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HTARC Fudan University

Monitoring GARD Initiative-Shanghai Pilot Study on HTA

Professor Jie Chen

Key Lab of Health Technology Assessment, MOH

HTARC Fudan University

Outline��������

����� Overview of Health Technology & Assessment( HTA)� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �

����� The Role of HTA for GARD* Action Plan� � � � � � �� � � � � � �� � � � � � �� � � � � � � � � � � � � � � � � � � � � � � � � � �� � � � � � � �� � � � � � � �� � � � � � � �

�� Shanghai Pilot Study on QC&HTA QC&HTA � � � � � � �� � � � � � �� � � � � � �� � � � � � �

����� QCCRM work in ShanghaiQCCRM � � � ! � " �� � � ! � " �� � � ! � " �� � � ! � " �

* GARD����Global Alliance Against Chronic Respiratory Diseases � � � � � � � � �� � � � � � � � �� � � � � � � � �� � � � � � � � �

HTARC Fudan University

�� Overview of Health Technology & Assessment(HTA)

������������������������������������������������

HTARC Fudan University

Health Technology �HT�Definition� � � � �

• Health Technology is considered to include the drugs, devices, medical and surgical proceduresused in healthcare delivery, the knowledgeassociated with this, as well as the organisationaland support systems within which such care is provided

� � � � � � � � � � � � �� � �

����� � � � � � � � � ! " # $ %&

' # $ � ( ) � * + , #

HTARC Fudan University

Support system����������������

Components of HT� � � � �

Procedure� �� �� �� �

Knowledge� �� �� �� �

Medical Device � � � � � � � �

Drugs � � � �

Equipment

� �� �� �� �

HTARC Fudan University

HTA Definition ��������(1)• HTA is a systematical evaluation on property, effects and

other impacts of HT

# � � � � � $ %# � � � � � $ %# � � � � � $ %# � � � � � $ % &&&&' ( � ) * + , - � . / � 0' ( � ) * + , - � . / � 0' ( � ) * + , - � . / � 0' ( � ) * + , - � . / � 0

• HTA is a comprehensive form of policy research that examines the short- and long-term social consequences of the application or use of technology

# � � 1 � 2 3 � 4 5 � 6 5 7 8 + , - � 9 : � � �# � � 1 � 2 3 � 4 5 � 6 5 7 8 + , - � 9 : � � �# � � 1 � 2 3 � 4 5 � 6 5 7 8 + , - � 9 : � � �# � � 1 � 2 3 � 4 5 � 6 5 7 8 + , - � 9 : � � �

�; < = 2 >�; < = 2 >�; < = 2 >�; < = 2 >

• HTA aims to provide useful information to health policies-making

? � @ A � � � � B C � 9 : D E F G H I? � @ A � � � � B C � 9 : D E F G H I? � @ A � � � � B C � 9 : D E F G H I? � @ A � � � � B C � 9 : D E F G H I

HTARC Fudan University

• HTA can foresee the directed, expected outcome of HT, deal with the indirected, unexpected outcome caused by HT

J K L M � � � � N O P Q � ' ( � R O � S T U (J K L M � � � � N O P Q � ' ( � R O � S T U (J K L M � � � � N O P Q � ' ( � R O � S T U (J K L M � � � � N O P Q � ' ( � R O � S T U (

• HTA employs the specific framework and methods

V � W X � Y Z [ \ � ] ^V � W X � Y Z [ \ � ] ^V � W X � Y Z [ \ � ] ^V � W X � Y Z [ \ � ] ^

• HTA is performed by multi-discipline collaboration

� � � � � � _ ` a b = � Q c 3� � � � � � _ ` a b = � Q c 3� � � � � � _ ` a b = � Q c 3� � � � � � _ ` a b = � Q c 3

HTA Definition ��������(2)

HTARC Fudan University

Basic HTA Orientations� � � � � � � �� � � � � � � �� � � � � � � �� � � � � � � �

