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Using Evidence

Finding Evidence

Presenters:

Clifford S. Goodman, Ph.D., Senior Scientist, The Lewin Group, Falls Church, VA.

Margaret Coopey, R.N., M.G.A., M.P.S., Senior Health Policy Analyst, Center for Practice and Technology Assessment, Agency for Healthcare Research and Quality (AHRQ), Rockville, MD.


There are many resources available to help policymakers find evidence that will allow them to make better informed coverage decisions. One of the largest sources of evidence is the National Library of Medicine (NLM), at the National Institutes of Health (NIH), which maintains several searchable databases useful for health technology assessment.

Dr. Goodman cited what he believes to be the five best sources available through the NLM for assessing health technologies:

  • MEDLINE®: Citations for peer-reviewed biomedical journal articles, including clinical trials and abstracts.
  • HealthSTAR: A subset of MEDLINE®, contains citations for planning or administration of health services research and technology assessment literature.
  • HSRProj: Lists ongoing health services research projects.
  • HSTAT: Used mostly by the government, this database contains full text of U.S. clinical practice guidelines, consensus development reports, and technical assistance reports.
  • PREMEDLINE: Recently established, contains basic citation information and abstracts of articles before they are indexed and placed into MEDLINE®.

Another evidence resource is the Cochrane Collaboration Library, an international database of systematic reviews of controlled trials on hundreds of clinical topics.

Making decisions based on published studies involves both effectively searching for and analyzing evidence. Dr. Goodman suggested 10 basic steps to search for evidence:

  1. Specify the problem.
  2. Specify search criteria.
  3. Formulate a plan for searching the literature.
  4. Conduct a literature search.
  5. Retrieve literature.
  6. Screen articles according to criteria.
  7. Interpret evidence.
  8. Extract data.
  9. Develop evidence tables.
  10. Conduct analysis.

Margaret Coopey discussed some sources of evidence-based information offered through AHRQ. She described the features of AHRQ's Evidence-Based Practice Centers (EPCs), research centers funded to create evidence reports and conduct technology assessment on specific topics, and AHRQ's National Guideline Clearinghouse™ (NGC), a major Internet database of evidence-based clinical practice guidelines.

Created in 1997, AHRQ's EPCs are public and private sector partners working to support the production of evidence reports, systematic literature reviews, technology assessments, and cost-effectiveness analyses of medical technologies and practices. Topics of published EPC evidence reports have included:

  • Cervical cytology.
  • Dysphagia in the elderly.
  • Attention deficit hyperactivity disorder (ADHD) treatment.
  • Sleep apnea diagnosis.
  • Acute sinusitis.
  • Alcoholism pharmacotherapy.
  • Stable angina management.
  • New drugs for depression.

The evidence reports produced by EPCs are used in the development of clinical practice guidelines, performance measures, quality improvement programs, and coverage policies. The full text of EPC evidence reports is available through AHRQ's Web site at: http://www.ahrq.gov/clinic/epcix.htm

Ms. Coopey also gave a short tutorial of AHRQ's NGC, including the components of guideline summaries on NGC, AHRQ's criteria for including a guideline in the clearinghouse, and the user features of the NGC website. She explained that the NGC contains more than 700 evidence-based clinical practice guidelines and that users of the clearinghouse can easily search and compare different guidelines online by viewing short, structured abstracts containing a guideline's major recommendations adapted to a standardized format. The NGC can be accessed at http://www.guideline.gov.

References

Center for Practice and Technology Assessment Mission and Programs. AHRQ Fact Sheet. Rockville (MD): U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality. 2000 May. AHRQ Publication No. 00-P065.

The National Guideline Clearinghouse™. AHRQ Fact Sheet. Rockville (MD): U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality. 2000 Jan. AHRQ Publication No. 00-P007.

AHRQ's Evidence-based Practice Centers. AHRQ Fact Sheet. Rockville (MD): U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality. 2000 Feb. AHRQ Publication No. 00-P013.

The New U.S. Preventive Services Task Force. AHRQ Fact Sheet. Rockville (MD): U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality. 2000 Apr. AHRQ Publication No. 00-P046.

AHRQ: Put Prevention Into Practice. Rockville (MD): U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality. 2000 Jan. AHRQ Publication No. 00-P029.

Hunt DL, Jaeschke R, McKibbon KA. Users' Guides to the Medical Literature: XXI. Using electronic health information resources in evidence-based practice. JAMA 2000 Apr 12;283(14):1875-9.

National Guideline Clearinghouse™ (NGC) Guideline Index. National Guideline Clearinghouse™. 2000 Apr 20; http://www.guideline.gov.


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