HTA in Hospital Management

Transcription

1 European HTA: From Research to Policy Parallel Forum F3 4th-7th October, 2006 HTA in Hospital Management Prof. Americo Cicchetti Director of Research HTA Unit A. Gemelli University Hospital

2 Agenda! HTA s Map! Decentralizing HTA! Toward hospital based HTA! Conclusion

3 HTA s Map DURING BEFORE AFTER WHO Macro Meso Micro HTA? What WHEN DRUGS DEVICES PROCEDURES Università Cattolica del Sacro Cuore

4 HTA s Map DURING BEFORE AFTER HTA AGENCY HTA Unit Hospitals, HCOs WHO Macro Meso Micro WHAT WHEN DRUGS DEVICES PROCEDURES Università Cattolica del Sacro Cuore

5 Decentralizing HTA! HTA Italian Network (25 partners)! Ricciardi, Cicchetti, Marchetti, IJPH 3(2) 2005! HTA Swiss Network (SNHTA; 22 partners)! Mini-HTA in Denmark! Helers et al (2006), IJTAHC 22(3): ! HTA Unit at McGill University Hospital (Montreal)! Mc Gregor & Brobhy, IJTAHC 21(2) 2005! HMOs and Health Care organizations (US)! Luce & Brown (1995), Int J Tech Ass Health Care, 11(1): 79-82! Es. Veterans Health Administration Technology Program! HTA in Israeli Medical Centers! Greenberg, Petersburg, Vekstein & Pliskin, IJATHC, 21 (2) 2005

6 Toward hospital based HTA! Bringing HTA into practice! Pressures to micro-economic efficiency! Technology-organization interaction

7 JAMA, October 20, 1999-Vol 282, No. 15 Università Cattolica del Sacro Cuore

8 Setting, delivering, monitoring standards Università Cattolica del Sacro Cuore National Institute for Clinical Excellence (NICE) National Service Frameworks (NSF) Clear standards of service Patient & public volvement Professional self-regulation Clinical governance Lifelong learning Dependable local delivery Commission for Health Improvement National Performance Framework National Patient and User Survey National Clinical Indicators Monitored standards

9 HTA s Map DURING BEFORE AFTER HTA & NICE WHO Macro Meso Micro Clinical Governance Framework WHAT WHEN DRUGS DEVICES PROCEDURES Università Cattolica del Sacro Cuore

10 The ambassadors at SBU! Ambassadors have to have high legitimacy and clear mandates! Ambassadors have to have resources i.e. defined time! A contract of what is to be achieved and how helps! Road show to faculties and county councils is of value! Both top down and bottom up necessary Nina Rehnqvist, Executive Director (Rome, June 21st 2005)

11 HTA Units and Mini-HTAs! Local participation in making analysis can be important to the implementation process! Analyses of implementation processes show that the course of the decision making process affects implementation process! Ehlers, L. et al Intl. J. Tech Ass. Health Care, 22(3)! Locally developed HTAs would have grater influence on health policy and decision making process! McGregor & Bropghy 2005 Intl. J. Tech Ass. Health Care, 21(2)

12 Toward hospital based HTA! Bringing HTA into practice! Pressures to micro-economic efficiency! Technology-organization interaction

13 Micro economic efficiency! Hospitals operating under budget constraints! payment mechanisms based on DRGs! Internal markets! Responsibility and autonomy at HCOs level - Financial equilibrium

14 Decision Making Alternative Approaches! Rational (Evidence Based Management Model based on HTA principles)! Based on scientific evidence! Granting distinctive competencies! Coherent with corporate strategies (Mission, Goals)! Shared with professionals (Involvement and commitment)! Multi-dimensional (efficacy, cost-effectiveness, organizational impact, equity, appropriateness, safety, ethics ) Value of innovation

15 Policlinico A. Gemelli Rome, Italy (HTA Unit: Estabilished in 2001) University Hospital and Network (5HCOs; Acute, Rehab, Hospice, Nursing Homes) beds Budget: 400 million /Year employed New tech investment plan (30 million )

16 HTA Unit! Aim! To support top-management decision making! Activities! To produce in-house HTA reports (reports based on external HTAs and on local evidences);! To manage a three-year technology investment plan! Structure! Professional staff (Multidisciplinary: MD, Eng, Health Econ)! Clinical committee! Other! Research and training (Ulysse Project; LDL HTA Course! Hospital-Industry collaborations on HTA Università Cattolica del Sacro Cuore

17 Clinical Departments Mission (Effectiveness) (Balance) (Appropriateness) Proposals Guidelines for technology needs assessment Goal setting (Selection of strategic options) HTA-U Strategic Plan Feedback Investment Budget Implementation of plans Strategic Monitoring HTA framework in the Strategic planning process Università Cattolica del Sacro Cuore

18 Toward hospital based HTA! Bringing HTA into practice! Pressures to micro-economic efficiency! Technology-organization interaction

19 Technology-Organization interaction Traditional approach in HTA! Among health care organizations there is an equal distribution of: - Professional-technical skills - Management skills - Managerial capabilities to control organizational processes! Impacts of health technologies use (eg. outcomes) is independent by other organizational factors A more reasonable approach! Technology is one organizational factor and it is a medium for organizational performance! Health technologies impact depends on resources and skills availability, organizational competencies managerial capabilities, personnel motivation, organizational climate It is reasonable to assess health technologies out of their organizational context? It seems impossible to solve the problem only designing multi-centric RCTs (the mean trap ) Università Cattolica del Sacro Cuore

20 Conclusion (1) System level Efficacy Cost effectiveness Ethical issues Patient perspective (populations) Patient perspective (specific groups) Hospital budget impact Organizational impact Overlapping Hospital level

21 Conclusion (2)! Increasing need for collaboration in HTA (more competencies, more resources)! Horizontal specialization! Division of labor (at national-regional levels)! Vertical Specialization! Distribution of competencies among different levels of the health care system! Network as a coordinating mechanism! Mutual trust and recognition! Setting quality standards and procedures (shared among network members)