AHRQ Evidence Reviews: Catalysts for Practice Change

Medical research keeps advancing while clinicians are busy taking care of patients. It is a constant challenge to keep up with the thousands of studies that are published every month relevant to the care we provide.

In order to deliver evidence-based care, physicians like us have come to rely on systematic evidence reviews that compile all of the latest evidence and evidence-based clinical guidelines developed from these comprehensive reviews. For decades, AHRQ has been a leading source of systematic evidence reviews in the United States. This work is not glamorous and rarely makes headlines, but it provides a solid foundation for the healthcare that all Americans want and deserve to receive.

AHRQ's recent evidence review about treatments for diverticulitis is an important example of these efforts. It is difficult to find a ribbon that raises awareness about this intestinal infection, which often afflicts older adults. Yet, its consequences can be severe: fevers, cramping, and other painful symptoms. Acute diverticulitis is estimated to result in more than 200,000 hospital admissions per year, making it the third most common reason for gastrointestinal inpatient admission in the United States.

Unfortunately, the way clinicians manage and treat diverticulitis varies considerably. While they may not be covered on the nightly news, two journal articles published this week in the Annals of Internal Medicine report findings from the AHRQ-sponsored systematic review that will help improve care for people with diverticulitis.

The first article summarizes the current evidence and concludes that for patients with uncomplicated diverticulitis, those who were treated in outpatient settings had the same clinical outcomes as those admitted to the hospital for treatment. Moreover, patients with uncomplicated diverticulitis treated with antibiotics had the same outcomes as those not treated with antibiotics, currently a standard treatment for the condition.

The second article concluded that patients with complicated diverticulitis are at increased risk of colorectal cancer; that elective surgery can reduce the risk of recurrence in patients who have previously suffered from diverticulitis; and that mesalamine (an anti-inflammatory medication used to treat ulcerative colitis) is ineffective at preventing recurrence of diverticulitis.

These AHRQ systematic evidence review findings were used by the American College of Physicians (ACP) to develop new guidance for clinicians that will help improve the care of patients with diverticulitis, preventing unnecessary hospitalizations and harms associated with unneeded treatments. That includes adverse effects resulting from the unnecessary use of antibiotics, like Clostridium difficile infections and antibiotic resistance.

The ACP has looked to AHRQ since its inception to provide evidence for many ACP recommendations and clinical guidelines, including guidelines on the management of adults with major depressive disorder and those with acute and recurrent gout. Other medical groups such as the American College of Obstetricians and Gynecologists, the American Academy of Pediatrics, and the American Academy of Family Physicians also frequently use AHRQ systematic reviews to create evidence-based practice guidelines to help physicians and other clinicians keep up to date.

This year marks the 25th anniversary of the AHRQ program that creates these valuable evidence reports—the Evidence-based Practice Center (EPC) Program. Currently there are nine EPCs at academic and research institutions across the United States. The EPCs are centers of excellence, and include research scientists, physicians, and other experts who analyze and summarize the available evidence while examining questions of critical importance to clinical practice and healthcare delivery.

Reports developed by AHRQ EPCs are also used to create research agendas, inform coverage decisions, and inform policies by Federal and State government agencies (such as the National Institutes of Health and the Centers for Medicare & Medicaid Services) and the U.S. Preventive Services Task Force.

There are several ways that clinicians, researchers, healthcare decision makers, and members of the public can be involved in this work. First, those with interest can nominate a topic for review via AHRQ's website. Nominating organizations may become partners, serving as resources to EPCs as they develop the evidence reports and promote dissemination of the findings. Second, anyone can comment on research questions and draft reports when they are posted for public review, which they all are. Third, researchers and advocates can submit relevant evidence and data to support the conduct of reviews. Contributing in each of these areas is essential to the development of reports that inform and advance practice.

These new diverticulitis articles demonstrate one important way that AHRQ ensures high-level, real-world research is used to improve care for patients. Research findings don't always generate headlines, but these kinds of advances are critical to making healthcare more effective, safer, and equitable.

Lionel Bañez is a medical officer in the EPC Division of AHRQ's Center for Evidence and Practice Improvement who oversaw development of the evidence report. David Meyers is the acting director of AHRQ and has served as a medical officer on many AHRQ EPC reports.

Get more AHRQ news, sign up for AHRQ news via email and follow AHRQ on Twitter, LinkedIn, Facebook, and YouTube.