Decision Making and Implementation: Is evidence based policy

1. Decision Making and Implementation: Is evidence based policy/decision making possible? Health Technology Assessment � Executive Workshop Don Juzwishin, Director HTA AHFMR October 27 � 28, 2005 St. John�s, Newfoundland & Labrador

2. Background to AHFMR Established by Legislative Act 25 years ago Endowed capital Independent supports biomedical and health research at Alberta universities, affiliated institutions, and other medical and technology-related institutions Programs � HTA, RTNA, SEARCH

3. Objectives Focus on decision making and implementation Using HTA to guide decision making Policy alternatives Consultation and education � consensus building Stakeholder involvement

4. Objectives Implementation � Social & demographic Technological Economic Ethical Political Legislation & regulations Environment

5. Objectives Follow-up and Evaluation Is the technology having the intended effect? Have there been unforeseen positive and negative impacts from the policy?

6. How do we define evidence? Evidence is information that comes closest to the facts of a matter. The form it takes depends on context. The findings of high-quality, methodologically appropriate research are the most accurate evidence. Because research is often incomplete and sometimes contradictory or unavailable, other kinds of information are necessary supplements to or stand-ins for research. The evidence base for a decision is the multiple forms of evidence combined to balance rigour with expedience�while privileging the former over the latter. Canadian Health Services Research Foundation

7. What knowledge can we draw on? An analytical framework for immunization programs in Canada Erickson, De Wals, Farand Conceptualizing and combining evidence for health system guidance Lomas, Cuyler, McCutheon, McAuley, Law

10. What are the barriers to using HTA or other form of HQE in policy making? Politicians perspective Displacement of the important with the urgent Protection of interests or security HQE may not be comprehensible Evidence may not exist Evidence not contextual Separate the signal to noise ratio

11. What are the barriers to using HTA or other form of HQE in policy making? Policy maker perspective Paying lip service to HQE Timelines Differing incentives Multiple caveats Best practice in policy making? Speaking truth to power

12. What are the barriers to using HTA or other form of HQE in policy making? Researchers perspective Misaligned incentives No definition of �best practice� in policy making Data inaccessible from government Timing Focused problem statement

13. Is best practice in policy making desirable? Possible? Who thinks it is? Not? What are the issues?

14. Framework for health regions to make optimal use of HTA Structure and process embedded Sensitive to needs and priorities Integrated into accountability chain Figure 5 page 11

15. Local HTA: A guide HTA for RHAs Attributes of technologies Which technologies need to be assessed? Approaches to assessment Sources Quality of an HTA

16. AHFMR Screening Procedure Screening process Prescreening needs assessment Evidence of effectiveness Impact on operations Financial assessment Executive summary

17. Bridging the Gap Social, cultural & system demographics Technology effects and effectiveness Economic Ethics Political Legislation & regulations Environment

18. Social and system demographics Patterns of illness population Burden of illness individual Patterns of care Cultural factors

19. Technology effects and effectiveness Conditions Effects Program context Effectiveness

20. Economic Rewards/costs Incentives/disincentives Multiplier effect Market effects Externalities Cost and utilization

21. Ethics Values underlying the issue Value conflict Picking an alternative Identified values Common good Fairness & equity Benefit/harm Patient choice

22. Political Government policy Role of government Priorities for the province Health funding policy Cross jurisdictional (F/P/T) alignment Political analysis Problem definition Technology as solution Other influences Stakeholder analysis manufacturers Providers Groups Four R Analysis

23. Legislation and regulations Relevant legislation & regulations Enabling effects Constraining effects International agreements Emerging legislative constraints or facilitators

24. Environment Compared to standard treatment Social externalities Safety issues Increased risk Energy consumption

25. Build in tough challenges Relevant Timely Understandable Demonstrate magnitude of effect Show offsets to investment costs Illustrate budget impact Demonstrate patient outcomes Show system efficiencies Provide options for consideration Contextualize for health system realities Identify pressures and issues Demonstrate a high conversion rate from evidence based analysis to policy and Be transparent of stakeholder involvement. Ontario Health Technology Advisory Committee (HTPA)

26. What are the lessons? The fact value distinction needs conciliation � deal with it Not all evidence is created equal Examine standards of best practice in health care policy making

27. Questions

28. References L.J. Erickson, P. De Wals, L. Farand. An analytical framework for immunization programs in Canada.Vaccine. 2005 Mar 31;23(19):2470-6. J. Lomas, T. Culyer, C. McCutcheon, L. McAuley, and S. Law, Conceptualizing and Combining Evidence for Health System Guidance, CHSRF, May 2005. J. Brehaut, D. Juzwishin, Bridging the Gap: The use of research evidence in policy development, AHFMR, September 2005.