The Center for Evidence-based Practice at UPHS is under the directorship of Kendal Williams (Director) and Craig Umscheid (Co-Director) and reports directly to PJ Brennan, the
Chief Medical Officer of the
University of Pennsylvania Health System. The Center is guided by an advisory board of academic and administrative leaders within UPHS and an executive board.
The Center performs evaluations of health care technologies defined broadly. These include pharmaceuticals, non-pharmaceutical technologies such as medical devices, and processes of care within the Health System. For each issue evaluated, CEP performs a systematic review of the evidence, and works alongside the issue’s key stakeholders to produce the most valid and relevant guidelines for best clinical practices. The CEP process consists of the following:
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Make a request – Leadership of the Pharmacy and Therapeutics Committees, the Corporate Supply Chain Committee, the Technology Committees, and the Clinical Effectiveness and Quality Improvement Committees of the Health System are welcomed to submit requests for health care technology evaluations (as defined above), as are individual members of the Health System. Requests are approved by CEP with guidance from CEP’s advisors.
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Introduction to the issue of concern - Initial meetings are held with the key stakeholders within UPHS (clinical experts and administrators) to clearly define the question and the outcomes of interest.
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Ad Hoc Task Force- A core group is created to review the evidence and develop a practice guideline for the Health System. This group consists of key stakeholders who are free from financial conflicts of interest and who are interested in participating in the process.
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Systematic literature review- A systematic review of the literature is performed by CEP. The review is guided by the previously identified questions and outcomes of concern.
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Extracting the evidence- The evidence relevant to the questions and outcomes of concern are abstracted and analyzed. Analysis may include a qualitative review of the evidence or quantitative summary estimates using the statistical techniques of meta-analysis.
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Reviewing the evidence- Structured reports of the evidence relevant to the questions and outcomes of concern are presented to the core group for discussion. The evidence for each outcome is graded by the group for overall quality and given a rating of high, moderate, low, or very low based on the system proposed by the GRADE investigators. Quality assessments are based on the nature of the evidence as well as its external validity and consistency.
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Open discussion- CEP then invites input from individuals outside of the core group, including industry scientific liaisons, key stakeholders within the institution who were not able to participate in the core group, and key stakeholders outside of the Health System.
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Clinical practices guideline- Once all of the important outcomes have been considered and graded, and an open discussion has occurred, the core group will develop a clinical practice guideline. A key component of guideline development is the balancing of benefits and harms with the overall quality of the evidence for the most critical outcomes.
