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Amann D, Kihlander I, Magnusson M. Managing affordability in concept development of complex product systems (CoPS). TECHNOLOGY ANALYSIS & STRATEGIC MANAGEMENT 2021. [DOI: 10.1080/09537325.2021.1968371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Daniel Amann
- Integrated Product Development, KTH Royal Institute of Technology, Stockholm, Sweden
- Department of Military Studies, Swedish Defence University, Stockholm, Sweden
| | - Ingrid Kihlander
- Integrated Product Development, KTH Royal Institute of Technology, Stockholm, Sweden
- RISE Research Institutes of Sweden, Stockholm, Sweden
| | - Mats Magnusson
- Integrated Product Development, KTH Royal Institute of Technology, Stockholm, Sweden
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Carlton J, Griffiths HJ, Horwood AM, Mazzone PP, Walker R, Simonsz HJ. Acceptability of childhood screening: a systematic narrative review. Public Health 2021; 193:126-138. [PMID: 33831694 PMCID: PMC8128098 DOI: 10.1016/j.puhe.2021.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/05/2021] [Accepted: 02/09/2021] [Indexed: 12/22/2022]
Abstract
Objectives A systematic narrative literature review was undertaken to assess the acceptability of childhood screening interventions to identify factors to consider when planning or modifying childhood screening programs to maximize participation and uptake. Study design This is a systematic narrative literature review. Methods Electronic databases were searched (MEDLINE, EMBASE, PsycINFO via Ovid, CINAHL, and Cochrane Library) to identify primary research studies that assessed screening acceptability. Studies were categorized using an existing theoretical framework of acceptability consisting of seven constructs: affective attitude, burden, ethicality, intervention coherence, opportunity costs, perceived effectiveness, and self-efficacy. A protocol was developed and registered with PROSPERO (registration no. CRD42018099763) Results The search identified 4529 studies, and 46 studies met the inclusion criteria. Most studies involved neonatal screening. Programs identified included newborn blood spot screening (n = 22), neonatal hearing screening (n = 13), Duchenne muscular dystrophy screening (n = 4), cystic fibrosis screening (n = 3), screening for congenital heart defects (n = 2), and others (n = 2). Most studies assessed more than one construct of acceptability. The most common constructs identified were affective attitude (how a parent feels about the program) and intervention coherence (parental understanding of the program, and/or the potential consequences of a confirmed diagnosis). Conclusions The main acceptability component identified related to parental knowledge and understanding of the screening process, the testing procedure(s), and consent. The emotional impact of childhood screening mostly explored maternal anxiety. Further studies are needed to examine the acceptability of childhood screening across the wider family unit. When planning new (or refining existing) childhood screening programs, it is important to assess acceptability before implementation. This should include assessment of important issues such as information needs, timing of information, and when and where the screening should occur.
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Affiliation(s)
- J Carlton
- School of Health and Related Research (ScHARR), Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK.
| | - H J Griffiths
- Academic Unit of Ophthalmology and Orthoptics, The Medical School, University of Sheffield, Health Sciences School, Beech Hill Road, Sheffield, S10 2RX, UK.
| | - A M Horwood
- Infant Vision Laboratory, School of Psychology and Clinical Language Sciences, University of Reading, Infant Vision Laboratory, Earley Gate, Reading, RG6 6AL, UK.
| | - P P Mazzone
- School of Health and Related Research (ScHARR), Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK.
| | - R Walker
- School of Health and Related Research (ScHARR), Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK.
| | - H J Simonsz
- Department of Ophthalmology, Erasmus Medical Center, P.O. Box 2040, NL-3000CA, Rotterdam, the Netherlands.
