Hostname: page-component-586b7cd67f-tf8b9 Total loading time: 0 Render date: 2024-11-23T00:15:24.989Z Has data issue: false hasContentIssue false
  • English
  • Français

UNTANGLING, UNBUNDLING, AND MOVING FORWARD: FRAMING HEALTH TECHNOLOGY REASSESSMENT IN THE CHANGING CONCEPTUAL LANDSCAPE

Published online by Cambridge University Press:  04 April 2018

Lesley J.J. Soril ,
Daniel J. Niven ,
Rosmin Esmail ,
Tom W. Noseworthy  and
Fiona M. Clement
Lesley J.J. Soril
Affiliation:
Department Community Health Sciences, O'Brien Institute for Public Health
Daniel J. Niven
Affiliation:
Department Community Health Sciences, O'Brien Institute for Public Health, Department of Critical Care Medicine
Rosmin Esmail
Affiliation:
Department Community Health Sciences, O'Brien Institute for Public Health, Health Technology Assessment and Adoption
Tom W. Noseworthy
Affiliation:
Department Community Health Sciences, O'Brien Institute for Public Health
Fiona M. Clement
Affiliation:
Department Community Health Sciences, O'Brien Institute for Public [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives: Health technology reassessment (HTR) is a policy process to manage health technologies throughout their lifecycle and ensure their ongoing optimal use. However, within an ever-evolving field, HTR is only one of many concepts associated with the optimization of health technologies. There is limited understanding of how other concepts and processes might differ and/or be interrelated. This study aims to describe the concepts underlying the various technology optimization processes and to reconcile their relationships within the HTR process.

Methods: A synthesis of the literature on approaches to HTR was completed. An inductive synthesis approach was completed to catalogue common concepts and themes. Expert stakeholders were consulted to develop a schematic to diagrammatically depict the relationships among concepts and frame them within the HTR process.

Results: A practical schematic was developed. Common concepts and themes were organized under six major domains that address the following discussion questions: (i) what is the value of the existing technology?; (ii) what is the current utilization gap?; (iii) what are the available tools and resources?; (iv) what are the levers for change?; (v) what is the desired outcome?; and (vi) who are the foundational actors?

Conclusions: Using these six questions to frame the issues faced by HTR will advance the common understanding of HTR, as well as improve implementation of HTR initiatives. These questions will clearly identify the process required to move forward within a complex healthcare system.

