mast: a model for hta-based assessment of telemedicine applications

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MAST: a model for HTA-based assessment of telemedicine applications ANNA KOTZEVA, on behalf of the MAST Working group Catalan Agency for Health Information, Assessment and Quality, Spain HTAi Annual meeting, June 2012, Bilbao

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MAST: a model for HTA-based assessment of telemedicine applications

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Page 1: MAST: a model for HTA-based assessment of telemedicine applications

MAST: a model for HTA-based assessment of telemedicine applications

ANNA KOTZEVA, on behalf of the MAST Working groupCatalan Agency for Health Information, Assessment and Quality, Spain

HTAi Annual meeting, June 2012, Bilbao

Page 2: MAST: a model for HTA-based assessment of telemedicine applications

Contents

1. MAST as a multidisciplinary assessment model Background Development process Aim and structure of the model

2. Empirical test of MAST in the RENEWING HEALTH project Project overview Experiences and results so far

3. Conclusions

Page 3: MAST: a model for HTA-based assessment of telemedicine applications

Background

Telemedicine is considered as a possible solution to thechallenges of healthcare systems

Critique of existing evidence for telemedicineHailey et al. 2002: Lack of clinical outcomesWhitten et al. 2002: Economic studies do not meet

standardsHersh et al. 2006: Few studies are well designed

Lack of high quality evidence on the effectiveness oftelemedicine as a main barrier for its wider implementation

Page 4: MAST: a model for HTA-based assessment of telemedicine applications

MethoTelemed project (2009)Aiming to provide a structured framework for assessing the

effectiveness and contribution to quality of care of telemedicine applications

Based on users’ and stakeholders’ needs

Background

Promotion of assessment of telemedicine-based services

Page 5: MAST: a model for HTA-based assessment of telemedicine applications

Development of MAST

Comprehensive process

Scientific evidence

• Systematic literature review

Stakeholder & users’ opinion

• 2 Workshops (20+18 participants)

Overview of other models

• EUnetHTA Core Model• Donabedian’s model for

quality of care• Med Res Council on

Complex interventions• Wootton et al.• Ohinmaa et al.• ......

MAST (Manual & Toolkit)

Page 6: MAST: a model for HTA-based assessment of telemedicine applications

MAST can be used when the assessment aims to describe effectiveness and contribution of telemedicine to quality of care and to produce basis for decision making

Assessment defined as:

A multidisciplinary process that summarizes and evaluates information about the clinical, economic, organizational and socio-ethical issues related to the use of telemedicine, in a systematic, unbiased and robust manner.

Aim

*based on EUnetHTA Core Model

Page 7: MAST: a model for HTA-based assessment of telemedicine applications

How does MAST ensure a multidisciplinary

assessment?

Page 8: MAST: a model for HTA-based assessment of telemedicine applications

The framework suggests 3 stages of assessment:

I. Preceding considerations

II. Multidisciplinary Assessment

III. Transferability of results

Structure and elements of MAST

Page 9: MAST: a model for HTA-based assessment of telemedicine applications

This stage is about “setting the context”

Various aspects have to be taken into consideration: Maturity of the technology Selection of appropriate comparator/s Level on which the assessment should be carried out – single

hospital, region, state Number of patients included in the assessment Existing legislation and reimbursement policy for telemedicine-

based services

I. Preceding considerations

Page 10: MAST: a model for HTA-based assessment of telemedicine applications

WHAT should be assessed?

1. Health problem and characteristics of the application

2. Clinical effectiveness 3. Safety 4. Patient perspectives5. Economic aspects 6. Organisational aspects

7. Socio-cultural, ethical and legal aspects

II. Multidisciplinary assessment

Descriptive

Descriptive

Evaluation by outcome(systematic review OR empirical study)

DO

MA

INS

Page 11: MAST: a model for HTA-based assessment of telemedicine applications

HOW it should be assessed?

Study design - Aim for highest possible level of evidence

Outcome measures should be: • patient-important outcomes• based on scientific literature to enable comparison• validated instruments

II. Multidisciplinary assessment

Page 12: MAST: a model for HTA-based assessment of telemedicine applications

Answers the question:

Can results be generalized to other settings?

This consideration has to be made within each of the domains!

Examples of limitations for direct transferability of results: Country-specific reimbursement conditions Healthcare price/hour Values and culture influence user preferences and hence, satisfaction

with the new service

III. Transferability assessment

?