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Davey Z, Jackson D, Henshall C. The value of nurse mentoring relationships: Lessons learnt from a work-based resilience enhancement programme for nurses working in the forensic setting. Int J Ment Health Nurs 2020; 29:992-1001. [PMID: 32536021 DOI: 10.1111/inm.12739] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 04/23/2020] [Accepted: 04/30/2020] [Indexed: 11/30/2022]
Abstract
This study aimed to evaluate a mentoring programme embedded in a work-based personal resilience enhancement intervention for forensic nurses. This qualitative study formed part of a wider mixed-methods study that aimed to implement and evaluate the intervention. Twenty-four semistructured interviews were carried out with forensic nurse mentees and senior nurse mentors; these explored their experiences of the mentoring programme and any benefits and challenges involved in constructing and maintaining a mentor-mentee relationship. Qualitative data were analysed thematically using the Framework Method. Four key themes relating to the initiation and maintenance of mentor-mentee relationships were identified: finding time and space to arrange mentoring sessions; building rapport and developing the relationship; setting expectations of the mentoring relationship and the commitment required; and the impact of the mentoring relationship for both mentees and mentors. Study findings highlight the benefits of senior nurses mentoring junior staff and provide evidence to support the integration of mentoring programmes within wider work-based resilience enhancement interventions. Effective mentoring can lead to the expansion of professional networks, career development opportunities, increased confidence and competence at problem-solving, and higher levels of resilience, well-being, and self-confidence.
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Affiliation(s)
- Zoe Davey
- Oxford Institute of Nursing Midwifery and Allied Health Research, Oxford Brookes University, Oxford, UK
| | - Debra Jackson
- Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Catherine Henshall
- Oxford Institute of Nursing Midwifery and Allied Health Research, Oxford Brookes University, Oxford, UK
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Henshall C, Davey Z, Jackson D. The implementation and evaluation of a resilience enhancement programme for nurses working in the forensic setting. Int J Ment Health Nurs 2020; 29:508-520. [PMID: 31930654 DOI: 10.1111/inm.12689] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/15/2019] [Indexed: 11/30/2022]
Abstract
This study aimed to implement and evaluate a work-based personal resilience enhancement intervention for forensic nurses. A mixed methods design consisting of surveys, interviews, and a case study approach, whereby the experiences of a group of nurses were studied in relation to their experiences of an intervention programme to enhance personal resilience, was utilized. Nurses working on forensic inpatient wards were invited to participate. Senior nurses were recruited as mentors. Data were collected via pre- and post-programme surveys to evaluate nurses' levels of resilience. Post-programme interviews were undertaken with nurses and mentors to explore their experiences of the programme. Descriptive statistics of survey data examined changes in nurses' resilience levels pre- and post-intervention. Free-text survey data and interview data were analysed thematically. The SQUIRE 2.0 checklist was adhered to. Twenty-nine nurses participated. Levels of personal resilience (M = 4.12, SD = 0.60) were significantly higher post-programme than pre-programme (M = 3.42, SD = 0.70), (t49 = 3.80, P = 0.000, 95% CI = 0.32, 1.07). Nurses felt the programme had a marked impact on their personal resilience, self-awareness, confidence, and professional relationships. The benefits of the programme demonstrate the advantages of providing a nurturing environment for nurses to consolidate their resilience levels. Findings demonstrated that resilience enhancement programmes can increase nurses' levels of resilience and confidence and improve inter-professional relationships. Our findings are important for clinicians, nurse managers, and policymakers considering strategies for improving the workplace environment for nurses. The long-term impact of resilience programmes may improve nurse retention and recruitment.
