Systematic reviews provide the evidence on which evidence-based health care can be based. In the Anglia and Oxford Regional Health Authority, covering a population of 5 million people, all aspects of health care from patient choice to policy making are increasingly evidence-based. Taking as a starting point the systematic reviews produced by the Cochrane Collaboration and other research workers, the Regional Health Authority's Research and Development and Public Health strategies have developed a comprehensive series of interventions to create an evidence-based health service. These include:


* CASP - critical appraisal skills programme for all decision-makers including patients;

* a Certificate in Evidence-based Health Care - a three-module Certificate, requiring three weeks of full-time study for key decision makers, for example nurse tutors, GP tutors and Directors of Finance;

* GRiPP - getting research into purchasing and practice - an initiative which takes specific topics such as the promotion of steroids in pre-term labour and ensures that they are implemented in practice;

* the development of Centres of Evidence-Based Clinical Practice to provide a focus for clinical epidemiology training and clinical practice and decision making, which is evidence-based;

* evidence-based patient choice - a programme to promote and evaluate initiatives to make patient choice more evidence-based;

* evidence-based hospital management - a programme of work linking together audit, continuing professional education and the library service within hospitals and health service providers, including primary care.