Understanding Healthcare Provider and Decision-Maker Perspectives on Health Technology Reassessment: A Qualitative Research StudyLESLEY J.J. SORIL, GAIL MACKEAN, TOM W. NOSEWORTHY, FIONA M. CLEMENT PhD Candidate, Department of Community Health Sciences, University of CalgaryHealth Technology Assessment Unit, O’Brien Institute for Public Health

2016 CADTH SYMPOSIUM

DISCLOSURE STATEMENTI have no actual or potential conflict of interest in relation to this topic or presentation

BACKGROUND

Health technologies are considered major cost-drivers 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

TECHNOLOGY SELECTION Identification Prioritization1

DECISION Evidence Synthesis Policy Development2 EXECUTION

Policy Implementation Monitoring and Evaluation3M

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Ongoing Know

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Proposed HTR Model, HTA Unit University of Calgary (2012)

IMPLICATIONS OF HTR

GOALOptimal use of health technologies throughout their lifecycle in the healthcare system

IMPLICATIONS OF HTR

GOALOptimal use of health technologies throughout their lifecycle

OUTCOMESDecrease 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

GOALOptimal use of health technologies throughout their lifecycle

OUTCOMESDecrease 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

EXPECTATIONSImprovements 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

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ALBERTA HEALTH SERVICES

Provincial healthcare delivery organization in Alberta

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STRATEGIC CLINICAL NETWORKS

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

SamplingPurposive sampling strategy, with both maximum variation and snowball sampling

ParticipantsHealthcare providers and decision-makers (i.e. administrators, operational leaders) in AHS involved in or with knowledge of HTR

Data CollectionSemi-structured telephone interviews were conducted from May-August 2014

Relevant documents were also reviewed

Data AnalysisQualitative research software (HyperResearch) was used to support the management and analysis of the interview data

Emerging ThemesConstant comparative analysis was employed to identify key themes and to articulate relationships between them

RESULTS: Study Participants

RESPONDENT CATEGORY RESPONDENT TYPE FREQUENCY

SCN AffiliatesDecision-makers* 7

Physicians 3

Other AHS AffiliatesDecision-makers* 9

Physicians 3

TOTAL 22

*Decision-Maker: Administrative or Operational Lead

RESULTS: Emerging Themes on the Concept of HTR

UnderstandingLanguage ValueProposition

LANGUAGE

Negativity associated with economic terminology1

Perceptions of veiled criticism2

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

UNDERSTANDING

Confusing HTR with simply rationing and budget cuts4

Managing waste in the healthcare system3

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

VALUE PROPOSITION

Recognizing the value of HTR will take time

Reinvestment is a key incentive6

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

Lack of clarity around HTR Varying conceptualizations and expectations

Timing and time are criticalMay not have been considered at the outset

Stakeholders generally supportiveWith recognition that waste must be addressed and improvements can be made

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 MacKeanDr. Fiona Clement

Dr. Tom NoseworthyHTA Unit, University of Calgary

Alberta Innovates Health Solutions (AIHS)

lsoril@ucalgary.caweb: https://obrieniph.ucalgary.ca/hta_unit

twitter: @lsoril