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Affiliation(s)
| | - Zoe Davey
- Oxford Brookes University, Oxford, UK
| | - Debra Jackson
- Faculty of Health, University of Technology, Sydney, Australia
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Santoro L, Lessa F, Nardi EP, Ferraz MB. Stakeholder value judgments in decision-making on the incorporation, financing, and allocation of new health technologies in limited-resource settings: a potential Brazilian approach. Rev Panam Salud Publica 2019; 42:e102. [PMID: 31093130 PMCID: PMC6386094 DOI: 10.26633/rpsp.2018.102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 11/28/2017] [Indexed: 11/24/2022] Open
Abstract
Objective To analyze the value judgments behind cost-benefit tradeoffs made by health stakeholders in deciding whether or not to incorporate new health technologies and how they should be financed and allocated in limited-resource settings in Brazil. Method From June 2009 to January 2010, a sample of stakeholders in the public and private health sector was identified and invited to complete an online survey consisting of two questionnaires: one collecting socio-demographic/professional information and one capturing resource allocation preferences in four hypothetical scenarios for the incorporation of new health technologies. Results A total of 193 respondents completed the survey; more than half were male (53.9%) and the most common age group was 31-40 years (36.8%). Scenario 1 (incorporation of a new drug treatment for chronic disease, by reducing/eliminating resources for existing programs) was rejected by 49.2% of the survey sample, who preferred to maintain the status quo for existing programs. Scenario 2 (incorporation of the same new treatment, but financed by a new tax) was rejected by 58.0%. Scenario 3 (incorporation of a new treatment for a highly lethal disease, by age group-20-75 years versus 75+ years-by reducing/eliminating resources for existing programs), was rejected by 42.0%, while 20.7% supported allocations for both groups, 34.2% supported allocations exclusively for the 20-75-year age group, and 3.1% supported allocations exclusively for the 75+ year age group. For Scenario 4, which consisted of five different resource allocations for prevention and treatment programs for another highly lethal disease, the most preferred option (chosen by 50.8% of respondents) was 75%:25% (prevention versus treatment). Conclusions When incorporating a new health technology requires reducing/eliminating other health programs, financing it through a tax, or having to choose certain age groups (e.g., younger, working people versus older people), respondents are likely to reject it. When offered the choice of limiting the scope of the program (e.g., prevention versus treatment), respondents are likely to favor prevention. This was the first study in Brazil to capture value judgments that affect stakeholder decision-making on various resource allocations for different scenarios for health technology introduction in limited-resource settings. Future research should investigate the perspective of society as a whole to determine the best approach for decision-making based on common values and consensus within a particular health care system.
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Affiliation(s)
- Luiz Santoro
- Department of Health Informatics, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Fernanda Lessa
- Department of Health Informatics, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | | | - Marcos Bosi Ferraz
- Department of Health Informatics, Universidade Federal de São Paulo, São Paulo, SP, Brazil
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Zuidema WP, Oosterhuis JWA, van der Heide SM, Zijp GW, van Baren R, van der Steeg AFW, van Heurn ELWE. Early cost-utility estimation of the surgical correction of pectus excavatum with the Nuss bar. Eur J Cardiothorac Surg 2019; 55:699-703. [PMID: 30380039 DOI: 10.1093/ejcts/ezy348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 09/07/2018] [Accepted: 09/10/2018] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The surgical correction of pectus excavatum (PE) with a Nuss bar provides satisfactory outcomes, but its cost-effectiveness is yet unproven. We prospectively analysed early outcomes and costs for Nuss bar placement. METHODS Fifty-four patients aged 16 years or older (6 females and 48 males; mean age, 17.9 years; range 16.0-29.4 years) with a PE filled out a Short Form-36 Health Survey (SF-6D) preoperatively and 1 year after a Nuss procedure. Costs included professional fees and fees for the operating room, materials and hospital care. Changes in the responses to the SF-36 or its domains were compared using the Wilcoxon signed rank test and the utility test results were calculated preoperatively and postoperatively from the SF-6D. The quality-adjusted life years (QALYs) were calculated from the results of these tests. RESULTS Significant improvements in physical functioning, social functioning, mental health and health transition (all P < 0.05) were noted. The other SF-36 subgroups showed improvement; however, the improvement was not significant. The SF-6D utility showed improvement from 0.76 preoperatively to 0.79 at the 1-year follow-up (P = 0.096). The mean direct costs were €8805. The 1-year discounted QALY gain was 0.03. The estimated cost-utility ratio was €293 500 per QALY gained. CONCLUSIONS Despite a significant improvement in many domains of the SF-36, the results of the SF-6D cost-utility analysis showed only a small improvement in cost-effectiveness (> €80 000/QALY) for patients with PE 1 year after Nuss bar placement. Based on this discrepancy, general health outcome measurements as the basis for cost-utility analysis in patients with PE may not be the best way forward.
