Understanding Healthcare Provider
and Decision-Maker Perspectives on
Health Technology Reassessment:
A Qualitative Research Study
LESLEY J.J. SORIL, GAIL MACKEAN,
TOM W. NOSEWORTHY, FIONA M. CLEMENT
PhD Candidate, Department of Community Health Sciences, University of Calgary
Health Technology Assessment Unit, O’Brien Institute for Public Health
2016 CADTH SYMPOSIUM
DISCLOSURE STATEMENT
I have no actual or potential conflict of interest in relation
to this topic or presentation
BACKGROUND
Health technologies are considered major costdrivers in the Canadian healthcare system
Focus on managing the entry or adoption of
new technologies into the healthcare system
However, there is no standardized process for
monitoring health technologies once adopted
BACKGROUND
Sub-optimal technology use:
◦ Overuse or misuse of ineffective or harmful
technologies
◦ Underuse of effective technologies
Comprise patient safety and health, as well as
the quality of care
Wasting of valuable healthcare resources
VALUE FOR MONEY
How can we continue to monitor and manage the use of health
technologies throughout their lifecycle?
Health Technology Reassessment (HTR)
Structured, evidence-based assessment of
the clinical, economic, social and ethical
impacts of a health technology currently
used in the healthcare system, to inform
its optimal use in comparison to its
alternatives
Meaningful Stakeholder Engagement
2
3
Identification
Prioritization
DECISION
Evidence Synthesis
Policy Development
EXECUTION
Policy Implementation
Monitoring and Evaluation
Ongoing Knowledge Exchange and Utilization
1
TECHNOLOGY SELECTION
Proposed HTR Model, HTA Unit University of Calgary (2012)
IMPLICATIONS OF HTR
GOAL
Optimal use of
health technologies
throughout their
lifecycle in the
healthcare system
IMPLICATIONS OF HTR
GOAL
Optimal use of
health technologies
throughout their
lifecycle
OUTCOMES
Decrease use,
increase use,
no change, or
exit of the
technology from
the system
Can identify funds
to be reallocated to
support
investments that
provide greater
value for money
IMPLICATIONS OF HTR
GOAL
Optimal use of
health technologies
throughout their
lifecycle
OUTCOMES
Decrease use,
increase use,
no change, or
exit of the
technology from
the system
Can identify funds
to be reallocated to
support
investments that
provide greater
value for money
EXPECTATIONS
Improvements in
patient outcomes,
and quality,
safety,
appropriateness
of care
THE FIELD OF HTR
HTR is in its infancy, with few documented
accounts internationally
Practical implementation experience with HTR
emerging in Canada
Prime opportunity to study the HTR process
ALBERTA HEALTH SERVICES
Provincial healthcare delivery
organization in Alberta
Place your screenshot here
STRATEGIC
CLINICAL
NETWORKS
Place your screenshot here
Remit to
conduct HTR
activities in
Alberta
STUDY OBJECTIVE
To understand
stakeholder perspectives
on the concept of HTR
and its integration into the
Alberta healthcare system
METHODOLOGY
Data Collection
Participants
Sampling
Semi-structured telephone
interviews were conducted
from May-August 2014
Healthcare providers and
decision-makers (i.e.
administrators, operational
leaders) in AHS involved in
or with knowledge of HTR
Purposive sampling
strategy, with both
maximum variation and
snowball sampling
Relevant documents were
also reviewed
Data Analysis
Emerging Themes
Qualitative research
software (HyperResearch)
was used to support the
management and analysis
of the interview data
Constant comparative
analysis was employed to
identify key themes and to
articulate relationships
between them
RESULTS: Study Participants
RESPONDENT CATEGORY
RESPONDENT TYPE
FREQUENCY
Decision-makers*
7
Physicians
3
Decision-makers*
9
Physicians
3
SCN Affiliates
Other AHS Affiliates
TOTAL
22
*Decision-Maker: Administrative or Operational Lead
RESULTS: Emerging Themes on the Concept of HTR
Language
Understanding
Value
Proposition
LANGUAGE
Critical for creating a level set
“People get their backs up
when they hear disinvest or
savings or even waste”1
“A lot of people go on the
defense right away with it. It
needs reassessment because
you are not doing the right
thing”2
Negativity associated with
economic terminology1
Perceptions of veiled
criticism2
UNDERSTANDING
Improving existing
processes and clinical
practices
“It’s about stopping something
that has no value or is wasteful
or causes harm or all three.
Don’t waste resources”3
“Some people will take any
of the words and interpret them
as budget cuts and they go
automatically to you’re cutting
my program”4
Managing waste in the
healthcare system3
Confusing HTR with simply
rationing and budget cuts4
VALUE PROPOSITION
Ensuring benefits to the
patient is paramount5
“The product is pretty to clear
to me. Improving health and
health care for people“5
“If there is money to be saved
some of that money should
come back to that program to
allow reinvestment in other
areas of priority”6
Recognizing the value of
HTR will take time
Reinvestment is a key
incentive6
Lack of clarity around HTR
Varying conceptualizations and expectations
Stakeholders generally supportive
With recognition that waste must be addressed
and improvements can be made
Timing and time are critical
May not have been considered at the outset
STUDY CONSIDERATIONS
Alberta HTR
experience:
transferability
limited
Credibility of
findings still need
to be fully
established through
verification
Intended to focus
on perceptions of
stakeholders at
“macro” level,
concerning early
integration of HTR
initiatives into the
system
THE WAY FORWARD
Commitment to advancing the HTR agenda
Consistent leadership and broad stakeholder
engagement
Provide support and education
Development of tools and levers to enable
change
Dr. Gail MacKean
Dr. Fiona Clement
Dr. Tom Noseworthy
HTA Unit, University of Calgary
Alberta Innovates Health Solutions (AIHS)
[email protected]
web: https://obrieniph.ucalgary.ca/hta_unit
twitter: @lsoril