Gagnon Marie-Pierre, Desmartis Marie, Poder Thomas, Witteman William
Centre de recherche du CHU de Québec, 10 rue de l'Espinay, D6-726 Quebec City, QC G1L 3L5, Canada.
Syst Rev. 2014 Oct 28;3:129. doi: 10.1186/2046-4053-3-129.
Health technology assessment (HTA) is increasingly performed at the local or hospital level where the costs, impacts, and benefits of health technologies can be directly assessed. Although local/hospital-based HTA has been implemented for more than two decades in some jurisdictions, little is known about its effects and impact on hospital budget, clinical practices, and patient outcomes. We conducted a mixed-methods systematic review that aimed to synthesize current evidence regarding the effects and impact of local/hospital-based HTA.
We identified articles through PubMed and Embase and by citation tracking of included studies. We selected qualitative, quantitative, or mixed-methods studies with empirical data about the effects or impact of local/hospital-based HTA on decision-making, budget, or perceptions of stakeholders. We extracted the following information from included studies: country, methodological approach, and use of conceptual framework; local/hospital HTA approach and activities described; reported effects and impacts of local/hospital-based HTA; factors facilitating/hampering the use of hospital-based HTA recommendations; and perceptions of stakeholders concerning local/hospital HTA. Due to the great heterogeneity among studies, we conducted a narrative synthesis of their results.
A total of 18 studies met the inclusion criteria. We reported the results according to the four approaches for performing HTA proposed by the Hospital Based HTA Interest Sub-Group: ambassador model, mini-HTA, internal committee, and HTA unit. Results showed that each of these approaches for performing HTA corresponds to specific needs and structures and has its strengths and limitations. Overall, studies showed positive impacts related to local/hospital-based HTA on hospital decisions and budgets, as well as positive perceptions from managers and clinicians.
Local/hospital-based HTA could influence decision-making on several aspects. It is difficult to evaluate the real impacts of local HTA at the different levels of health care given the relatively small number of evaluations with quantitative data and the lack of clear comparators. Further research is necessary to explore the conditions under which local/hospital-based HTA results and recommendations can impact hospital policies, clinical decisions, and quality of care and optimize the use of scarce resources.
卫生技术评估（HTA）越来越多地在地方或医院层面开展，在此层面可以直接评估卫生技术的成本、影响和效益。尽管基于地方/医院的卫生技术评估在一些辖区已经实施了二十多年，但对于其对医院预算、临床实践和患者结局的影响知之甚少。我们开展了一项混合方法的系统评价，旨在综合关于基于地方/医院的卫生技术评估的影响和作用的现有证据。
我们通过PubMed和Embase以及对纳入研究的引文追踪来识别文章。我们选择了定性、定量或混合方法的研究，这些研究具有关于基于地方/医院的卫生技术评估对决策、预算或利益相关者认知的影响的实证数据。我们从纳入研究中提取了以下信息：国家、方法学方法以及概念框架的使用；所描述的地方/医院卫生技术评估方法和活动；基于地方/医院的卫生技术评估报告的影响和作用；促进/阻碍使用医院卫生技术评估建议的因素；以及利益相关者对地方/医院卫生技术评估的认知。由于研究之间存在很大的异质性，我们对其结果进行了叙述性综合。
共有18项研究符合纳入标准。我们根据医院卫生技术评估兴趣小组提出的进行卫生技术评估的四种方法报告了结果：大使模式、小型卫生技术评估、内部委员会和卫生技术评估单位。结果表明，这些进行卫生技术评估的方法各自对应特定的需求和结构，并且有其优点和局限性。总体而言，研究表明基于地方/医院的卫生技术评估对医院决策和预算有积极影响，并且管理者和临床医生也有积极的认知。
基于地方/医院的卫生技术评估可能在多个方面影响决策。鉴于定量数据的评估数量相对较少且缺乏明确的对照，很难评估地方卫生技术评估在不同医疗保健层面的实际影响。有必要进一步开展研究，以探索在何种条件下基于地方/医院的卫生技术评估结果和建议能够影响医院政策、临床决策和医疗质量，并优化稀缺资源的利用。