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Affiliation(s)
- Wietse P Zuidema
- Department of Surgery, VU University Medical Center, Amsterdam, Netherlands.,Pediatric Surgical Center of Amsterdam, Emma Children's Hospital AMC, VU University Medical Center, Amsterdam, Netherlands
| | - Jan W A Oosterhuis
- Department of Thoracic Surgery, Haaglanden Medical Center, The Hague, Netherlands
| | - Stefan M van der Heide
- Department of Cardio-thoracic Surgery, Radboud University Medical Center, Nijmegen, Netherlands
| | - Gerda W Zijp
- Department of Pediatric Surgery, Juliana Children's Hospital/Haga-Hospital, The Hague, Netherlands
| | - Robertine van Baren
- Department of Surgery and Pediatric Surgery, University Medical Center Groningen, Groningen, Netherlands
| | - Alida F W van der Steeg
- Pediatric Surgical Center of Amsterdam, Emma Children's Hospital AMC, VU University Medical Center, Amsterdam, Netherlands.,Center of Research on Psychology in Somatic Diseases (CoRPS), Tilburg University, Tilburg, Netherlands
| | - Ernst L W E van Heurn
- Pediatric Surgical Center of Amsterdam, Emma Children's Hospital AMC, VU University Medical Center, Amsterdam, Netherlands
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National health innovation systems: Clustering the OECD countries by innovative output in healthcare using a multi indicator approach. RESEARCH POLICY 2019. [DOI: 10.1016/j.respol.2018.08.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Liu X, Sun X, Zhao Y, Meng Q. Financial protection of rural health insurance for patients with hypertension and diabetes: repeated cross-sectional surveys in rural China. BMC Health Serv Res 2016; 16:481. [PMID: 27608976 PMCID: PMC5017002 DOI: 10.1186/s12913-016-1735-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Accepted: 09/01/2016] [Indexed: 11/10/2022] Open
Abstract
Background The New Cooperative Medical Scheme (NCMS) in rural China has been expanding in both population coverage and benefit package. China has also established an essential medicine policy in recent years to further reduce patients’ medical expenditures and financial burden. This study aims to evaluate the impact of these policies on reducing medical expenditures and financial burden of patients diagnosed with hypertension and diabetes. Methods This study used repeated cross-sectional surveys in 2011 and 2012 in three counties of Shandong Province. Outpatient and inpatient service expenditures and catastrophic health expenditures (CHE) were measured and analyzed. Results Medical expenditures for outpatient services significantly increased for hypertensive and diabetic patients within a 1 year period, while inpatient service expenditures remained unchanged. Although NCMS increased its reimbursement rate, hypertensive and diabetic patients still heavily suffered CHE from both outpatient and inpatient services. Outpatient services were more important factors than inpatient services contributing to non-communicable chronic diseases (NCD) patients’ financial burden. Conclusions The effects of NCMS expansion have been offset by the rapid escalation of medical expenditures. More attention should be paid to the design of NCMS benefit package to cover NCD outpatient services. There is also an urgent need to reform the current Fee for Service to other provider payment methods in order to control the escalating NCD medical expenditures. Electronic supplementary material The online version of this article (doi:10.1186/s12913-016-1735-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Xiaoyun Liu
- China Center for Health Development Studies, Peking University, Beijing, China.
| | - Xiaojie Sun
- Center for Health Management and Policy, Shandong University, Jinan, China
| | - Yang Zhao
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Qingyue Meng
- China Center for Health Development Studies, Peking University, Beijing, China
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Introduction to Cost Analysis in IR: Challenges and Opportunities. J Vasc Interv Radiol 2016; 27:539-545.e1. [PMID: 26922978 DOI: 10.1016/j.jvir.2015.12.754] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 12/22/2015] [Accepted: 12/22/2015] [Indexed: 11/20/2022] Open
Abstract
Demonstration of value has become increasingly important in the current health care system. This review summarizes four of the most commonly used cost analysis methods relevant to IR that could be adopted to demonstrate the value of IR interventions: the cost minimization study, cost-effectiveness assessment, cost-utility analysis, and cost-benefit analysis. In addition, the issues of true cost versus hospital charges, modeling in cost studies, and sensitivity analysis are discussed.
