A Methodological Approach for Measuring the Impact of HTA

There is a lack of evidence concerning the link between HTA and outcomes in terms of health improvements. This work proposes a framework for assessing the impact of HTA. This impact assessment is a necessary step in then better understanding the value for money of HTA bodies. We emphasis that this is still a work in progress. iDSI has developed a theory of change-based framework in order to evaluate the impact the iDSI has on institutional strengthening – leading to ‘better decisions’ for ‘better health’. This framework recognises that there is a complex translation process between better decisions and better health dependent on many assumptions about local factors and systems, including linkage between decisions and budgets, delivery, implementation, and data accuracy. Work has been undertaken over the last 6 months developing a methodological approach for measuring the impact of health technology assessment (HTA). Two case studies are used to illustrate the approach. At the core of impact assessment is a requirement to link causes and effects, to explain ‘how’ and ‘why’ and to identify – and thus improve or adapt – mechanisms leading to impact. Policy makers also want to know ‘to what extent’ or ‘the magnitude of impact’. The framework developed adopts an economic approach nested in theory of change as a means of both quantifying the magnitude of impact (utilising economic models) as well as explaining why and how impact happens (drawing on theory based approaches) in order to reinforce learning as to how to improve our response and optimise the use of HTA to have the greatest impact in a given context. This should also enable us to capture and explain wider impact – perhaps more intangible aspects which cannot be easily quantified. This may also possibly increase policy-makers’ ‘buy-in’

Development and testing of a risk indexing framework to determine field-scale critical source areas of faecal bacteria on grassland.

This paper draws on lessons from a UK case study in the management of diffuse microbial pollution from grassland farm systems in the Taw catchment, south west England. We report on the development and preliminary testing of a field-scale faecal indicator organism risk indexing tool (FIORIT). This tool aims to prioritise those fields most vulnerable in terms of their risk of contributing FIOs to water. FIORIT risk indices were related to recorded microbial water quality parameters (faecal coliforms [FC] and intestinal enterococci [IE]) to provide a concurrent on-farm evaluation of the tool. There was a significant upward trend in Log[FC] and Log[IE] values with FIORIT risk score classification (r2 =0.87 and 0.70, respectively and P<0.01 for both FIOs). The FIORIT was then applied to 162 representative grassland fields through different seasons for ten farms in the case study catchment to determine the distribution of on-farm spatial and temporal risk. The high risk fields made up only a small proportion (1%, 2%, 2% and 3% for winter, spring, summer and autumn, respectively) of the total number of fields assessed (and less than 10% of the total area), but the likelihood of the hydrological connection of high FIO source areas to receiving watercourses makes them a priority for mitigation efforts. The FIORIT provides a preliminary and evolving mechanism through which we can combine risk assessment with risk communication to end-users and provides a framework for prioritising future empirical research. Continued testing of FIORIT across different geographical areas under both low and high flow conditions is now needed to initiate its long term development into a robust indexing tool

Mozambican Civil Society Within: Evaluation, Challenges, Opportunities and Action

The aim of this ambitious venture is to evaluate the main dimensions of civil society's exercise of citizenship: a) its organisational Structure, covering its free and voluntary involvement, participation and contribution to society; b) the socio-economic and political Environment in which it exists and the space for its intervention; c) the Values that support its actions and, finally, d) the Impact of its intervention at all levels

Knowledge and information needs of informal caregivers in palliative care : a qualitative systematic review

Objectives: To review current understanding of the knowledge and information needs of informal caregivers in palliative settings. Data sources: Seven electronic databases were searched for the period January 1994–November 2006: Medline, CINAHL, PsychINFO, Embase, Ovid, Zetoc and Pubmed using a meta-search engine (Metalib®). Key journals and reference lists of selected papers were hand searched. Review methods: Included studies were peer-reviewed journal articles presenting original research. Given a variety of approaches to palliative care research, a validated systematic review methodology for assessing disparate evidence was used in order to assign scores to different aspects of each study (introduction and aims, method and data, sampling, data analysis, ethics and bias, findings/results, transferability/generalizability, implications and usefulness). Analysis was assisted by abstraction of key details of study into a table. Results: Thirty-four studies were included from eight different countries. The evidence was strongest in relation to pain management, where inadequacies in caregiver knowledge and the importance of education were emphasized. The significance of effective communication and information sharing between patient, caregiver and service provider was also emphasized. The evidence for other caregiver knowledge and information needs, for example in relation to welfare and social support was weaker. There was limited literature on non-cancer conditions and the care-giving information needs of black and minority ethnic populations. Overall, the evidence base was predominantly descriptive and dominated by small-scale studies, limiting generalizability. Conclusions: As palliative care shifts into patients’ homes, a more rigorously researched evidence base devoted to understanding caregivers knowledge and information needs is required. Research design needs to move beyond the current focus on dyads to incorporate the complex, three-way interactions between patients, service providers and caregivers in end-of-life care setting

Transforming failure into success through organisational learning: An analysis of a manufacturing information system

This paper describes the idiosyncracies of a case study company, through highlighting issues and problems experienced during their attempts to evaluate, implement and realise the holistic implications of a manufacturing information system. Although the Information System (IS) was operational for a period of time, it was eventually deemed a failure. The reason for this was that a range of human and organisational factors prevented the organisation from embracing the full impact of the system. The eventual success of their information system was realised through a bespoke implementation, based upon a traditional systems development lifecycle that indirectly addressed learning issues following the earlier failed deployment. The paper highlights key issues relating to business success and failure, and then contrasts them alongside the presented case study. In doing so, the authors conclude by proposing methods through which manufacturing information systems can be transformed for business success. This is described achievable through both a realisation in the positioning of the organisation relative to technology management, and the related mapping of human and technological constructs that support information systems related succes

Understanding the user - why, what and how?

Explains the need, importance, purposes and scope of user studies, discusses procedure for conducting sound user studies together with associated problems of research like selection of problem, formulation of hypothesis, design of study, sampling strategy, data collection methods, scaling techniques, pilot study, processing and analysis of data, testing of hypothesis, interpretation, drawing inferences, communication and dissemination of results and finally concludes by highlighting methodological flaws and gaps in user studies

ASSESSING THE EFFICIENCY OF LOCAL ACTION GROUPS AND AUCTIONS FOR DESIGNING AND IMPLEMENTING AGRI-ENVIRONMENTAL MEASURES IN THE EU - RESULTS FROM AN EXPERT SURVEY

In this article the authors focus on two important innovations for agri-environmental measures in the new council regulation: The implementation of local action groups and a call for tenders. The article describes how relevant actors assess the innovations. The results are based on 276 interviews, carried out in 2006 in nine EU Member States. Generally, actors assume that measures designed in local action groups are not necessarily more economically efficient than current measures, but they do have potential to result in a higher ecological effectiveness and in a greater acceptance. However, the opinion on auctions is comparatively critical