations for what services should be included in the periodic health examination. The USPSTF 1995 report, Guide to Clinical Preventive Services, has been a major source of information for primary care clinicians, health plans, policymakers, and purchasers. The Center for Practice and Technology Assessment has programmatic oversight over the USPSTF.

The USPSTF was reconvened in 1998 to:

• Continue its work of educating primary care physicians, health plans, and payers on the effectiveness of clinical preventive services.
• Updating its existing evaluations and recommendations.
• Assessing new topics under deliberation.

Research and Evaluation

CPTA supports and conducts research grants and evaluation projects that focus on two key areas:

1. Methodologies used in conducting systematic, evidence-based reviews and syntheses, such as meta analysis, cost and cost-effectiveness analysis, and decision analysis.
2. Approaches for implementing evidence-based clinical information and recommendations into the health care delivery system.

Projects compare alternative strategies for facilitating change in provider behavior and investigate the impact of implementation efforts on health outcomes as well as patient knowledge, behavior, and satisfaction. Important research questions of interest include, but are not limited to, the following:

• What effect does health care system structure have on implementation of evidence-based tools and information? Conversely, what effect do implementation efforts have on health systems (e.g., managed care vs. fee for service; degree of system integration; urban vs. rural health care systems; and insurance status of the population served)?
• What are the most effective tools or approaches for enhancing adoption of evidence-based clinical information (e.g., electronic decision support systems, performance measurement, and physician profiling)?
• What are the effects of implementation efforts on:
  1. Clinical decisionmaking (e.g., referral patterns, type and quantity of services utilized, prescribing patterns, length of stay, and cost of care).
  2. Patient outcomes (e.g., patient satisfaction, morbidity/mortality, perceived health status, and functional status).
  3. Patient behavior (e.g., decisionmaking, self-help and awareness, and use of services)?
• What are the implications of implementation efforts for purchasers (e.g., costs of medical care, employee satisfaction, days lost from work, and litigation)?

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More Information

For more information about CPTA programs, contact:

Jean R. Slutsky, P.A., M.S.P.H., Acting Director
Center for Practice and Technology Assessment
Agency for Healthcare Research and Quality
540 Gaither Road, Suite 6000
Rockville, MD 20852
(301) 427-1600
Fax: (301) 427-1639

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