11/10/2015 Sinikka Sihvo1 Impact of Managed Uptake of Medical Methods (MUMM) - program on uptake of new technologies in secondary health care in Finland Sinikka Sihvo 1, Tuija S Ikonen 1, Sirpa-Liisa Hovi 1, Marjukka Mäkelä 1, Risto P. Roine 2, Pirjo Räsänen 2, 1) Finohta, THL (National Institute of Health and Welfare) 2) Hospital District of Helsinki and Uusimaa

Managed Uptake of Medical Methods (MUMM) A joint venture of the 20 hospital districts providing specialized care and Finnish Office for Health Technology Assessment (Finohta) started in 2006 The aim is to use critical appraisal and joint decisions in uptake of new methods Effectiveness / Efficacy Safety Costs 11/10/2015 Sinikka Sihvo22

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11/10/2015 Sinikka Sihvo4 4 MUMM recommendations (Traffic light model) Should be used - may have limitations Should not be used Use while gathering information research, registry, literature

11/10/2015 Sinikka Sihvo5 MUMM recommendation: Induced hypothermia in the treatment of acute brain damages Content: * Effectiveness * Safety * Costs * Restrictions * Distribution of work * Prodedure code (new)

11/10/2015 Sinikka Sihvo6 Since 2008: 38 recommendations for 32 technologies: red 3 red yellow 19 yellow green 14 green

Objective Since the program started in 2006, there is a need to evaluate its impact The objective was to evaluate the impact of MUMM program on the uptake of assessed methods 11/10/2015 Sinikka Sihvo 7

Methods 1) Methods in MUMM reviews/recommendations from years were searched from the National Hospital Discharge Register using procedure codes. ► Correspondence of trend of a procedure and the colour of traffic light were compared 2) A query to hospital districts on one method (STAN) which had a red light recommendation 3) A survey for chief physicians responsible for decisions about uptake of new methods in hospital districts in May-June /10/2015 Sinikka Sihvo8

Results Based on the Hospital Discharge Register: 11/10/2015 Sinikka Sihvo9

Green light Source: National Hospital Discharge Register

Yellow light Spinal nerve stimulation in severe neuropathic pain (2009) Green laser treatment of benign prostatic hyperplasia (2009)

Red light Fetal intrapartum surveillance with STAN – recommendation in May 2009 –a survey for hospital districts in September 2009 (17/20 responded)

Results from survey to chief physicians ” The contents of MUMM recommendations are unambigious and easy to understand” 11/10/2015 Sinikka Sihvo13

”There is enough informing about MUMM recommendations” 11/10/2015 Sinikka Sihvo14

”MUMM recommendations are followed/obeyed well in my specialty” 11/10/2015 Sinikka Sihvo15

Conclusions (1) This was a first attempt to evalute impact of recommendations in MUMM programme: Hospital discharge registers are currently inadequate source for evaluation since prodedure codes are often missing Impact of other factors than recommendations on seen changes cannot be ruled out MUMM recommendations are not yet well known -> need for more informing 11/10/2015 Sinikka Sihvo16

Conclusions (2) Large number of yellow lights makes evaluation difficult Inclusion of the code on MUMM recommendations hopefully will increase use of codes in the future Methods to follow impact of recommendations need to be developed Especially for those methods that are not registered anywhere Systematic follow-up for RED lights 11/10/2015 Sinikka Sihvo17