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Quinn AD, Dixon D, Meenan BJ. Barriers to hospital-based clinical adoption of point-of-care testing (POCT): A systematic narrative review. Crit Rev Clin Lab Sci 2015; 53:1-12. [DOI: 10.3109/10408363.2015.1054984] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Jacob HJ, Abrams K, Bick DP, Brodie K, Dimmock DP, Farrell M, Geurts J, Harris J, Helbling D, Joers BJ, Kliegman R, Kowalski G, Lazar J, Margolis DA, North P, Northup J, Roquemore-Goins A, Scharer G, Shimoyama M, Strong K, Taylor B, Tsaih SW, Tschannen MR, Veith RL, Wendt-Andrae J, Wilk B, Worthey EA. Genomics in clinical practice: lessons from the front lines. Sci Transl Med 2014; 5:194cm5. [PMID: 23863829 DOI: 10.1126/scitranslmed.3006468] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
The price of whole-genome and -exome sequencing has fallen to the point where these methods can be applied to clinical medicine. Here, we outline the lessons we have learned in converting a sequencing laboratory designed for research into a fully functional clinical program.
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Affiliation(s)
- Howard J Jacob
- Human and Molecular Genetic Center, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA.
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Poulin P, Austen L, Scott CM, Poulin M, Gall N, Seidel J, Lafrenière R. Introduction of new technologies and decision making processes: a framework to adapt a Local Health Technology Decision Support Program for other local settings. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2013; 6:185-93. [PMID: 24273415 PMCID: PMC3836686 DOI: 10.2147/mder.s51384] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Introducing new health technologies, including medical devices, into a local setting in a safe, effective, and transparent manner is a complex process, involving many disciplines and players within an organization. Decision making should be systematic, consistent, and transparent. It should involve translating and integrating scientific evidence, such as health technology assessment (HTA) reports, with context-sensitive evidence to develop recommendations on whether and under what conditions a new technology will be introduced. However, the development of a program to support such decision making can require considerable time and resources. An alternative is to adapt a preexisting program to the new setting. MATERIALS AND METHODS We describe a framework for adapting the Local HTA Decision Support Program, originally developed by the Department of Surgery and Surgical Services (Calgary, AB, Canada), for use by other departments. The framework consists of six steps: 1) development of a program review and adaptation manual, 2) education and readiness assessment of interested departments, 3) evaluation of the program by individual departments, 4) joint evaluation via retreats, 5) synthesis of feedback and program revision, and 6) evaluation of the adaptation process. RESULTS Nine departments revised the Local HTA Decision Support Program and expressed strong satisfaction with the adaptation process. Key elements for success were identified. CONCLUSION Adaptation of a preexisting program may reduce duplication of effort, save resources, raise the health care providers' awareness of HTA, and foster constructive stakeholder engagement, which enhances the legitimacy of evidence-informed recommendations for introducing new health technologies. We encourage others to use this framework for program adaptation and to report their experiences.
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Affiliation(s)
- Paule Poulin
- Department of Surgery, Alberta Health Services, Calgary, AB, Canada
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Poulin P, Austen L, Scott CM, Waddell CD, Dixon E, Poulin M, Lafrenière R. Multi-criteria development and incorporation into decision tools for health technology adoption. J Health Organ Manag 2013; 27:246-65. [PMID: 23802401 DOI: 10.1108/14777261311321806] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE When introducing new health technologies, decision makers must integrate research evidence with local operational management information to guide decisions about whether and under what conditions the technology will be used. Multi-criteria decision analysis can support the adoption or prioritization of health interventions by using criteria to explicitly articulate the health organization's needs, limitations, and values in addition to evaluating evidence for safety and effectiveness. This paper seeks to describe the development of a framework to create agreed-upon criteria and decision tools to enhance a pre-existing local health technology assessment (HTA) decision support program. DESIGN/METHODOLOGY/APPROACH The authors compiled a list of published criteria from the literature, consulted with experts to refine the criteria list, and used a modified Delphi process with a group of key stakeholders to review, modify, and validate each criterion. In a workshop setting, the criteria were used to create decision tools. FINDINGS A set of user-validated criteria for new health technology evaluation and adoption was developed and integrated into the local HTA decision support program. Technology evaluation and decision guideline tools were created using these criteria to ensure that the decision process is systematic, consistent, and transparent. PRACTICAL IMPLICATIONS This framework can be used by others to develop decision-making criteria and tools to enhance similar technology adoption programs. ORIGINALITY/VALUE The development of clear, user-validated criteria for evaluating new technologies adds a critical element to improve decision-making on technology adoption, and the decision tools ensure consistency, transparency, and real-world relevance.