Keywords

Health technology reassessmentDisinvestmentTechnology managementLow-value careDe-adoption
Type
Policy
Information
International Journal of Technology Assessment in Health Care , Volume 34 , Issue 2 , 2018 , pp. 212 - 217
Copyright
Copyright © Cambridge University Press 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1.Haas, M, Hall, J, Viney, R, Gallego, G. Breaking up is hard to do: Why disinvestment in medical technology is harder than investment. Aust Health Rev. 2012;36:148–152.CrossRefGoogle Scholar
2.Henshall, C, Schuller, T, Mardhani-Bayne, L. Using health technology assessment to support optimal use of technologies in current practice: The challenge of “disinvestment”. Int J Technol Assess Health Care. 2012;28:203.CrossRefGoogle ScholarPubMed
3. US Preventive Services Task Force. About the USPSTF. https://www.uspreventiveservicestaskforce.org/Page/Name/about-the-uspstf (accessed March 2, 2018).Google Scholar
4.National Institute of Health and Care Excellence. Guide to the processes of technology appraisal. https://www.nice.org.uk/process/pmg19/chapter/acknowledgements (accessed March 2, 2018).Google Scholar
5.Australian Government Department of Health. National Medicines Policy. http://www.health.gov.au/nationalmedicinespolicy (accessed March 2, 2018).Google Scholar
6.Choosing Wisely. The Choosing Wisely lists: Choosing wisely, an initiative of the American Board of Internal Medicine; 2017 [2016].http://www.choosingwisely.org/doctor-patient-lists/ (accessed March 2, 2018).Google Scholar
7.Bryan, S, Mitton, C, Donaldson, C. Breaking the addiction to technology adoption. Health Econ. 2014;23:379–383.CrossRefGoogle ScholarPubMed
8.Elshaug, AG, Moss, JR, Littlejohns, P, Karnon, J, Merlin, TL, Hiller, JE. Identifying existing health care services that do not provide value for money. Med J Aust. 2009;190:269–273.CrossRefGoogle Scholar
9.Noseworthy, T, Clement, F. Health technology reassessment: Scope, methodology, & language. Int J Technol Assess Health Care. 2012;28:201.CrossRefGoogle ScholarPubMed
10.Soril, LJ, MacKean, G, Noseworthy, TW, Leggett, LE, Clement, FM. Achieving optimal technology use: A proposed model for health technology reassessment. SAGE Open Med. 2017;5: 2050312117704861.CrossRefGoogle ScholarPubMed
11.Chambers, JD, Salem, MN, D'Cruz, BN, Subedi, P, Kamal-Bahl, SJ, Neumann, PJ. A review of empirical analyses of disinvestment initiatives. Value Health. 2017;20:909–918.CrossRefGoogle ScholarPubMed
12.Leggett, L, Noseworthy, TW, Zarrabi, M, Lorenzetti, D, Sutherland, LR, Clement, FM. Health technology reassessment of non-drug technologies: Current practices. Int J Technol Assess Health Care. 2012; 28:220–227.CrossRefGoogle ScholarPubMed
13.Leggett, LE, Mackean, G, Noseworthy, TW, Sutherland, L, Clement, F. Current status of health technology reassessment of non-drug technologies: Survey and key informant interviews. Health Res Policy Syst. 2012;10:38.CrossRefGoogle ScholarPubMed
14.MacKean, G, Noseworthy, T, Elshaug, AG, et al. Health technology reassessment: The art of the possible. Int J Technol Assess Health Care. 2013;29:418–423.CrossRefGoogle ScholarPubMed
15.Niven, DJ, Mrklas, KJ, Holodinsky, JK, et al. Towards understanding the de-adoption of low-value clinical practices: A scoping review. BMC Med. 2015;13:255.CrossRefGoogle ScholarPubMed
16.Gnjidic, D, Elshaug, AG. De-adoption and its 43 related terms: Harmonizing low-value care terminology. BMC Med. 2015;13: 273.CrossRefGoogle ScholarPubMed
17.Mayer, J, Nachtnebel, A. Disinvesting from ineffective technologies: Lessons learned from current programs. Int J Technol Assess Health Care. 2015;31:355–362.CrossRefGoogle ScholarPubMed
18.Seo, H-J, Park, JJ, Lee, SH. A systematic review on current status of health technology reassessment: Insights for South Korea. Health Res Policy Syst. 2016;14:82.CrossRefGoogle ScholarPubMed
19.Porter, ME. What is value in health care? N Engl J Med. 2010;363:2477–2481.CrossRefGoogle ScholarPubMed
20.Elshaug, AG, Rosenthal, MB, Lavis, JN, et al. Levers for addressing medical underuse and overuse: Achieving high-value health care. Lancet. 2017;390:191–202.CrossRefGoogle ScholarPubMed
21.Bhatia, RS, Levinson, W, Shortt, S, et al. Measuring the effect of Choosing Wisely: An integrated framework to assess campaign impact on low-value care. BMJ Qual Saf. 2015;24:523–531.CrossRefGoogle ScholarPubMed
22.Morgan, DJ, Brownlee, S, Leppin, AL, et al. Setting a research agenda for medical overuse. BMJ. 2015;351:h4534.CrossRefGoogle ScholarPubMed
23.Elshaug, AG, Hiller, JE, Tunis, SR, Moss, JR. Challenges in Australian policy processes for disinvestment from existing, ineffective health care practices. Aust N Z Health Policy. 2007;4:23.CrossRefGoogle ScholarPubMed
24.Scotland, G, Bryan, S. Why do health economists promote technology adoption rather than the search for efficiency? A proposal for a change in our approach to economic evaluation in health care. Med Decis Making. 2017;37:139–147.CrossRefGoogle Scholar
25.Saini, V, Brownlee, S, Elshaug, AG, Glasziou, P, Heath, I. Addressing overuse and underuse around the world. Lancet. 2017;390: 105–107.CrossRefGoogle ScholarPubMed
26.National Institute for Health and Care Excellence. Do not do recommendations 2016 [cited 2016 July 27]. https://www.nice.org.uk/savingsandproductivity/collection?page=1&pagesize=2000&type=do not do (accessed March 2, 2018).Google Scholar
27.Elshaug, AG, Watt, AM, Mundy, L, Willis, CD. Over 150 potentially low-value health care practices: An Australian study. Med J Aust. 2012;197:556–560.CrossRefGoogle ScholarPubMed
28.Paprica, PA, Culyer, AJ, Elshaug, AG, Peffer, J, Sandoval, GA. From talk to action: Policy stakeholders, appropriateness, and selective disinvestment. Int J Technol Assess Health Care. 2015;31:236–240.CrossRefGoogle ScholarPubMed
29.Daniels, T, Williams, I, Robinson, S, Spence, K. Tackling disinvestment in health care services: The views of resource allocators in the English NHS. J Health Organ Manag. 2013;27:762–780.CrossRefGoogle ScholarPubMed
30.Rooshenas, L, Owen-Smith, A, Hollingworth, W, Badrinath, P, Beynon, C, Donovan, JL. “I won't call it rationing. . .”: An ethnographic study of healthcare disinvestment in theory and practice. Soc Sci Med. 2015;128:273–281.CrossRefGoogle ScholarPubMed
31.Grimshaw, JM, Thomas, RE, MacLennan, G, et al. Effectiveness and efficiency of guideline dissemination and implementation strategies. Health Technol Assess. 2004;8: iii-iv, 1–72.CrossRefGoogle ScholarPubMed
32.Michie, S, Johnston, M, Francis, J, Hardeman, W, Eccles, M. From theory to intervention: Mapping theoretically derived behavioural determinants to behaviour change techniques. Applied Psychol. 2008;57:660–680.CrossRefGoogle Scholar
33.Polisena, J, Clifford, T, Elshaug, AG, Mitton, C, Russell, E, Skidmore, B. Case studies that illustrate disinvestment and resource allocation decision-making processes in health care: A systematic review. Int J Technol Assess Health Care. 2013;29:174–184.CrossRefGoogle ScholarPubMed
34.Prasad, V, Ioannidis, J. Evidence-based de-implementation for contradicted, unproven, and aspiring healthcare practices. Implement Sci. 2014;9:5908–5909.CrossRefGoogle ScholarPubMed
35.Sevick, K, Soril, LJJ, MacKean, G, Noseworthy, TW, Clement, FM. Unpacking early experiences with health technology reassessment in a complex healthcare system. Int J Healthc Manag. 2017: 1–7.Google Scholar
Supplementary material: File

Soril et al. supplementary material 1

Soril et al. supplementary material

Download Soril et al. supplementary material 1(File)
File 53.4 KB