toll in terms of lost lives, pain and suffering, and wasted resources is staggering. The Agency for Healthcare Research and Quality (AHRQ) has established a track record in funding the synthesis and dissemination of clinical knowledge and best practices through its work with the evidence-based practice centers (EPCs), primary care practice-based research networks (PBRNs), and the Integrated Delivery System Research Network (IDSRN). There are currently 13 EPCs developing evidence-based reports and technology assessments based on rigorous analysis of the scientific literature on clinical, social science/behavioral, economic, and other health care and delivery issues (Agency for Healthcare Research and Quality, 2003a). The EPCs and their partners, including federal and state agencies, private-sector professional societies, health delivery systems, providers, payers, and others, are expected to translate the findings into practice guidelines or other implementation tools to improve the quality of care within their organizations. To date, most of the EPCs have focused on selected chronic conditions, such as diabetes, epilepsy, stroke, congestive heart failure, and cancer.

Putting these evidence-based guidelines into a computer-readable format that can be used with decision support systems during clinical encounters is the objective of the informatics community. Many groups have been undertaking applied research on various approaches to modeling the guidelines (Peleg et al., 2003); however, none of these approaches are providing optimum performance in clinical practice (Maviglia et al., 2003). Another issue that impacts the development of computer-readable guidelines is the need for interoperability with a number of information systems operating in the context of the NHII. Therefore, several of the research groups are banding together to use the best from research to date and develop a generic model intended to serve as the baseline standard guideline format (Peleg et al., 2003). Chapter 9 provides a detailed discussion of these efforts.

Since 1993, AHRQ has supported important research through PBRNs. A PBRN is a group of ambulatory practices devoted to the primary care of patients, formed to investigate research questions related to community-based clinical practice (Agency for Healthcare Research and Quality, 2001). Typically, PBRNs draw on the experience and insight of practicing clinicians to identify and frame research questions that can be investigated with rigorous research methods to produce findings that can improve primary care practice (Agency for Healthcare Research and Quality, 2001). To date, the PBRNs have studied such topics as the role of antibiotics in improving outcomes in children with acute otitis media, the referral process in pediatric care, and primary and secondary prevention of coronary artery disease and stroke (Agency for Healthcare Research and Quality, 2001). Nineteen net-



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