Evidence reviews help doctors and patients make health care decisions together
Independent research teams help ensure patients’ health care decisions are guided by the best scientific evidence
Dr. Jennifer Lin, MD, MCR
When it comes to screenings, vaccinations, and medications, we look to our primary care clinicians to advise us on what actions to take to protect our health and wellness. But our clinicians don’t always have the time to read and critique all the relevant research.
To help doctors and patients make these decisions together, the U.S. Preventive Services Task Force (USPSTF), an independent panel of national experts in primary care, disease prevention, and evidence-based medicine, makes recommendations based on reviews of scientific evidence conducted by evidence-based practice centers across the country. Those recommendations can have a big impact on people’s lives, from how often adults should get cancer screenings to whether they should take low-dose aspirin to prevent heart disease.
Last month, the USPSTF announced a draft recommendation that doctors screen all adults for illicit drug use, including improper use of prescription drugs. That recommendation was based on an evidence review led by Carrie Patnode, PhD, MPH, an investigator with the Kaiser Permanente Research Affiliates Evidence-based Practice Center (KPRA EPC) at the Kaiser Permanente Center for Health Research (CHR). Patnode leads systematic reviews for the USPSTF on screening for drug use, as well as screening and treatment of cognitive impairment among older adults, treatment of adult obesity, and tobacco cessation.
How Kaiser Permanente researchers at the Evidence-based Practice Center (EPC) work with the U.S. Preventive Services Task Force (USPSTF) to make health recommendations for you and your doctor.
The KPRA EPC is one of 12 centers nationwide currently designated as an official evidence-based practice center by the federal Agency for Healthcare Research and Quality (AHRQ). The KPRA EPC involves more than 75 researchers from the Center for Health Research, Kaiser Permanente Washington Health Research Institute, and HealthPartners Institute for Education and Research.
This Kaiser-based EPC has produced evidence reviews to support recommendations by the USPSTF for more than 17 years. Other recent reviews for the USPSTF include reviews on screening for pancreatic cancer, led by Nora Henrickson, PhD, MPH; preventing depression around the time of childbirth, led by Elizabeth O’Connor, PhD; screening for Hepatitis B in pregnant women, led by Jillian Henderson, PhD, MPH; and preventing falls in older adults, led by Janelle Guirguis-Blake, MD, a CHR affiliate investigator.
First established in 1997, the KPRA EPC also conducts reviews for groups interested in making evidence-based guidelines, recommendations, or coverage decisions, like the Centers for Disease Control and Prevention (CDC), Kaiser Permanente, and professional societies.
The investigators at the KPRA EPC have extensive experience in key cross-cutting areas, such as systematic reviews in preventive services and genomic test evaluations, and focused expertise in methods development. They analyze available scientific material on health care topics by conducting systematic reviews, which are not limited to published studies, but can include FDA documents, web sources, and even PhD dissertations.
“Our research has to be gathered and reviewed in an explicit, scientific, and systematic way in order for the USPSTF to consider our reviews for their recommendations,” notes Dr. Jennifer Lin, MD, MCR, a board-certified general internist in primary care with Northwest Permanente and the director of the KPRA EPC.
There is a systematic and rigorous science behind vetting the literature, which is critical in order to identify any hidden biases or other limitations of the existing research. Examples of hidden bias might be by omission, such not reporting outcomes that don’t support desired goals or only including participants that are likely to receive a benefit.
“Because the USPSTF recommendations are tied to coverage decisions, their recommendations garner much attention and can be, unnecessarily, embroiled in the politics of medicine,” Lin pointed out. “Therefore, the work we do to support these recommendations needs to be methodologically sound. In other words, they must be rigorous and free from any real or perceived conflicts of interest.” While the KPRA EPC involves the USPSTF and content experts in the process of the work, they are not involved in the identification, critical appraisal, or synthesis of the research included in the reviews.
Making decisions about your health care can be complex. Individual preferences and values will always be factors in how patients and their doctors reach decisions, but evidence should always be part of the discussion and part of the decision-making process. The researchers who make up the KPRA EPC will continue to make sure the best scientific evidence is available to guide those decisions in the years to come.