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Evidence-based Synthesis Program
The Evidence-based Synthesis Program (ESP) was established to provide timely and accurate
synthesis of targeted health care topics of particular importance to VA managers and policy makers
and to disseminate these reports broadly throughout VA. Available reports are listed and linked below.
Diabetes is a prevalent and costly disease in Veterans. Control of blood glucose is an important VA objective. Self-monitoring of blood glucose (SMBG) is advocated as a method to better achieve control. The Key Questions investigated in this report were:
- Is regular SMBG effective in either achieving or maintaining target A1c levels for patients with type 2 diabetes?
- Does regular SMBG reduce the frequency of hypoglycemia in patients with type 2 diabetes?
- Is there evidence that different frequencies of testing result in differences in improvements in A1c?
(680 KB, PDF)
Numerous studies have demonstrated racial and ethnic disparities in
health care in the United States. These disparities have been demonstrated in
the Veterans Affairs (VA) healthcare system, where financial barriers to
receiving care are minimized. The VA is committed to delivering high-quality
care in an equitable manner, and as such, to eliminating racial and ethnic
disparities in health care. To inform this effort,
the existing evidence on disparities within the VA was systematically reviewed, to address the following objectives:
- Determine in which clinical areas racial and ethnic disparities are prevalent within the VA;
- Describe what is known about the sources of those disparities; and
- Qualitatively synthesize that knowledge to determine the most promising avenues
for future research aimed at improving equity in VA health care.
(868 KB, PDF)
- Appendix IV - Evidence Tables (535 KB, MS Excel)
Although 25% of men over the age of 60 will sustain osteoporotic fractures during their lifetime,
data suggest that male osteoporosis is underdiganosed and undertreated. In order to help inform
decisions about whether the Veterans Health Administration should develop screening guidelines
for male osteoporosis, the following Key Questions were analysed in this report:
- What are the prevalence of and risk factors for osteopenia, osteoporosis and
osteoporotic fractures among men in general and among male Veterans specifically?
- Are there any validated tools (outside of central bone density) to screen for osteoporosis in men?
- What values of bone mineral density (BMD) determined by Dual energy X-ray Absorptiometry (DXA)
(and by different DXA techniques) have been used to diagnose osteopenia and osteoporosis; and
what is the evidence regarding the relationship between differing definitions and the development
of osteoporotic fractures?
(800 KB, PDF)
Benign prostatic hyperplasia (BPH) causes urinary hesitancy and intermittency, weak urine stream,
nocturia, frequency, urgency, and the sensation of incomplete bladder emptying. These symptoms,
collectively called "lower urinary tract symptoms," or LUTS, can significantly reduce quality of life.
Depending upon the severity of sypmtoms, men may be managed without pharmacotherapy, or they may
require medical treatments of drugs from two main classes. This Evidence Synthesis Report addresses
the following questions about treatment for BPH:
- For patients with BPH, what are the comparative benefits, harms, and efficacy of
combination therapy with a 5-alpha-reductase inhibitor plus an alpha blocker, versus either treatment alone?
- What are the comparative efficacy and harms of alpha-1-adrenergic antagonists?
- Are there subgroups of patients based on demographics (age, racial groups), other
medications, or co-morbidities for which one treatment is more effective or associated with fewer adverse events?
(1 MB, PDF)
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