Development, implementation and evaluation of an evidence-based program for introduction of new health technologies and clinical practices in a local healthcare setting.
Development, implementation and evaluation of an evidence-based program for introduction of new health technologies and clinical practices in a local healthcare setting.
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DOI：
10.1186/s12913-015-1178-4
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发表时间：
2015-12-28
影响因子：
2.8
通讯作者：
Farjou D
中科院分区：
文献类型：
--
作者：
Harris C;Garrubba M;Allen K;King R;Kelly C;Thiagarajan M;Castleman B;Ramsey W;Farjou D
本文报告了在澳大利亚一个大型医疗网络中建立一个透明的、负责任的、以证据为基础的引入新技术和临床实践(TCP)计划的过程。许多国家都有强有力的循证程序，用于在国家一级评估新的技转方案。然而，许多决定是由当地卫生部门作出的，那里进行卫生技术评估的资源和专业知识有限，而且据报道缺乏结构、程序和透明度。过程改变的循证模型被用来建立该计划。来自研究和当地数据的证据、卫生服务工作人员的经验和消费者的观点被纳入四个步骤中的每一个：确定改革的必要性、制定建议、实施和评估。应用了评估成功特征、可持续性因素以及障碍和促进因素的核对表，并根据这些调查结果制定了实施战略。过程和结果评价采用定量和定性相结合的方法。行动研究方法巩固了对系统、流程和资源的持续改进。根据文献和利益攸关方协商制定的最佳实践指南确定了七个计划组成部分：治理、决策、应用程序、监测和报告、资源、管理、评估和质量改进。实现了透明度和问责制的目标。这些过程是明确的，公布的决定，记录的结果和报告的活动。并非在所有情况下都实现了为决策确定严格的循证信息的目标。提出新的三氯甲烷方案的申请人提供了来自研究文献和当地数据的证据，但这些信息往往是不正确或不充分的，高估了收益，低估了成本。由于这些限制，最初的申请程序被申请者的意向书取代，随后由独立的内部专家进行严格的HTA。该计划适用于大多数医疗保健组织。除了一个例外，这些组成部分可以用最少的额外资源来实现；HTA所需的技能和资源的缺乏将限制在许多情况下的有效应用。提供了一个工具包，其中包含程序和样本材料的细节，以方便那些希望建立类似计划的人进行复制或本地改编。本文的在线版本(doi：10.1186/s12913-0151178-4)包含补充材料，授权用户可以使用。
This paper reports the process of establishing a transparent, accountable, evidence-based program for introduction of new technologies and clinical practices (TCPs) in a large Australian healthcare network. Many countries have robust evidence-based processes for assessment of new TCPs at national level. However many decisions are made by local health services where the resources and expertise to undertake health technology assessment (HTA) are limited and a lack of structure, process and transparency has been reported. An evidence-based model for process change was used to establish the program. Evidence from research and local data, experience of health service staff and consumer perspectives were incorporated at each of four steps: identifying the need for change, developing a proposal, implementation and evaluation. Checklists assessing characteristics of success, factors for sustainability and barriers and enablers were applied and implementation strategies were based on these findings. Quantitative and qualitative methods were used for process and outcome evaluation. An action research approach underpinned ongoing refinement to systems, processes and resources. A Best Practice Guide developed from the literature and stakeholder consultation identified seven program components: Governance, Decision-Making, Application Process, Monitoring and Reporting, Resources, Administration, and Evaluation and Quality Improvement. The aims of transparency and accountability were achieved. The processes are explicit, decisions published, outcomes recorded and activities reported. The aim of ascertaining rigorous evidence-based information for decision-making was not achieved in all cases. Applicants proposing new TCPs provided the evidence from research literature and local data however the information was often incorrect or inadequate, overestimating benefits and underestimating costs. Due to these limitations the initial application process was replaced by an Expression of Interest from applicants followed by a rigorous HTA by independent in-house experts. The program is generalisable to most health care organisations. With one exception, the components would be achievable with minimal additional resources; the lack of skills and resources required for HTA will limit effective application in many settings. A toolkit containing details of the processes and sample materials is provided to facilitate replication or local adaptation by those wishing to establish a similar program. The online version of this article (doi:10.1186/s12913-015-1178-4) contains supplementary material, which is available to authorized users.