Best practice in undertaking and reporting health technology assessments : Working Group 4 report

[Executive Summary] The aim of Working Group 4 has been to develop and disseminate best practice in undertaking and reporting assessments, and to identify needs for methodologic development. Health technology assessment (HTA) is a multidisciplinary activity that systematically examines the technical performance, safety, clinical efficacy, and effectiveness, cost, costeffectiveness, organizational implications, social consequences, legal, and ethical considerations of the application of a health technology (18). HTA activity has been continuously increasing over the last few years. Numerous HTA agencies and other institutions (termed in this report “HTA doers”) across Europe are producing an important and growing amount of HTA information. The objectives of HTA vary considerably between HTA agencies and other actors, from a strictly political decision making–oriented approach regarding advice on market licensure, coverage in benefits catalogue, or investment planning to information directed to providers or to the public. Although there seems to be broad agreement on the general elements that belong to the HTA process, and although HTA doers in Europe use similar principles (41), this is often difficult to see because of differences in language and terminology. In addition, the reporting of the findings from the assessments differs considerably. This reduces comparability and makes it difficult for those undertaking HTA assessments to integrate previous findings from other HTA doers in a subsequent evaluation of the same technology. Transparent and clear reporting is an important step toward disseminating the findings of a HTA; thus, standards that ensure high quality reporting may contribute to a wider dissemination of results. The EUR-ASSESS methodologic subgroup already proposed a framework for conducting and reporting HTA (18), which served as the basis for the current working group. New developments in the last 5 years necessitate revisiting that framework and providing a solid structure for future updates. Giving due attention to these methodologic developments, this report describes the current “best practice” in both undertaking and reporting HTA and identifies the needs for methodologic development. It concludes with specific recommendations and tools for implementing them, e.g., by providing the structure for English-language scientific summary reports and a checklist to assess the methodologic and reporting quality of HTA reports

Estimating travel reduction associated with the use of telemedicine by patients and healthcare professionals: proposal for quantitative synthesis in a systematic review

<p>Abstract</p> <p>Background</p> <p>A major benefit offered by telemedicine is the avoidance of travel, by patients, their carers and health care professionals. Unfortunately, there is very little published information about the extent of avoided travel. We propose to undertake a systematic review of literature which reports credible data on the reductions in travel associated with the use of telemedicine.</p> <p>Method</p> <p>The conventional approach to quantitative synthesis of the results from multiple studies is to conduct a meta analysis. However, too much heterogeneity exists between available studies to allow a meaningful meta analysis of the avoided travel when telemedicine is used across all possible settings. We propose instead to consider all credible evidence on avoided travel through telemedicine by fitting a linear model which takes into account the relevant factors in the circumstances of the studies performed. We propose the use of stepwise multiple regression to identify which factors are significant.</p> <p>Discussion</p> <p>Our proposed approach is illustrated by the example of teledermatology. In a preliminary review of the literature we found 20 studies in which the percentage of avoided travel through telemedicine could be inferred (a total of 5199 patients). The mean percentage avoided travel reported in the 12 store-and-forward studies was 43%. In the 7 real-time studies and in a single study with a hybrid technique, 70% of the patients avoided travel. A simplified model based on the modality of telemedicine employed (i.e. real-time or store and forward) explained 29% of the variance. The use of store and forward teledermatology alone was associated with 43% of avoided travel. The increase in the proportion of patients who avoided travel (25%) when real-time telemedicine was employed was significant (<it>P </it>= 0.014). Service planners can use this information to weigh up the costs and benefits of the two approaches.</p

Standardizing admission and discharge processes to improve patient flow: a cross sectional study

Background: The aim of this study was to evaluate how hospital capacity was managed focusing on standardizing the admission and discharge processes. Methods: This study was set in a 900-bed university affiliated hospital of the National Health Service, near Barcelona (Spain). This is a cross-sectional study of a set of interventions which were gradually implemented between April and December 2008. Mainly, they were focused on standardizing the admission and discharge processes to improve patient flow. Primary administrative data was obtained from the 2007 and 2009 Hospital Database. Main outcome measures were median length of stay, percentage of planned discharges, number of surgery cancellations and median number of delayed emergency admissions at 8:00 am. For statistical bivariate analysis, we used a Chi-squared for linear trend for qualitative variables and a Wilcoxon signed ranks test and a Mann-Whitney test for non-normal continuous variables. Results: The median patients' global length of stay was 8.56 days in 2007 and 7.93 days in 2009 (p < 0.051). The percentage of patients admitted the same day as surgery increased from 64.87% in 2007 to 86.01% in 2009 (p < 0.05). The number of cancelled interventions due to lack of beds was 216 patients in 2007 and 42 patients in 2009. The median number of planned discharges went from 43.05% in 2007 to 86.01% in 2009 (p < 0.01). The median number of emergency patients waiting for an in-hospital bed at 8:00 am was 5 patients in 2007 and 3 patients in 2009 (p < 0.01). Conclusions: In conclusion, standardization of admission and discharge processes are largely in our control. There is a significant opportunity to create important benefits for increasing bed capacity and hospital throughput

Oftalmopatía en la diabetes mellitus: detección desde la Atención Primaria de salud

1er. Premi Josep M. Plans d'Atenció Primària, que atorga la Delegació Comarcal de Vallès Occidental del Col.legi Oficial de Metges de Barcelona, i la Filial del Vallès Occidental de l'Acadèmia de Ciències Mèdiques i de la Salut de Catalunya i Balears.Objetivo: Conocer la viabilidad de la realización de la exploración oftalmológica básica de la patología ocular del paciente diabético desde el ámbito de la Atención Primaria de Salud (APS). Diseño: Estudio transversal observacional prospectivo y multicéntrico. Participantes y método: Muestra de 712 diabéticos tipo II. Intervenciones: realización, por parte de un optometrista, de una exploración de la agudeza visual, medición de la presión intraocular y fotografía de fondo de ojo con cámara de retina no midriática. Interpretación de los resultados e indicación de derivación realizada, a doble ciego, por oftalmólogos y médicos APS. Resultados: Alteración agudeza visual: médico APS 43,7%, oftalmólogo 36,1%, concordancia 70%; sospecha glaucoma: médico APS 8,8%, oftalmólogo 7,6%, concordancia 94%; retinopatía diabética: médico APS 28,2%, oftalmólogo 13,4%, concordancia 78%. Derivación Servicios Oftalmología: médico APS 56,8%, oftalmólogo 41,3% (p=0,001). Conclusiones: El nivel de concordancia en los diagnósticos entre médico APS y oftalmólogo hace fiable la exploración oftalmológica del paciente diabético desde el ámbito de la APS. A pesar del supradiagnóstico y del 16% de derivación no justificada realizada por parte del médico APS, se evita la derivación a las consultas de oftalmología, de cerca de la mitad de los pacientes diabéticos.Peer ReviewedAward-winningPostprint (published version