Achieving optimal technology use: A proposed model for health technology reassessment

Abstract

Background:Healthcare providers, managers and policy-makers in many jurisdictions are focused on a common goal: optimizing value and quality of care provided to their citizens within a resource envelope. Health technology reassessment is a structured, evidence-based assessment of the clinical, social, ethical and economic effects of a technology currently used in the healthcare system to inform optimal use of that technology in comparison with its alternatives. There are, however, few practical experiences with health technology reassessment and, as such, a nascent theoretical and methodological base. Health technology reassessment is a key strategy to achieve optimal healthcare resource utilization, and establishing a model for health technology reassessment is a required methodological step.Methods and results:The purpose of this article is to answer three formative questions: (1) What is health technology reassessment? (2) When should a health technology reassessment be implemented? (3) What is the role of health technology reassessment in evidence-informed health policy? Finally, we propose a conceptual framework for health technology reassessment, which others can modify, adapt, or adopt in their own context. The model consists of three broad phases and six iterative stages: (1) identification, (2) prioritization, (3) evidence synthesis, (4) determine policy/practice recommendation, (5) policy/practice implementation and (6) monitoring and evaluation. Two foundational components (meaningful stakeholder engagement and ongoing knowledge exchange and utilization) are represented across all stages.Conclusion:This description of health technology reassessment and the proposed model can be used by healthcare policy-makers and researchers to advance the field of technology management, with the goal of achieving optimal use throughout a technology’s lifecycle.

Characteristics of Knowledge Translation Theories, Models and Frameworks for Health Technology Reassessment: Expert Perspectives Through a Qualitative Exploration

“…Step 1: Build the Case for HTR This step involves prioritization of HTR to justify its requirement, as not all technologies will require a reassessment. Participants noted that criteria to prioritize reassessment such as geographic variation could be used and has been outlined in other studies (3,37). They also added that this step focuses on identi cation and articulation of the problem through the synthesis of evidence on the technology and the evidence for why it should be reduced or removed.…”

“…The principle of being patient-centered has also been articulated in the HTR literature (42). The need for stakeholder engagement as a foundational element within the HTR model has been described (43). Meaningful and effective stakeholder engagement needs to be throughout, with engagement being authentic and early on in the process (43,44).…”

“…Health Technology Reassessment (HTR) is an evidence-based approach that systematically reviews the clinical, social, ethical and economical effects of a technology to ensure it is being used optimally in health care (1)(2)(3). The process results in four outputs: increase or decrease use of a technology, no change, or removal of a technology (1)(2)(3). In recent years, HTR programs have been developed that focus on actual phases of the HTR process.…”

“…In recent years, HTR programs have been developed that focus on actual phases of the HTR process. A recent systematic review of HTR frameworks in seven countries identi ed four components: identi cation, prioritization, assessment, and decision dissemination strategies (3,4).…”

Moving low value care lists into action: prioritizing candidate health technologies for reassessment using administrative data

“…The objective of this study was to develop a data-driven methodological process, leveraging existing knowledge and data assets, to develop a list of prioritized candidate technologies for health technology reassessment (HTR). HTR is defined as the structured, evidence-based evaluation of the medical, economic, social, and ethical impacts of a technology currently used in the system, in order to inform its optimal use compared to its alternatives [ 20 , 21 ]. A case example of the implementation of the data-driven process to advance HTR initiatives within a Canadian health system context will also be described.…”