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Affiliation(s)
- Paule Poulin
- Department of Surgery and Surgical Services, University of Calgary and Alberta Health Services, Calgary, Canada.
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Olson SA, Obremskey WT, Bozic KJ. Healthcare technology: physician collaboration in reducing the surgical cost. Clin Orthop Relat Res 2013; 471:1854-64. [PMID: 23404417 PMCID: PMC3706644 DOI: 10.1007/s11999-013-2828-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The increasing cost of providing health care is a national concern. Healthcare spending related to providing hospital care is one of the primary drivers of healthcare spending in the United States. Adoption of advanced medical technologies accounts for the largest percentage of growth in healthcare spending in the United States when compared with other developed countries. Within the specialty of orthopaedic surgery, a variety of implants can result in similar outcomes for patients in several areas of clinical care. However, surgeons often do not know the cost of implants used in a specific procedure or how the use of an implant or technology affects the overall cost of the episode of care. QUESTIONS/PURPOSES The purposes of this study were (1) to describe physician-led processes for introduction of new surgical products and technologies; and (2) to inform physicians of potential cost savings of physician-led product contract negotiations and approval of new technology. METHODS We performed a detailed review of the steps taken by two centers that have implemented surgeon-led programs to demonstrate responsibility in technology acquisition and product procurement decision-making. RESULTS Each program has developed a physician peer review process in technology and new product acquisition that has resulted in a substantial reduction in spending for the respective hospitals in regard to surgical implants. Implant costs have decreased between 3% and 38% using different negotiating strategies. At the same time, new product requests by physicians have been approved in greater than 90% of instances. CONCLUSIONS Hospitals need physicians to be engaged and informed in discussions concerning current and new technology and products. Surgeons can provide leadership for these efforts to reduce the cost of high-quality care.
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Affiliation(s)
- Steven A. Olson
- Department of Orthopaedic Surgery, Duke University School of Medicine, DUMC Box 3389, Durham, NC 27710 USA
| | - William T. Obremskey
- Department of Orthopaedic Surgery, Vanderbilt University School of Medicine, Nashville, TN USA
| | - Kevin J. Bozic
- Department of Orthopaedic Surgery, University of California–San Francisco School of Medicine, San Francisco, CA USA
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Sorenson C, Drummond M, Bhuiyan Khan B. Medical technology as a key driver of rising health expenditure: disentangling the relationship. CLINICOECONOMICS AND OUTCOMES RESEARCH 2013; 5:223-34. [PMID: 23807855 PMCID: PMC3686328 DOI: 10.2147/ceor.s39634] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Indexed: 11/27/2022] Open
Abstract
Health care spending has risen steadily in most countries, becoming a concern for decision-makers worldwide. Commentators often point to new medical technology as the key driver for burgeoning expenditures. This paper critically appraises this conjecture, based on an analysis of the existing literature, with the aim of offering a more detailed and considered analysis of this relationship. Several databases were searched to identify relevant literature. Various categories of studies (eg, multivariate and cost-effectiveness analyses) were included to cover different perspectives, methodological approaches, and issues regarding the link between medical technology and costs. Selected articles were reviewed and relevant information was extracted into a standardized template and analyzed for key cross-cutting themes, ie, impact of technology on costs, factors influencing this relationship, and methodological challenges in measuring such linkages. A total of 86 studies were reviewed. The analysis suggests that the relationship between medical technology and spending is complex and often conflicting. Findings were frequently contingent on varying factors, such as the availability of other interventions, patient population, and the methodological approach employed. Moreover, the impact of technology on costs differed across technologies, in that some (eg, cancer drugs, invasive medical devices) had significant financial implications, while others were cost-neutral or cost-saving. In light of these issues, we argue that decision-makers and other commentators should extend their focus beyond costs solely to include consideration of whether medical technology results in better value in health care and broader socioeconomic benefits.
