Chantale Lessard, BPharm, MSc, PhD (Cand) Ana î s Tanon, MSc, PhD (Cand)

1. Potential Roles forHealth 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 MontréalFaculté de médecineProgramme de formation interdisciplinaire AnÉISC.P. 6128, succursale Centre-VilleMontréal (Québec) H3C 3J7Tel: 514-343-6111 ext. 1998www.medsp.umontreal.ca/aneis/ chantale.lessard@umontreal.ca aam.tanon@umontreal.ca