The Center for Evidence-based Practice at UPHS is under the directorship of Nikhil Mull, MD. The Director reports directly to PJ Brennan, the Chief Medical Officer of the University of Pennsylvania Health System. The Center includes research analysts who perform evidence reviews, a health economist, biostatistician, clinical liaisons, librarians and administrators.
The Center performs assessments of health care technologies defined broadly. These include pharmaceuticals, non-pharmaceutical technologies such as medical devices, and processes of care within UPHS. Most assessments are performed at the request of medical, nursing or administrative leaders. 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 actionable report. These reports are then used to inform a variety of decisions ranging from formulary and purchasing decisions to those regarding medical practice. CEP policy is to base reports on the best available evidence. When possible, reports are based on good-quality evidence-based guidelines or systematic reviews that have already been published. If such evidence is not available, CEP will proceed to search for primary evidence in the clinical literature. Since CEP's mission is to support the quality and safety of care at UPHS, developing and implementing strategies for translating evidence-based conclusions into routine practice at our hospitals is a crucial part of our work. Techniques used for this purpose include presentations of our reports to decision makers, development of clinical practice guidelines, and creation of order sets and other electronic decision supports. An example of the process we follow for development of our clinical practice guidelines is provided below:
- Make a request – Medical, nursing or administrative leaders submit a request for a health care technology evaluation (as defined above). Requests are approved by CEP with guidance from CEP’s advisors.
- 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.
- 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.
- 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.
- 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.
- 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 based on the system proposed by the GRADE working group. Quality assessments are based on the nature of the evidence as well as its internal and external validity.
- 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.
- Clinical practice 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.
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Submit A Request
Medical, nursing and administrative leaders are welcomed to submit requests for health technology assessments, as are individual faculty and staff of UPHS. Requests are approved by CEP with guidance from CEP’s advisors. Please call or email Nikhil Mull for more information.
The Center works closely with the Chief Medical Officers (CMOs) of UPHS's three hospitals, as well as the leadership of the Pharmacy and Therapeutics (P & T) Committees, the Corporate Supply Chain Committee, the Technology Committees, and the Clinical Effectiveness and Quality Improvement Committees at UPHS.
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