Page 13: MAST: a model for HTA-based assessment of telemedicine applications

Empirical test of MAST in the RENEWING HEALTH project

Project overview

Experiences and results so far Tools to support study design, reporting &

analysis

Training

Close collaboration and feedback from users

Page 14: MAST: a model for HTA-based assessment of telemedicine applications

Empirical test of MAST in the RENEWING HEALTH project

Project overview

Experiences and results so far Tools to support study design, reporting &

analysis

Training

Close collaboration and feedback from users

Page 15: MAST: a model for HTA-based assessment of telemedicine applications

Funded by the European CommunityICT Policy Support Program, Competitiveness and Innovation Framework Program

So far, the largest pragmatic RCT in the area of telemedicine

7158 patients

84 centers

21 pilots

10 clusters

3 diseases

1 observ.

9 RCTs

DMCOPDCVD

9 European regions

Page 16: MAST: a model for HTA-based assessment of telemedicine applications

General objective:

To produce evidence and decision support for the EU health policies and the regional authorities regarding the future deployment of telemedicine services in those fields where these can lead to improved care and reduced cost.

RENEWING HEALTH Project is not envisioned to produce scientific evidence on clinical outcomes of telehealth, BUT

a broader knowledge on benefits of telemedicine services through a number of multidisciplinary outcomes

Page 17: MAST: a model for HTA-based assessment of telemedicine applications

Empirical test of MAST in the RENEWING HEALTH project

Project overview

Experiences and results so far Tools to support study design, reporting &

analysis

Training

Close collaboration and feedback from users

Page 18: MAST: a model for HTA-based assessment of telemedicine applications

Application of MAST in practice stimulates its further development and improvement

A number of tools were developed to support study design, data management, analysis

and reporting of results

Page 19: MAST: a model for HTA-based assessment of telemedicine applications

1• Clinical study protocols

2• Minimum dataset of common outcomes

3• Clinical database and guidance on coding

and monitoring

4• Guide for analysis and reporting of results

Ensures quality and comparability of data

Page 20: MAST: a model for HTA-based assessment of telemedicine applications

Open seminars Berlin, May 2010

Introduction to the framework, 80 participantswww.mast-model.info

Treviso, Feb 2012

Guidance on data analysis and reporting of results, 60 participants

Training

Dissemination Kidholm et al. A model for assessment of telemedicine applications -

MAST. Int J Tech Ass Health Care, 28:1, Jan 2012 Communications Website forthcoming!!!

Page 21: MAST: a model for HTA-based assessment of telemedicine applications

Collaboration and users feedback

European projects

RENEWING HEALTH http://www.renewinghealth.eu/ (21 trials)

http://www.incasa-project.eu/news.php (5 trials)

INTEGRATED HOME CARE http://www.integratedhomecare.eu/

Recommended by:British Thoracic Society (statement on respiratory care)National Danish Strategy for Telemedicine

Page 22: MAST: a model for HTA-based assessment of telemedicine applications

Collaboration and users feedback

European regions adopting MAST as a general framework for telemedicine assessment Norbotten (Sweden) Veneto (Italy) Basque country (Spain)

Development of a French versionMEETIC: Modèle pour l'Evaluation (Economique) de la Télémédecine Recherche Clinique Santé Publique, Paris

Page 23: MAST: a model for HTA-based assessment of telemedicine applications

In conclusion…

Advantages of MAST Multidisciplinary and very comprehensive Based on scientific evidence, on criteria for quality and on

stakeholders’ needs Establishes a common standard for all stages of study development

(design, data collection, analysis and reporting)

Limitations of MAST Time consuming Only relevant in assessment of mature telemedicine applications Doesn’t give indications for prioritization when resources are limited More operational criteria are needed

MAST 2ON THE WAY TO

Page 24: MAST: a model for HTA-based assessment of telemedicine applications

Empirical test of MAST is ongoing (>25 trials use it currently)

Based on the results a revision will be made

So far MAST has been a useful and comprehensive framework for study design, data collection and assessment, and ensures comparability of results for telemedicine studies in different cultural contexts

Based on the validation we hope MAST will be established as the first widely accepted methodology for the evaluation of complex telemedicine interventions

In conclusion…

Page 25: MAST: a model for HTA-based assessment of telemedicine applications

www.renewinghealth.eu

Thank you!

Anna [email protected]

Kristian [email protected]