Health Technology Assessment Centers-an Infrastructure for Health Systems to Translate Evidence into Practice.
Health Technology Assessment Centers-an Infrastructure for Health Systems to Translate Evidence into Practice.
复制标题
卫生技术评估中心 - 卫生系统将证据转化为实践的基础设施。
DOI：
10.1007/s11606-019-05534-1
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发表时间：
2020
影响因子：
5.7
通讯作者：
Umscheid,CraigA
中科院分区：
文献类型：
--
作者：
Sharaf,RaviN;Khullar,Dhruv;Umscheid,CraigA
J Gen Intern Med DOI: 10.1007/s11606-019-05534-1©General Internal Medicine Society 2020 evidence”（数据来源于系统自身的临床、利用和支出估算）；(4)根据需要进行经济分析；7(5)将HTA过程的结果与利益相关者的意见结合起来，形成标准化的指南、临床路径和临床决策支持工具，直接将证据、利益相关者的价值观和偏好与临床实践联系起来；(6)分析实施结果，制定需要改进的策略。7尽管许多美国卫生系统寻求证据来指导技术和药品的获取或新的医疗服务模式的实施，8但大多数没有在实践中获取或实施证据的基础设施。以卫生系统为基础的HTA中心填补了这一空白。例如，宾夕法尼亚大学卫生系统于2006年建立了循证实践中心，以支持基于卫生系统的HTA和将证据整合到实践中。启动成本和基础设施最低；最初的支持部分资助了两名医师管理人员和一名硕士级研究分析师。随着服务需求的增长，人员配备也在增加，到四名全职分析师、一名行政助理和两名内科教员联合主任，他们每人投入了相当于0.5名全职人员的工作。在宾夕法尼亚大学，证据审查是根据临床和行政领导要求的主题产生的。对当地的护理模式进行分析，并根据需要进行计量经济学分析。最终产品是快速审查和成本分析，将临床证据纳入当地情况，并确保最佳做法为护理和支出决策提供信息。自2006年以来，该中心共开展了450项新的快速证据审查或经济评估，传播或实施了250多条临床路径和25项计算机化临床决策支持干预措施，从而改善了患者的治疗效果，并提供了高价值的护理。例如，由于宾夕法尼亚大学基于医疗保健系统的HTA流程，静脉血栓栓塞预防的适当使用增加了30%。10使用氯己定而不是碘进行术前皮肤消毒的决定，据估计不仅可以减少手术部位感染，还可以每年节省50万美元的成本11 -比最初运行循证实践中心的费用还少。
J Gen Intern Med DOI: 10.1007/s11606-019-05534-1© Society of General Internal Medicine 2020 evidence”(data derived from a system’s own clinical, utilization and expenditure estimates); 8 (4) conduct economic analyses as needed; 7 (5) combine results from the HTA process with stakeholder input to forge standardized guidelines, clinical pathways, and clinical decision support tools that directly bridge evidence and stakeholder values and preferences with clinical practice 2 and last;(6) analyze results of implementation and strategize needed enhancements. 7 Although many US health systems seek evidence to guide acquisition of technology and pharmaceuticals or the implementation of new care delivery models, 8 most do not have the infrastructure to obtain or implement evidence in practice. 7 Health system–based HTA centers fill this void. As an example, University of Pennsylvania Health System established the Center for Evidence-based Practice in 2006 to support health system–based HTA and the integration of evidence into practice. 9 Startup cost and infrastructure were minimal; initial support partially funded two physicianadministrators and a masters-level research analyst. Staffing grew as demand for services grew, to four full-time analysts, one administrative assistant, and two physician faculty codirectors who each dedicated 0.50 full-time equivalents to the effort. At Penn, evidence reviews are generated on topics requested by clinical and administrative leaders. Local patterns of care are analyzed and econometric analyses conducted as needed. The end-products are rapid reviews and cost analyses that put clinical evidence into local context, and ensure that best practices inform care and expenditure decisions. Since 2006, in total, 450 new rapid evidence reviews or economic evaluations have been produced and the Center has disseminated or implemented over 250 clinical pathways and 25 computerized clinical decision support interventions, resulting in improved patient outcomes and the delivery of high-value care. 7 For example, as a result of Penn’s healthcare system–based HTA process, the appropriate use of venous thromboembolism prophylaxis has increased 30%. 10 The decision to use chlorhexidine as opposed to iodine for preoperative skin antisepsis was estimated to not only decrease surgical site infections but also to incur cost savings of $500,000 per year 11—less than the expenditure to initially run the Center for Evidence-based Practice.