Hospital managers' need for information in decision-making--An interview study in nine European countries.

Assessments of new health technologies in Europe are often made at the hospital level. However, the guidelines for health technology assessment (HTA), e.g. the EUnetHTA Core Model, are produced by national HTA organizations and focus on decision-making at the national level. This paper describes the results of an interview study with European hospital managers about their need for information when deciding about investments in new treatments. The study is part of the AdHopHTA project. Face-to-face, structured interviews were conducted with 53 hospital managers from nine European countries. The hospital managers identified the clinical, economic, safety and organizational aspects of new treatments as being the most relevant for decision-making. With regard to economic aspects, the hospital managers typically had a narrower focus on budget impact and reimbursement. In addition to the information included in traditional HTAs, hospital managers sometimes needed information on the political and strategic aspects of new treatments, in particular the relationship between the treatment and the strategic goals of the hospital. If further studies are able to verify our results, guidelines for hospital-based HTA should be altered to reflect the information needs of hospital managers when deciding about investments in new treatments

Adaptation of the Model for Assessment of Telemedicine (Mast) for IoT telemedicine services

Internet of Things (IoT) based solutions and services may be used to support and extend the independent living of older adults in their living environments by responding to real needs of caregivers, service providers and public authorities. Telemedicine and telehealth platforms are among the various types of IoT services that could support the provision of health services. Current Health Technology Assessment (HTA) models that are used for the evaluation of telehealth and telemedicine services do not consider IoT aspects. HTA models would ideally need to be extended to include IoT platforms, for an optimal introduction of IoT in everyday provision of health and care services. This paper presents an initial adaptation of the Model for Assessment of Telemedicine (MAST) for IoT Telemedicine services based on a literature review of IoT, telemedicine and telehealth services characteristics. MAST involves assessment of outcomes within the following seven domains: Health problem and characteristics of the application, Safety, Clinical effectiveness, Patient perspectives, Economic aspects, Organizational aspects, Socio-cultural, ethical and legal aspects. The domains of the characteristics of the application, socio-cultural, safety and ethical and legal aspects were identified as those to be adapted to cover new challenges associated to IoT services. © Springer International Publishing AG 2017

Cost analysis of neonatal tele-homecare for preterm infants compared to hospital-based care

Neonatal homecare (NH) can be used to provide parents the opportunity of bringing cardiopulmonary-stable preterm infants home for tube feeding and the establishment of breastfeeding supported by neonatal nurses visiting the home. However, home visits can be challenging for hospitals covering large regions, and, therefore, regular neonatal hospital care has remained the first choice in Denmark. As an alternative to home visits, telehealth may be used to deliver NH. Thus, neonatal tele-homecare (NTH) was developed. Positive infant outcomes and the optimization of family-centred care have been described, but the costs of telehealth in the context of NH remain unknown. This study aims to assess the costs of NTH compared to regular neonatal hospital care, from the health service perspective.The cost analysis was based on an observational study of NTH in Denmark (run from November 2015 to December 2016) and followed the Consolidated Health Economic Evaluation Reporting Standards. The intervention group were the families of preterm infants receiving NTH ( n = 96). The control group comprised a historic cohort of families with preterm infants, receiving standard care in the neonatal intensive care unit (NICU) ( n = 278). NTH infants and the historical group were categorized according to gestational age at birth at/under and over 32 weeks. The outcomes were NTH resource utilization, in-NICU hospital bed days, re-admissions and total costs on average per infant. The time horizon was from birth to discharge.The costs of NTH resource utilization were, on average, €695 per infant, and the total costs per infant, on average, were €12,200 and €4200 for infants at/under and over 32 weeks, respectively. The corresponding costs of the control group were €14,300 and €4400. The difference in total costs showed statistical significance for the group of infants under 32 weeks ( p