• Technology-oriented assessments are intended to determine the characteristics or impacts of particular technologies.�������������������������������� � � � ��� � � � � ��� � � � � ��� � � � � ��� � ����� �� �� �� � ����� � �� � �� � �� � � ����

• Problem-oriented assessments focus on solutions or strategies for managing a particular problem for which alternative or complementary technologies might be used.� � ������� � ������� � ������� � ������ � � � � � � � �� � � � � � � � � � � �� � � � � � � � � � � �� � � � � � � � � � � �� � � � !!!!" # $ � � % & ' ( ) *" # $ � � % & ' ( ) *" # $ � � % & ' ( ) *" # $ � � % & ' ( ) *

+ �, - ��� . / ��+ �, - ��� . / ��+ �, - ��� . / ��+ �, - ��� . / ��

• Project-oriented assessments focus on a local placement or use of a technology in a particular institution, program, or other designated project.0 1 ������0 1 ������0 1 ������0 1 ������ � � � �� � 2 3� � � �� � 2 3� � � �� � 2 3� � � �� � 2 3 44445 6 � 7 8 9 � 05 6 � 7 8 9 � 05 6 � 7 8 9 � 05 6 � 7 8 9 � 0

1 : �; < = )1 : �; < = )1 : �; < = )1 : �; < = ) >>>>

HTARC Fudan University

Why HTA is necessary?��������������������������������

• Technology as two sides of a coin ����������������������������

–Advantagesdddd•Technology innovation � � e f� � e f� � e f� � e f

•Improve medical quality g h i j % kg h i j % kg h i j % kg h i j % k

•Enhance population’s health F l m n o pF l m n o pF l m n o pF l m n o p

–Disadvantagesqqqq•Adverse effects caused by technologies � � P Q � r s U (� � P Q � r s U (� � P Q � r s U (� � P Q � r s U (

•Ethic dispute t u v wt u v wt u v wt u v w

•Excess increase of medical expense i j x � y z { 6i j x � y z { 6i j x � y z { 6i j x � y z { 6

HTARC Fudan University

Why HTA is necessary?��������������������������������

• Visibility of new technologies ��������������������������������

• High expenditures for health care � ��� � � � ��� � � � ��� � � � ��� � �

• Necessity to begin to rationalize health care technology � � ��� � � � �� �� � ��� � � � �� �� � ��� � � � �� �� � ��� � � � �� �

HTARC Fudan University

Content������ ������� ������� ������� �

• Technical properties ��� ���� ���� ���� �

• Safety � � � �

• Efficacy and effectiveness � � � �� � � �� � � �� � � �

• Cost and other economic attributes � � �� � �� � �� � �

• Social, legal, ethical, or political impacts � �� �� �� � ����� �� �� �� � ����� � � � � � � �� � � � � � � �� � � � � � � �� � � � � � � �

HTARC Fudan University

A Process for HTA��������������������������������

Testing� �� �� �� �

Identification� �� �� �� �

Synthesis� �� �� �� �

Dissemination� �� �� �� �

Banta, D. Health care technology and its assessment

HTARC Fudan University

Two Main Groups of Studies (Methods) � � � � � � � � � � � � � � � � � � � � � � � � � � � �

• Primary data collection � � ! " #� � ! " #� � ! " #� � ! " #

– Collect original new data, for example, using experiments

� � � � � � � �� � � � � � � �� � � � � � � �� � � � � � � � ����� �� �� �� � ����� � � � � �� � � � � �� � � � � �� � � � � �

• Secondary data analyses $ % & ! ' ($ % & ! ' ($ % & ! ' ($ % & ! ' (

– Combine (Synthesize or integrate) data from existing sources � � � � !� � � � !� � � � !� � � � ! ( " # $ % & #" # $ % & #" # $ % & #" # $ % & # )

HTARC Fudan University

Secondary Data Analyses����������������������������

• Expert opinion | } S ~| } S ~| } S ~| } S ~

• Group judgment (Consensus development) � � � �� � � �� � � �� � � � ����� � �� S ~� � �� S ~� � �� S ~� � �� S ~ ����

• Literature review � � � �� � � �� � � �� � � �

• Meta-analysis � � < = Y Z� � < = Y Z� � < = Y Z� � < = Y Z

• Decision analysis, other modeling � : Y Z � ) * � �� : Y Z � ) * � �� : Y Z � ) * � �� : Y Z � ) * � �

HTARC Fudan University

��������The Role of HTA for GARD Action Plan

� � � � � � � � � � � � � � � � GARD � � � � � � � �� � � � � � � �� � � � � � � �� � � � � � � �

HTARC Fudan University

• To reduce the global burden of CRDs' ( � � � � � ) � * +' ( � � � � � ) � * +' ( � � � � � ) � * +' ( � � � � � ) � * +

• To better recognize, prevent and manage CRDs, - . /, - . /, - . /, - . / ����0 � 1 2 3 � � � � � ) �0 � 1 2 3 � � � � � ) �0 � 1 2 3 � � � � � ) �0 � 1 2 3 � � � � � ) �

• To propose an action plan for CRDs, coordinated by the WHO4444WHO� # 5 6� # 5 6� # 5 6� # 5 6 ����7 87 87 87 8 CRDs 9 : ; <9 : ; <9 : ; <9 : ; <

• To foster country focused initiatives according to the specialneeds of each specific country= � > ? @ A B C D E F G H I= � > ? @ A B C D E F G H I= � > ? @ A B C D E F G H I= � > ? @ A B C D E F G H I CRDs 9 :9 :9 :9 :

Goals of GARD� �� �� �� �

HTARC Fudan University

• To help the admission of Health technology� � � � � � � � �� � � � � � � � �� � � � � � � � �� � � � � � � � �

• To the selection of benefit package for health insurance � � � � � d� � � � �� � � � � d� � � � �� � � � � d� � � � �� � � � � d� � � � �

• To decide the appropriate intervention of clinical practice � � = � � � � � L ] �� � = � � � � � L ] �� � = � � � � � L ] �� � = � � � � � L ] �

• To support scientific evidence for policy makerA � � 9 : D � � F G b a �  A � � 9 : D � � F G b a �  A � � 9 : D � � F G b a �  A � � 9 : D � � F G b a �  

The Role of HTA for GARDHTA����GARD � � � �� � � �� � � �� � � �

HTARC Fudan University

���� Shanghai Pilot Studyon QC&HTA

QC&HTA � � � � � �� � � � � �� � � � � �� � � � � �

HTARC Fudan University

A proposal of practicing GARD in ShanghaiGARD � � � � � � !� � � � � � !� � � � � � !� � � � � � !

The Platform of Quality Control and Health Technology Assessment for Respiratory Medicine in Shanghai ) * + , - . / 0 1 2 3 4 5 6 ��7 8 9 :) * + , - . / 0 1 2 3 4 5 6 ��7 8 9 :) * + , - . / 0 1 2 3 4 5 6 ��7 8 9 :) * + , - . / 0 1 2 3 4 5 6 ��7 8 9 :

HTARC Fudan University

• To reduce chronic respiratory disease burden ; < = �. / > 0 ? @; < = �. / > 0 ? @; < = �. / > 0 ? @; < = �. / > 0 ? @

- asthma ¡ ¢¡ ¢¡ ¢¡ ¢- chronic obstructive pulmonary disease£ $ ¤ ¥ $ ¦ § ¨£ $ ¤ ¥ $ ¦ § ¨£ $ ¤ ¥ $ ¦ § ¨£ $ ¤ ¥ $ ¦ § ¨

- occupational lung disease © ª $ ¦ ¨© ª $ ¦ ¨© ª $ ¦ ¨© ª $ ¦ ¨

- lung cancer ¦ «¦ «¦ «¦ «

Objective� � � �

HTARC Fudan University

• The Quality Control Center for Respiratory Medicine (Zhongshan HospitalAAAA¬ ­ ¨ % k ® D � ¯¬ ­ ¨ % k ® D � ¯¬ ­ ¨ % k ® D � ¯¬ ­ ¨ % k ® D � ¯ ����� ° i ±� ° i ±� ° i ±� ° i ± ����

