Eric Bass, MD, MPH is a Professor of Medicine with joint appointments in Health Policy and Management, Epidemiology, and Nursing at the Johns Hopkins University. He also serves as the Director for the Johns Hopkins Evidence-based Practice Center (EPC). Supported by the Effective Healthcare Program of the Agency for Healthcare Research and Quality (AHRQ), the EPC aims to promote evidence-based practice in everyday care. As Director, Dr. Bass has lead the Johns Hopkins EPC in collaborating with 13 other EPCs to develop a rigorous standardized approach to conducting systematic reviews in a manner that is flexible enough to accommodate the unique challenges encountered in each topic area. Download Dr. Bass’s ROCC Star Profile.
Please describe the goals of the Johns Hopkins Evidence-based Practice Center (JHU EPC) currently supported by the Effective Healthcare Program (EHC) of the Agency for Healthcare Research and Quality (AHRQ).
The main goal of the Evidence-based Practice Center (EPC) is to promote evidence-based practice in everyday care. The EPC has had substantial impact on clinical practice and health policy, through its contributions to the development and updating of trustworthy clinical practice guidelines, its guidance in helping to define future research needs, its role in promoting greater engagement of stakeholders in evidence reviews, and other activities that help to promote a more consistent approach to delivering evidence-based health care.
Please describe the systematic reviews that the Johns Hopkins EPC has performed on the comparative effectiveness of medications for type 2 diabetes.
The EPC has completed three large systematic reviews on the comparative effectiveness and safety of medications for type 2 diabetes. The reviews have supported a number of publications that have helped to keep clinicians up to date with the evidence on the comparative effectiveness and safety of the increasing number of medications available for the treatment of type 2 diabetes. The publications have included highly cited articles in one of the premier general medical journals, Annals of Internal Medicine. The reviews also supported the development of guides for consumers and patients, including a Best Buy Drugs report by Consumer Union. In addition, systematic reviews have been used to support clinical practice guidelines by the American College of Physicians on the treatment of type 2 diabetes. Selected publications include the following:
- Bolen S, Feldman L, Vassy J, Wilson L, Yeh HC, Marinopoulos S, Wiley C, Selvin E, Wilson R, Bass EB, Brancati FL. Systematic review: comparative effectiveness and safety of oral medications for type 2 diabetes mellitus. Ann Intern Med. 2007; 147: 386-99.
- Bennett WL, Maruthur NM, Singh S, Segal JB, Wilson LM, Chatterjee R, Marinopoulos SS, Puhan MA, Ranasinghe P, Block L, Nicholson WK, Hutfless S, Bass EB, Bolen S. Comparative effectiveness and safety of medications for type 2 diabetes: an update including new drugs and 2-drug combinations. Ann Intern Med. 2011; 154: 602-13.
- Maruther NM, Tseng E, Hutfless S, Wilson LM, Suarez-Cuervo C, Berger Z, Chu Y, Iyoha E, Segal JB, Bolen S. Diabetes medications as monotherapy or metformin-based combination therapy for type 2 diabetes. Ann Intern Med. 2016; 164: 740-51.
- Qaseem A, Humphrey LL, Sweet DE, Starkey M, Shekelle P, for the Clinical Guidelines Committee of the American College of Physicians. Oral pharmacologic treatment of type 2 diabetes mellitus: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2012; 156: 218-31
Please provide a brief description of findings from the systematic review of the comparative effectiveness of measures to reduce the risk of contrast-induced nephropathy (CIN).
In this comprehensive systematic review, we evaluated the evidence regarding the effects of different contrast media in patients requiring diagnostic imaging or image-guided procedures, and the comparative efficacy of measures to prevent CIN. The review found that the risk of CIN does not differ between types of low osmolar contrast media (LOCM), with low strength of evidence (SOE). However, iso-osmolar contrast media (IOCM) has a slightly lower risk of CIN than LOCM, with moderate SOE. Although the lower risk was statistically significant, it is unlikely to be clinically important. The risk of CIN was similar for LOCM and IOCM when studies involving intravenous or intra-arterial administration were considered separately. Regarding prevention of CIN, evidence supports a statistically significant and clinically important benefit for three interventions, and that evidence is limited to specific contexts: N-acetylcysteine plus intravenous saline is superior to intravenous saline when an LOCM is used (moderate SOE); low-dose N-acetylcysteine plus intravenous saline is superior to intravenous saline (low SOE); and statins plus N-acetylcysteine plus IV saline (or bicarbonate) is superior to N-acetylcysteine plus intravenous saline (or bicarbonate) in patients receiving intra-arterial contrast media (low SOE). The SOE was insufficient to determine the effect of other interventions on the risk of CIN, and was insufficient to assess how the effectiveness of strategies to prevent CIN varies according to baseline kidney function and other patient characteristics.
Please describe the nature of collaboration between the 13 EPCs currently supported by AHRQ.
The EPCs have worked together for 19 years to develop a rigorous standardized approach to conducting systematic reviews that is flexible enough to accommodate the unique challenges encountered in each topic area. Through workgroups formed by members of the EPCs, the EPC Program has made continuing efforts to advance the methods used in systematic reviews on important topics in clinical medicine and public health. The EPCs also have collaborated in developing a rigorous peer-review process for all evidence reports prepared by the EPCs.
How do you envision academic medical centers’ role in advancing medical research and the health of the nation in the future?
Academic medical centers have an incredibly important role in supporting the entire spectrum of medical research that is needed to improve the health of the nation. That means academic medical centers must continue to be leaders not only in conducting basic science research that will generate new discoveries, but also leaders in performing clinical and population-oriented research that will help to translate discoveries into routine clinical practice and promote evidence-based health policies.