Rosenberg-Yunger Zahava R S, Bayoumi Ahmed M
School of Health Services Management, Ted Rogers School of Management, Ryerson University, 350 Victoria St., Toronto, ON, Canada M5B 2K3.
School of Health Services Management, Ted Rogers School of Management, Ryerson University, 350 Victoria St., Toronto, ON, Canada M5B 2K3; Department of Medicine, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada; Division of General Internal Medicine, St. Michael's Hospital, Toronto, ON, Canada.
Health Policy. 2014 Nov;118(2):255-63. doi: 10.1016/j.healthpol.2014.08.010. Epub 2014 Aug 30.
Transparency in health care resource allocation decisions is a criterion of a fair process. We used qualitative methods to explore transparency across 11 Canadian drug advisory committees.
We developed seven criteria to assess transparency (disclosure of members' names, disclosure of membership selection criteria, disclosure of conflict of interest guidelines and members' conflicts, public posting of decisions not to fund drugs, public posting of rationales for decisions, stakeholder input, and presence of an appeals mechanism) and two sub-criteria for when rationales were posted (direct website link and readability). We interviewed a purposeful sample of key informants who were conversant in English and a current or past member of either a committee or a stakeholder group. We analyzed data using a thematic approach. Interviewing continued until saturation was reached.
We examined documents from 10 committees and conducted 27 interviews. The median number of criteria addressed by committees was 2 (range 0-6). Major interview themes included addressing: (1) accessibility issues, including stakeholders' degree of access to the decision making process and appeal mechanisms; (2) communication issues, including improving internal and external communication and public access to information; and (3) confidentiality issues, including the use of proprietary evidence.
Most committees have some mechanisms to address transparency but none had a fully transparent process. The most important ways to improve transparency include creating formal appeal mechanisms, improving communication, and establishing consistent rules about the use of, and public access to, proprietary evidence.
医疗保健资源分配决策的透明度是公平程序的一项标准。我们采用定性方法来探究11个加拿大药品咨询委员会的透明度情况。
我们制定了七条评估透明度的标准（披露成员姓名、披露成员选拔标准、披露利益冲突准则及成员冲突情况、公开不资助药品的决定、公开决策理由、利益相关方参与以及设有上诉机制）以及两条关于何时公布决策理由的子标准（直接网站链接和可读性）。我们对一些关键信息提供者进行了有目的抽样访谈，这些信息提供者精通英语，并且是委员会或利益相关方团体的现任或前任成员。我们采用主题分析法对数据进行分析。访谈持续进行直至达到饱和状态。
我们审查了10个委员会的文件并进行了27次访谈。各委员会涉及的标准中位数为2条（范围为0 - 6条）。主要访谈主题包括解决：（1）可及性问题，包括利益相关方参与决策过程及上诉机制的程度；（2）沟通问题，包括改善内部和外部沟通以及公众获取信息的情况；（3）保密问题，包括专有证据的使用。
大多数委员会有一些解决透明度问题的机制，但没有一个委员会有完全透明的程序。提高透明度的最重要方法包括建立正式的上诉机制、改善沟通以及就专有证据的使用和公众获取制定一致的规则。
