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Unraveling Social and System Demographics in Health Technology Assessment

Delve into how the IHE tackles social and system demographical information in HTA reports, exploring population dynamics, care patterns, and more. Discover the challenges faced in searching for SSD info and the methodologies employed.

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Unraveling Social and System Demographics in Health Technology Assessment

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  1. Searching for Social and System Demographical Information: Providing Context in HTA Liz Dennett, Dagmara Chojecki June 24, 2012

  2. Outline Background – IHE/HTA Unit/ AHTDP/ STEP Reports What does the HTA lit say about SSD info? Why is searching for SSD info so difficult? IHE SSD Workshop How the IHE tackles SSD info

  3. IHE

  4. HTA Unit, AHW, & AHTDP

  5. STE(P) Reports • T- Technology Effects and Effectiveness • Safety, efficacy/effectiveness, risks, side effects, adverse events, • Health Canada approvals • Best practice guidelines • E- Economics • Lit review • Economics Analysis • Unit costs, services avoided, demand estimates, results of economic evaluation • (P)- Policy*

  6. STE(P) Reports • S- Social Systems and Demographics • Patterns of Illness • Burden of illness • Population dynamics • Patterns of care • History • Procedures Overview and Trends • Access to Technology in Alberta • Demand for Technology • Health System Capacity (Workforce and Infrastructural)

  7. SSD at IHE: Patterns of Illness Questions What are the population dynamics and the prevalence/ incidence of the condition in Alberta and/or Canada? What is the burden of the condition (i.e. in terms of associated complications/co-morbidities, mortality, and impact on psycho-social, lifestyle, quality of life, and economic situation?

  8. Patterns of Care Questions What is the standard of care for the condition in Alberta or similar jurisdictions? Any issues surrounding acceptability of, adherence to, or compliance associated with treatment? Any quality of life issues associated with treatment? Any ethical issues associated with treatment?

  9. Patterns of Care Questions cont’d What is the current demand/ utilization of the treatment in Alberta? What is the capacity (staff and infrastructure) of Alberta system to provide this treatment? Do barriers exist to accessing/using this treatment in Alberta (e.g. patient characteristics, system barriers)

  10. What Does the HTA Lit Say About SSD Info? • Focus on methods for T & E sections • No agreed upon placement/makeup of sections in reports • Background info? • Incorporated into T & E? • Patient Section & Organizational Section? • In discussion section/separate review/combined results • Ethics?

  11. What Does the HTA Lit Say About SSD Info? • No agreement upon search/analysis methodology • Standard SR methods (search & analysis)? • Cherry picking & synthesized sources (textbooks etc…)? • Qualitative analysis methods or lit review? • Primary research (surveys, interviews, focus groups, patient websites)?

  12. SSD Searching Isn’t Easy Answering multiple, broad questions Vague concepts with no directly relevant MeSH headings Long, complex search strategies mean that translating between databases is time consuming Limiting by study type is problematic Need information relevant to local context

  13. Searching for SSD at IHE • Found searches challenging. After the first three or four we held a workshop to discuss this. Started doing separate searches for this section in 2008 Only six topics so far: HPV Vaccination, Insulin Pump, Bariatrics, First and Second Trimester Screening, Islet transplant, Hysteroscopic Tubal Sterilisation Not all STE reports include an S section. If timelines are particularly short, we try to negotiate it out.

  14. IHE Workshop Summer 2010 4 Information Specialists, client representative, IHE research analysts Discussed overall methodology of section as well as three questions relating to the search

  15. Question 1: For each SSD question, are answers likely to be in the literature or are they better answered by non-literature sources? Literature : Population dynamics, burden of condition, standard of care, background info on technology, ethical, accessibility, acceptability, QoL issues with technology Administrative databases : population dynamics Expert Advisory Group or other healthcare providers: system capacity, uptake/diffusion in Alberta, barriers specific to Alberta

  16. Question 2: For questions best answered by literature, which resources should be used and how can we do it efficiently? Created a table of which resources work best for which question (handout) Decision that for certain background questions, a single current source such as Dynamed or another evidence based textbook could be appropriate Decision to predominantly use MEDLINE when a bibliographic database made the most sense.

  17. Question 3: What keywords and MeSH headings provide the best search results for the social and demographic sections? Since no one else was experienced at doing comprehensive searches at this workshop, we shared the list of headings and keywords that the IHE IS came up with in the process of conducting multiple SSD searches (handout)

  18. Basic Approach to SSD searching For Patterns of Illness searching: Population + (burden, demographics, QoL, economic) May use more restrictive limits to reduce large sets (geographic, date, reviews) For Patterns of Care searching: Population + Intervention(s) + (QoL, ethics, access, acceptability) May use fewer limits if appropriate

  19. Additional learnings since workshop Although it might be better to directly contact staff to find out information about health system capacity there are ethical implications of doing so Improved search for ethical issues thanks to Sigrid Droste’s IJTAHC paper and work at IHE done in this area Add in additional non-medical databases Doing a grey lit search for all three sections at the same time is practical and time saving

  20. References Goodman CS. HTA 101: Introduction to Health Technology Assessment [Internet]: NLM; 2004. Available from: http://www.nlm.nih.gov/nichsr/hta101/ta101_c1.html Velasco M, Perleth M, Drummond M, Gürtner F, Jørgensen T, Jovell A, Malone J, Rüther A, Wild C. Best practice in undertaking and reporting health technology assessments. Working group 4 report Int J Technol Assess Health Care 2002 Spring;18(2):361-422. Kristensen FB & Sigmund H (ed.) Health Technology Assessment Handbook. Copenhagen: Danish Centre for Health Technology Assessment, National Board of Health, 2007 Centre for Reviews and Dissemination, York University. Systematic Reviews: CRD’s Guidance for Undertaking Reviews in Health Care. York: CRD, University of York, 2009. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane-handbook.org. Droste S, Dintsios CM, Gerber A. Information on ethical issues in health technology assessment: how and where to find them. Int J Technol Assess Health Care. 2010 Oct;26(4):441-9.

  21. Thank you very muchfor your attention! www.ihe.cadchojecki@ihe.caldennett@ihe.ca Questions?

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