1. Potential Roles for Health Technology Assessment Agencies: Opportunities and Challenges for an Effective Health Technology Assessment Practice at the Meso Level Chantale Lessard, BPharm, MSc, PhD (Cand) Anaîs Tanon, MSc, PhD (Cand) 2005 Joint CES/AEA Conference Toronto, Ontario, Canada October 24-30, 2005

2. Overview  Health technology assessment (HTA)  Current situation  Objectives and Methods  Analysis  Proposed roles for HTA agencies  Conclusion

3. Health technology assessment (HTA)  Health technology  Pharmaceutical and devices  Vaccines  Medical and surgical procedures  Prevention and rehabilitation  Health services and organization

4. Health technology assessment (HTA)  Multidisciplinary field of policy analysis  Medical, economic, social, and ethical implications of development, introduction, diffusion, and utilization of health technology  Provide rigorous and objective data to inform and improve the health care decision-making process

5. HTA Agencies  Support their Minister of Health and decision makers in their healthcare system by means of HTAs  Macro (policy) level  Meso (administrative) level  Micro (clinical) level  International Network of Agencies for Health Technology Assessment (INAHTA)  41 member agencies in 21 countries

6. Current situation  With the growth of healthcare costs, policy makers and managers have begun to turn towards HTA  HTA agencies have focused on the macro level  Use and diffusion of health technologies occur primarily in hospitals  Little evidence at the meso level  Use of HTA in the decision-making process  Potential roles for HTA agencies

7. Objectives  Propose roles for HTA agencies at the meso (hospital) level  Highlight opportunities and challenges for an effective HTA practice

8. Methods  Literature review  Hospital-based HTA programs  Determinants influencing hospital work environments

9. Organizational and professional cultures in hospitals  Many professionals bring their skills to the task  Community  Managers  Physicians  Nurses and other health professionals  Critical role of expertise and values  Significant differences between hospitals

10. Decision-making process in hospitals  Various competing arguments can influence the decision-making process  Power is a determining factor in medical decisions  Opinions of peers, prevailing positions at a given hospital, influence of leaders, and ability of physicians to reconcile clinical and administrative perspectives also influence the decision-making process

11. Decision-making process in hospitals  Lack of available information may force an intuitive decision-making approach inspired by  The hospital's history, vocation and technology  Changes in the composition of the medical staff  Political arguments and lobbying by interest groups bring influence to bear in the decision-making process

12. Management of health technologies in hospitals  Introduction, diffusion, utilization and withdrawal of health technologies  Ethical debates  New technologies focus on the patient's individual needs  New technologies also call for society's responsibilities to act in its citizens' interest

13. Management of health technologies in hospitals  Lack of structure in technology management  Technology management is embedded in an organizational dynamic  Decisions made in a context of limited rationality

14. HTA in hospitals  Few arguments describing how HTA practice should be adopted, implemented and sustained  No investment made in the financial, human and physical resources necessary  Hospitals have always operated otherwise

15. HTA in hospitals  Players have divergent views of the professional and organizational issues underlying the rationalization of the use of technologies  Weak impact of HTA reports on decisions and practices in hospital settings

16. Potential roles for HTA agencies - Development of a HTA culture in hospitals  Identify key players  On a priority basis in university hospitals  HTA agencies should be proactive in promoting their functions and activities, and disseminating their reports

17. Potential roles for HTA agencies - Development of a HTA culture in hospitals  Promote the rational dissemination of new technologies  Institute incentives for using HTA information in the decision-making process  Seek a consensus among the players

18. Potential roles for HTA agencies - Development of a HTA culture in hospitals  Institute exchange and discussion mechanisms enabling managers, physicians, nurses and other health professionals, and the community to develop a better understanding of HTA  “Infiltrate” the users’ exchange forums

19. Potential roles for HTA agencies - Development of HTA services tailored to the needs of hospitals  Recognize the complexity of health care  HTA agencies should be resolutely oriented toward a transdisciplinary knowledge production mode  Oriented toward applying complex knowledge  Multidisciplinary team  Sensitive to its impact on several types of stakeholders

20. Potential roles for HTA agencies - Development of HTA services tailored to the needs of hospitals  Identify HTA users and their needs  Deliver HTA information that is accessible, relevant, reliable, credible, useful, and available in a timely manner  Achieve a balance in the information included in HTA reports  Disseminate HTA information effectively

21. Potential roles for HTA agencies - Development of HTA services tailored to the needs of hospitals  Make greater investments  Human, physical and financial resources needed for the activities and tasks relating to adapting the disseminated results to the users' needs  Dissemination efforts  Exchange mechanisms between HTA researchers and users

22. Conclusion  The development of a HTA culture in hospitals is a sine qua non  HTA agencies must turn towards a transdisciplinary knowledge production mode  Particularly relevant for contextual knowledge, which is often ignored or marginalized in HTA  Extension of stakeholders involvement in the production, evaluation and application of HTA knowledge  Policy role of HTA

23. Université de Montréal Faculté de médecine Programme de formation interdisciplinaire AnÉIS C.P. 6128, succursale Centre-Ville Montréal (Québec) H3C 3J7 Tel: 514-343-6111 ext. 1998 www.medsp.umontreal.ca/aneis/ chantale.lessard@umontreal.ca aam.tanon@umontreal.ca