RTI-UNC Evidence-based Practice Center (EPC)

Synthesizing and distilling evidence to shape clinical practice, inform health policy, and drive future research

The field of evidence synthesis identifies, reviews and analyzes scientific evidence to inform practice and policy decisions. 

Since 1997, we have operated the RTI International-University of North Carolina Evidence-based Practice Center (RTI-UNC EPC), producing a range of products grounded in evidence synthesis methods to inform health care and public health practice, policy, and research.  The syntheses that we produce are distillations of studies in the scientific literature and include comprehensive systematic evidence reviews, health technology assessments, evidence maps, and other evidence synthesis products. 

One of 11 EPCs sponsored by the Agency for Healthcare Research and Quality (AHRQ), the RTI-UNC EPC is led by RTI in collaboration with the Cecil G. Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill and faculty at the Ohio State University and the University for Continuing Education Krems. Our EPC is also an affiliate of the US Cochrane Network. In addition to reviews sponsored by AHRQ, we conduct evidence syntheses commissioned by other federal agencies, states, health care professional organizations, and other non-commercial entities.

We conduct systematic reviews and related evidence syntheses of drugs, medical devices or procedures, and health care delivery and public health interventions across a variety of health topics. Policymakers, payors, patients, health care providers and administrators, professional societies, and advocates use our reviews to inform patient and provider decisions, insurance coverage decisions, clinical practice guidelines, and the direction of future health research.

Conducting Consistent, Transparent, and Rigorous Reviews in Support of the United States Preventive Services Task Force

As a key part of our portfolio, we conduct systematic reviews for the U.S. Preventive Services Task Force (USPSTF) to inform their recommendations for primary care clinicians regarding the effectiveness of preventive clinical services such as screening, behavioral counseling, and preventive interventions.

Under the Affordable Care Act, USPSTF-recommended services must be covered at no cost to patients, meaning our reviews carry significant policy weight. In recognition of the high stakes of applying our review results, we institute and maintain quality processes to ensure consistency, transparency, and rigor across multiple concurrent reviews.

Specifically, we follow national and international standards endorsed by the National Academy of Medicine, the Cochrane Collaboration, the USPSTF, and AHRQ in conducting systematic reviews. For USPSTF and other reviews, we routinely

• Vet investigators conducting the review for financial and nonfinancial conflicts of interest to ensure a well-balanced and unbiased review team.
• Develop review protocols in consultation with methodologists and clinical and content experts and modify based on public comment received.
• Search multiple bibliographic databases and grey literature sources and hand-search references from key citations.
• Develop and test forms for article screening and abstraction, including the use of a human-in-the-loop application of Artificial Intelligence (AI) tools for efficiency
• Use internationally recognized tools and instruments for conducting risk-of-bias assessments of included studies.
• Conduct strength of evidence (GRADE) assessments.
• Post draft reports for public comment, distribute them for expert peer review, and revise reports based on feedback.

Recent USPSTF Reviews

Our 2025 review supported the USPSTF's updated recommendations to screen for osteoporosis to prevent fracture. Osteoporosis is a bone disorder that results in bone fragility and increases the risk of fracture. Our systematic review of 145 studies reported in 195 publications informed the USPSTF’s recommendation to screen women 65 years and older and younger women with risk factors. 

Informing Clinical Practice and Policy

Since its founding, the RTI-UNC EPC has delivered evidence to inform health care practice.

Our recent AHRQ-funded Effective Health Care program review evaluated blood-based tests to screen for multiple cancers. We identified no controlled studies of such tests that reported on benefits of screening (e.g., mortality, cancer detection, quality of life), though some studies are ongoing. The accuracy of multi-cancer screening tests varied by test and study design; and the evidence was insufficient to evaluate harms of screening. 

We worked with the Patient-Centered Outcomes Research Institute (PCORI) to develop an evidence map to visualize information about studies addressing social needs interventions to improve health outcomes. The map distills complex information on study and population characteristics, health outcomes, and study quality in an accessible visual format for researchers, physicians, payers, and purchasers.

Our EPC also conducts syntheses for other organizations. For example, our health technology assessments conducted for the Washington State Health Care Authority informed coverage determinations for a variety of medical tests and interventions including hyperbaric oxygen therapy, whole genome sequencing, and sacroiliac joint fusion.

Driving Future Health Research

Our efforts have changed and continue to change research in many ways.

Our syntheses help identify gaps in the evidence that can then serve as the basis for future funding initiatives. For example, our PCORI-funded rapid review assessing the effectiveness and harms of video telehealth modalities reported gaps in understanding of effects in underserved and vulnerable populations, especially in relation to health disparities and health equity. Further, our PCORI-funded suite of systematic reviews on telephone-only care for managing mental health, diabetes, and other chronic conditions clarified the evidence base and research gaps about this modality of care.

Additional evidence of the influence of EPC systematic reviews and synthesis of methodological approaches include incorporation of reviews into federal requests for applications and the frequency with which reviews are cited in the literature.

Advancing Methods for Conducting Systematic Reviews

Our EPC has been in the forefront of several methodological advances for systematic reviews, such as

• Assessing risk of bias
• Establishing and validating standards for assessing strength of evidence
• Reviewing complex interventions
• Conducting network meta-analyses
• Distinguishing efficacy from effectiveness
• Exploring the nature of heterogeneity, including the use of qualitative comparative analysis in evaluation of complex interventions
• Enhancing systematic review methods to center health equity and address the needs of vulnerable populations
• Creating reporting standards for assessing nonfinancial conflicts of interests
• Developing methods for rapid reviews

We are actively involved in conducting methods work in collaboration with methodologists from international institutions such as the Cochrane Collaboration and GRADE.

Use of Artificial Intelligence (AI) for Evidence Synthesis

With a collaborative team of systematic review experts and data scientists, our work has demonstrated that human-in-the-loop generative AI for semi-automating data extraction from articles is accurate and can increase efficiency. Through this work, we have identified important lessons for evaluating AI for this task.  We have further demonstrated the usefulness of generative AI to distill complex findings from systematic reviews into plain language summaries. As the field of generative and agentic AI evolves, we rigorously assess tools, develop and test new processes.  

RTI’s early investment in developing and assessing the use of generative AI for evidence synthesis has made us a leader in the field of responsible AI use including achieving “Awardable” status for our automation of systematic review services through the Department of Defense Chief Digital and Artificial Intelligence Office’s (CDAO) Tradewinds Solutions Marketplace.

Disseminating Findings

To ensure that evidence-based recommendations benefit patients by making their way into clinical practice, we disseminate and translate our findings through multiple venues—including conference presentations, peer-reviewed publications, materials for continuing medical education, and clinical practice guidelines. RTI-UNC publications include:

• AHRQ Evidence Reports
• PCORI Projects and Reports
• Recent Journal Publications from RTI-UNC-affiliated Investigators

Collaborate with Our Experts

Our experts collaborate with researchers and agencies across the globe, serve as peer-reviewers and journal editors, and contribute to the development of Cochrane methods guidance and the update to standards for systematic reviews from the National Academies of Sciences, Engineering, and Medicine.

Our services include:

• Topic scoping
• Evidence identification
• Evidence synthesis
• Methods consultation
• Methods development

We have experience scaling processes to meet client timelines and resources, and when working to scope a topic, we communicate the tradeoffs in timeliness, rigor, and comprehensiveness. Although our core expertise is in the area of health care and public health, our methods apply across industries.  We have access to subject matter experts in education, social policy, justice, and beyond. 

Contact us about collaboration at epc@rti.org.