Putting evidence to work: prevention, practice and policy

This paper will discuss how evidence-based medicine can be used as a policy tool and some of the challenges of using evidence as a discipline that will inform decision-making. Within the US federal structure (the Department of Health and Human Services, the US Public Health Service) there are a number of agencies which have fairly high public profiles, such as the National Institutes of Health (NIH), the Centers for Disease Control, and the Food and Drug Administration (FDA). The Agency for Healthcare Research and Quality (AHRQ) is a relatively small agency that has existed for about 10 years. Approximately $300 million dollars were appropriated to AHRQ in 2001, compared to $21 billion dollars devoted to the NIH for biomedical research. The sole focus of AHRQ is on health services. research and quality. Examples of activities which are funded by AHRQ include the US Preventive Services Task Force, technology assessment, evidence-based practice centres, translating research into practice, and basic health services research. Evidence-based medicine is fundamental to how AHRQ operates. AHRQ is also the leadership agency within the US Public Health Service for ensuring there is funding and dissemination of the issues of evidence-based medicine.