- Collecting data for practicing the guidelinesA ² ³ ´ µ ¶ · ¸  A ² ³ ´ µ ¶ · ¸  A ² ³ ´ µ ¶ · ¸  A ² ³ ´ µ ¶ · ¸  

- Supervising the quality of facilities and human resources of hospitals i ± ¹ º � m » ¼ ½ % k � ¾ ¿i ± ¹ º � m » ¼ ½ % k � ¾ ¿i ± ¹ º � m » ¼ ½ % k � ¾ ¿i ± ¹ º � m » ¼ ½ % k � ¾ ¿

- Inspecting the hospital performance and qualityi ± À ' � % k � Á Âi ± À ' � % k � Á Âi ± À ' � % k � Á Âi ± À ' � % k � Á Â

Background � �� �� �� � � � �� � �� � �� � �

HTARC Fudan University

• The Key Lab of Health Technology Assessment, MOH in ChinaBBBBFudan UniversityAAAA� � à � � � � � � Ä � ² Å Æ� � à � � � � � � Ä � ² Å Æ� � à � � � � � � Ä � ² Å Æ� � à � � � � � � Ä � ² Å Æ ����Ç È É aÇ È É aÇ È É aÇ È É a ����

-Research � �� �� �� �-Training Ê ËÊ ËÊ ËÊ Ë-Information H IH IH IH I-Communication and collaboration Ì Í Î = �Ì Í Î = �Ì Í Î = �Ì Í Î = �

Background � �� �� �� � � � �� � �� � �� � �

HTARC Fudan University

The HTA Research Center of Fudan University is an active naThe HTA Research Center of Fudan University is an active national and tional and international organizationinternational organization ����������� ����������������� ����������������� ����������������� ��������������������� ����������������� ����������������� ����������������� ����������

�� � � � � ��� � � � � ��� � � � � ��� � � � � ��� � � � � ��� � � � � ��� � � � � ��� � � � � � � � �� � �� � �� � �� � �� � �� � �� � � � �� �� �� �� �� �� �� �

HTARC Fudan University

Organization � � � �� � � �� � � �� � � �

QCCRM&HTA

Advisory ��������

Steering � �� �� �� �

Departments or Divisions for Respiratory Medicine, � � � � � � � � � � � � � � � �

at 58 Hospitals in Shanghai

Supervising � �� �� �� �

������������������������������������

� � � � � �� � � � � �� � � � � �� � � � � �

HTARC Fudan University

• Information (data collection) H IH IH IH I ����¸   ¶ ·¸   ¶ ·¸   ¶ ·¸   ¶ · ����

• Training (capacity building) Ê ËÊ ËÊ ËÊ Ë ����Ï » Ê ÐÏ » Ê ÐÏ » Ê ÐÏ » Ê Ð ����

• Developing standard clinical pathway Ñ � � � Ò Ó � ÔÑ � � � Ò Ó � ÔÑ � � � Ò Ó � ÔÑ � � � Ò Ó � Ô

• Disease management(quality and cost control)

§ ¨ ¿ u§ ¨ ¿ u§ ¨ ¿ u§ ¨ ¿ u ����% k � 3 Õ ® D% k � 3 Õ ® D% k � 3 Õ ® D% k � 3 Õ ® D ����

• Medical technology assessment������• Inspection &supervising hospital performancei ± À ' � ¾ ¿i ± À ' � ¾ ¿i ± À ' � ¾ ¿i ± À ' � ¾ ¿

Main Action � � � �� � � �� � � �� � � �

HTARC Fudan University

��������QCCRM work in Shanghai

QCCRM � � � " # � $ �� � � " # � $ �� � � " # � $ �� � � " # � $ �

HTARC Fudan University

-Professor Chunxue Bai (Zhongshan Hospital)� � � � � � � � � � � � ����� � �� � �� � �� � � ����

