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Berücksichtigung organisatorischer Aspekte in HTA-Berichten
Abstract
Compared to the assessment of efficacy, effectiveness, safety and costs, the analysis of the organisational impact of medical technologies has often been neglected. In addition, no international consensus has been reached so far about the definition of what is meant by the organisational impact of a medical technology.
This article integrates different methodological approaches (translation model, input-output model), and an analytical matrix is developed that may be used to assess the impact of a technology on the organisation of health care.
Basically, a distinction will be made between a technology's impact on organisational care and on health care providers. In the context of the German legal regulatory system, quality assurance is an important instrument and thus a constituent element of the analysis of the organisational impact of technologies. This includes, e.g., qualification requirements, minimum thresholds and technical standards regarding equipment.
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The aim of this study was to assess whether a literature review of a technology can allow a learning curve to be quantified.
The literature for fiberoptic intubation was searched for studies reporting information relevant to the learning curve. The Cochrane Library, Medline, Embase, and Science Citation index were searched. Studies that reported a procedure time were included. Data were abstracted on the three features of learning: initial level, rate of learning, and asymptote level. Random effects meta-analysis was performed.
Only twenty-one studies gave explicit information concerning the previous experience of the operator(s). There were thirty-two different definitions of procedure time. From four studies of fiberoptic nasotracheal intubation, the mean starting level and time for the 10th procedure was estimated to be 133 seconds (95 percent confidence interval, 113-153) and 71 seconds (95 percent confidence interval, 62-79), respectively.
The review approach allowed learning to be quantified for our example technology. Poor and insufficient reporting constrained formal statistical estimation. Standardized reporting of nondrug techniques with adequate learning curve details is needed to inform trial design and cost-effectiveness analysis.
To make best use of scarce healthcare resources the diffusion and adoption of new technologies should be linked to evidence of their clinical and cost effectiveness. 1 2 Yet despite major recent developments in the conduct and dissemination of health technology assessment, 3 4 the diffusion of technologies continues with little reference to research. So why does health technology assessment still have so little impact in the political world of healthcare organisations?The answer lies partly in the complexity of the forces (such as clinician enthusiasm, media campaigns, public opinion, manufacturers' inducements, hospital developments, and government regulations) that determine the diffusion of new technologies and the way that health technology assessment interacts with them. For example, government regulations delayed the introduction of lithotripsy in France until French made machines were available, even after its effectiveness was proved in selected patients.5 In contrast, laparoscopic cholecystectomy was in widespread use by 1994 despite there having been only three peer reviewed randomised trials. The reason for this rapid uptake has not been studied in depth, but Hatlie argues that in the United States “a rapid response to the market's demand for new treatment modalities that involve less pain or a shorter recovery period may be wholly appropriate.”6 He admits concern, however, about the additional influences of the revenue interests of surgical centres, surgeons' desires to expand their markets, and manufacturers' desires for equipment sales.
Summary points
Reasons for the limited influence of health technology assessment on the use of new technologies include failure to assess the effect of new technologies on the organisations which adopt them, the complex nature of knowledge about new technologies, and the personal and social values through which results are interpreted
The current focus on clinical and cost effectiveness produces work of limited relevance to managerial decision makers, who …
[Executive Summary] The aim of Working Group 4 has been to develop and disseminate best practice in undertaking
and reporting assessments, and to identify needs for methodologic development.
Health technology assessment (HTA) is a multidisciplinary activity that systematically examines the technical performance, safety, clinical efficacy, and effectiveness, cost, costeffectiveness, organizational implications, social consequences, legal, and ethical considerations
of the application of a health technology (18). HTA activity has been continuously
increasing over the last few years. Numerous HTA agencies and other institutions (termed in this report “HTA doers”) across Europe are producing an important and growing amount
of HTA information. The objectives of HTA vary considerably between HTA agencies and other actors, from a strictly political decision making–oriented approach regarding advice on market licensure, coverage in benefits catalogue, or investment planning to information
directed to providers or to the public. Although there seems to be broad agreement on the general elements that belong to the HTA process, and although HTA doers in Europe use similar principles (41), this is often difficult to see because of differences in language and
terminology.
In addition, the reporting of the findings from the assessments differs considerably.
This reduces comparability and makes it difficult for those undertaking HTA assessments to integrate previous findings from other HTA doers in a subsequent evaluation of the same technology. Transparent and clear reporting is an important step toward disseminating the findings of a HTA; thus, standards that ensure high quality reporting may contribute to a wider dissemination of results.
The EUR-ASSESS methodologic subgroup already proposed a framework for conducting and reporting HTA (18), which served as the basis for the current working group.
New developments in the last 5 years necessitate revisiting that framework and providing a solid structure for future updates. Giving due attention to these methodologic developments, this report describes the current “best practice” in both undertaking and reporting HTA and identifies the needs for methodologic development. It concludes with specific recommendations and tools for implementing them, e.g., by providing the structure for English-language scientific summary reports and a checklist to assess the methodologic and reporting quality
of HTA reports.
The health technology assessment handbook. Kopenhagen: Danish Institute for
- K Tryggestad
- F Borum
Organisational aspects. In: HTA Core Model for medical and surgical interventions
- U Saalasti-Koskinen
- J Koivisto
- C Palmhoj-Nielsen
- F B Kristensen
- P Reiman-Möttönen
- Velasco Garrido