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Affiliation(s)
- Corinna Sorenson
- LSE Health, London School of Economics and Political Science, London, UK
- European Health Technology Institute for Socioeconomic Research, Brussels, Belgium
| | - Michael Drummond
- European Health Technology Institute for Socioeconomic Research, Brussels, Belgium
- Centre for Health Economics, University of York, York, UK
| | - Beena Bhuiyan Khan
- LSE Health, London School of Economics and Political Science, London, UK
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Tibesku CO, Hofer P, Portegies W, Ruys CJM, Fennema P. Benefits of using customized instrumentation in total knee arthroplasty: results from an activity-based costing model. Arch Orthop Trauma Surg 2013; 133:405-11. [PMID: 23242451 DOI: 10.1007/s00402-012-1667-4] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The growing demand for total knee arthroplasty (TKA) associated with the efforts to contain healthcare expenditure by advanced economies necessitates the use of economically effective technologies in TKA. The present analysis based on activity-based costing (ABC) model was carried out to estimate the economic value of patient-matched instrumentation (PMI) compared to standard surgical instrumentation in TKA. METHODOLOGY The costs of the two approaches, PMI and standard instrumentation in TKA, were determined by the use of ABC which measures the cost of a particular procedure by determining the activities involved and adding the cost of each activity. Improvement in productivity due to increased operating room (OR) turn-around times was determined and potential additional revenue to the hospital by the efficient utilization of gained OR time was estimated. RESULTS Increased efficiency in the usage of OR and utilization of surgical trays were noted with patient-specific approach. Potential revenues to the hospital were estimated with the use of PMI by efficient utilization of time saved in OR. Additional revenues of <euro>78,240 per year were estimated considering utilization of gained OR time to perform surgeries other than TKA. CONCLUSIONS The analysis suggests that use of PMI in TKA is economically effective when compared to standard instrumentation.
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MR/PET or PET/MRI: does it matter? MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2013; 26:1-4. [PMID: 23385880 DOI: 10.1007/s10334-012-0365-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Revised: 12/20/2012] [Accepted: 12/21/2012] [Indexed: 01/01/2023]
Abstract
After the very successful clinical introduction of combined PET/CT imaging a decade ago, a hardware combination of PET and MR is following suit. Today, three different approaches towards integrated PET/MR have been proposed: (1) a triple-modality system with a 3T MRI and a time-of-flight PET/CT installed in adjacent rooms, (2) a tandem system with a 3T MRI and a time-of-flight PET/CT in a co-planar installation with a joint patient handling system, and (3) a fully-integrated system with a whole-body PET system mounted inside a 3T MRI system. This special issue of MAGMA brings together contributions from key experts in the field of PET/MR, PET/CT and CT. The various papers share the author's perspectives on the state-of-the-art PET/MR imaging with any of the three approaches mentioned above. In addition to several reviews discussing advantages and challenges of combining PET and MRI for clinical diagnostics, first clinical data are also presented. We expect this special issue to nurture future improvements in hardware, clinical protocols, and efficient post-processing strategies to further assess the diagnostic value of combined PET/MR imaging. It remains to be seen whether a so-called "killer application" for PET/MRI will surface. In that case PET/MR is likely to excel in pre-clinical and selected research applications for now. This special issue helps the readers to stay on track of this exciting development.