The work has been done by QCCRM in recent two years� � �� � �� � �� � � QCCRM � � � � �� � � � �� � � � �� � � � �

HTARC Fudan University

-Support from GARD GARD��������- Support from WHO WHO ��������

Expectation � �� �� �� �

HTARC Fudan University

Thank you����

HTARC Fudan University

-Prof. Chunxue Bai (Zhongshan Hospital, Fudan University)� � � � � � � � � � � � ����� � � � � � �� � � � � � �� � � � � � �� � � � � � � ����

QCCRM Accomplishmentin the past two years� � �� � �� � �� � � QCCRM � � � � �� � � � �� � � � �� � � � �

HTARC Fudan University

QCCRM in Shanghai

Launch of QCCRM in Shanghai, March 23, 2004

HTARC Fudan University

Main Work In 2004

• QCCRM has investigated all the necessary data (including facilities and human resources) at 58 departments of Respiratory Medicine in Shanghai.

• QCCRM has developed simple guidelines for COPD, ARDS according to the related guidelines .

HTARC Fudan University

Main Work In 2005• QCCRM had supervised the quality of

facilities and human resources for all the Departments of Respiratory Medicine in Shanghai.

• QCCRM had developed simple guidelines for mechanical ventilation, nebulizing therapy and antibiotic therapy according to the related guidelines.

HTARC Fudan University

How to perform Quality Control for Respiratory Medicine?

HTARC Fudan University

Set up scoring criteria

• Regularly Convened Steering Committee is responsible for supervision scoring criteria and considering related guidelines.

• Get approval from the joint meeting by Regularly Convened Steering Committee & Advisory Committee.

HTARC Fudan University

Rehearsal of Supervising Committee

• 42 censors of Supervising Committee were trained before supervision according the scoring criteria .

• In order to standardize the scoring criteria and guarantee the justness, QCCRM supervised 2 hospitals in advance as rehearsal .

HTARC Fudan University

Example of the first supervision

• Rules and regulations – the records of professional education,

malpractice, death discussion, intractable case discussion

– shifting of duty• Case history and discharge abstract

– the medical records in out-patient clinic – the diagnosis background – the discharge abstracts

• Three-grade clinical roundsThe records of discussion and solution

HTARC Fudan University

Example of the first supervision

• Applying medical techniquesthe common techniques

• Emergency and monitoring: – the emergency apparatus – Respiratory Care Unit.

• Examination on site– theory – X-ray reading

• Human resources

HTARC Fudan University

2����3.4��������

1����1.7��������

11����19.0��������

31����53.4��������

13����22.4��������

Total

2110214Class IIA

001109Class III

under qualifiedScore<60

PassedScore> 60

MiddlingScore> 70

FineScore> 80

ExcellentScore> 90Hospital

classification

Results (June, 2005)

HTARC Fudan University

Feedback of the results• The censors pointed out the problems

on site and fed back the results after supervision.

• QCCRM sent the supervision proposal in document to those hospitals with severe problems based on the inspection.

HTARC Fudan University

Recheck

• Recheck the scores for all hospitals after half year.

• The four worst scored hospitals made some progress.

HTARC Fudan University

Main Work In 2006• QCCRM will be supervising the

practice of pulmonary function test, nebulizing therapy, mechanical ventilation and antibiotic therapy according to the guidelines .

HTARC Fudan University

Summary• It has been quite cooperative between

QCCRM and each hospital in Shanghai.• QCCRM has been capable of managing the

necessary data (including facilities and human resources) from all the Departments of Respiratory Medicine in Shanghai.

• QCCRM is such an unique platform with the function of supervision that it could play a very important role for GUARD.

HTARC Fudan University

-Support from GARD (GARD��������)- Support from WHO (WHO ��������)

Expectation � �� �� �� �

HTARC Fudan University

Thank you����

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