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Jian W, Chan KY, Tang S, Reidpath DD. A case study of the counterpart technical support policy to improve rural health services in Beijing. BMC Health Serv Res 2012; 12:482. [PMID: 23272703 PMCID: PMC3561279 DOI: 10.1186/1472-6963-12-482] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Accepted: 12/21/2012] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND There is, globally, an often observed inequality in the health services available in urban and rural areas. One strategy to overcome the inequality is to require urban doctors to spend time in rural hospitals. This approach was adopted by the Beijing Municipality (population of 20.19 million) to improve rural health services, but the approach has never been systematically evaluated. METHODS Drawing upon 1.6 million cases from 24 participating hospitals in Beijing (13 urban and 11 rural hospitals) from before and after the implementation of the policy, changes in the rural-urban hospital performance gap were examined. Hospital performance was assessed using changes in six indices over-time: Diagnosis Related Groups quantity, case-mix index (CMI), cost expenditure index (CEI), time expenditure index (TEI), and mortality rates of low- and high-risk diseases. RESULTS Significant reductions in rural-urban gaps were observed in DRGs quantity and mortality rates for both high- and low-risk diseases. These results signify improvements of rural hospitals in terms of medical safety, and capacity to treat emergency cases and more diverse illnesses. No changes in the rural-urban gap in CMI were observed. Post-implementation, cost and time efficiencies worsened for the rural hospitals but improved for urban hospitals, leading to a widening rural-urban gap in hospital efficiency. CONCLUSIONS The strategy for reducing urban-rural gaps in health services adopted, by the Beijing Municipality shows some promise. Gains were not consistent, however, across all performance indicators, and further improvements will need to be tried and evaluated.
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Affiliation(s)
- Weiyan Jian
- Department of Health Policy and Management, School of Public Health, Peking University Health Science Centre, 38 Xueyuan Road, Haidian District, Beijing 100191, China
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Kalemis A, Delattre BMA, Heinzer S. Sequential whole-body PET/MR scanner: concept, clinical use, and optimisation after two years in the clinic. The manufacturer’s perspective. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2012; 26:5-23. [DOI: 10.1007/s10334-012-0330-y] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Revised: 07/10/2012] [Accepted: 07/11/2012] [Indexed: 01/08/2023]
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Beyer T, Freudenberg LS, Czernin J, Townsend DW. The future of hybrid imaging-part 3: PET/MR, small-animal imaging and beyond. Insights Imaging 2011; 2:235-246. [PMID: 22347950 PMCID: PMC3270262 DOI: 10.1007/s13244-011-0085-4] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2010] [Revised: 01/04/2011] [Accepted: 02/18/2011] [Indexed: 11/30/2022] Open
Abstract
Since the 1990s, hybrid imaging by means of software and hardware image fusion alike allows the intrinsic combination of functional and anatomical image information. This review summarises in three parts the state of the art of dual-technique imaging with a focus on clinical applications. We will attempt to highlight selected areas of potential improvement of combined imaging technologies and new applications. In this third part, we discuss briefly the origins of combined positron emission tomography (PET)/magnetic resonance imaging (MRI). Unlike PET/computed tomography (CT), PET/MRI started out from developments in small-animal imaging technology, and, therefore, we add a section on advances in dual- and multi-modality imaging technology for small animals. Finally, we highlight a number of important aspects beyond technology that should be addressed for a sustained future of hybrid imaging. In short, we predict that, within 10 years, we may see all existing multi-modality imaging systems in clinical routine, including PET/MRI. Despite the current lack of clinical evidence, integrated PET/MRI may become particularly important and clinically useful in improved therapy planning for neurodegenerative diseases and subsequent response assessment, as well as in complementary loco-regional oncology imaging. Although desirable, other combinations of imaging systems, such as single-photon emission computed tomography (SPECT)/MRI may be anticipated, but will first need to go through the process of viable clinical prototyping. In the interim, a combination of PET and ultrasound may become available. As exciting as these new possible triple-technique—imaging systems sound, we need to be aware that they have to be technologically feasible, applicable in clinical routine and cost-effective.
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Affiliation(s)
- Thomas Beyer
- cmi-experts GmbH, Pestalozzistr 3, 8032 Zürich, Switzerland
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany
| | - Lutz S. Freudenberg
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany
- Department of Nuclear Medicine, ZRN, Grevenbroich, Germany
| | - Johannes Czernin
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, UCLA, Los Angeles, CA USA
| | - David W. Townsend
- Singapore Bioimaging Consortium, 11 Biopolis Way, 02-02 Helios, Singapore, 138667 Singapore
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