Ahumada-Canale Antonio, Jeet Varinder, Bilgrami Anam, Seil Elizabeth, Gu Yuanyuan, Cutler Henry
Macquarie University Centre for the Health Economy, Macquarie Business School & Australian Institute of Health Innovation, Macquarie University, Level 5, 75 Talavera Rd, Macquarie Park, New South Wales, 2109, Australia.
Soc Sci Med. 2023 Apr;322:115790. doi: 10.1016/j.socscimed.2023.115790. Epub 2023 Feb 20.
Health care budgets in high-income countries are having issues coping with unsustainable growth in demand, particularly in the hospital setting. Despite this, implementing tools systematising priority setting and resource allocation decisions has been challenging. This study answers two questions: (1) what are the barriers and facilitators to implementing priority setting tools in the hospital setting of high-income countries? and (2) what is their fidelity? A systematic review using the Cochrane methods was conducted including studies of hospital-related priority setting tools reporting barriers or facilitators for implementation, published after the year 2000. Barriers and facilitators were classified using the Consolidated Framework for Implementation Research (CFIR). Fidelity was assessed using priority setting tool's standards. Out of thirty studies, ten reported program budgeting and marginal analysis (PBMA), twelve multi-criteria decision analysis (MCDA), six health technology assessment (HTA) related frameworks, and two, an ad hoc tool. Barriers and facilitators were outlined across all CFIR domains. Implementation factors not frequently observed, such as 'evidence of previous successful tool application', 'knowledge and beliefs about the intervention' or 'external policy and incentives' were reported. Conversely, some constructs did not yield any barrier or facilitator including 'intervention source' or 'peer pressure'. PBMA studies satisfied the fidelity criteria between 86% and 100%, for MCDA it varied between 36% and 100%, and for HTA it was between 27% and 80%. However, fidelity was not related to implementation. This study is the first to use an implementation science approach. Results represent the starting point for organisations wishing to use priority setting tools in the hospital setting by providing an overview of barriers and facilitators. These factors can be used to assess readiness for implementation or to serve as the foundation for process evaluations. Through our findings, we aim to improve the uptake of priority setting tools and support their sustainable use.
高收入国家的医疗保健预算在应对需求的不可持续增长方面存在问题，尤其是在医院环境中。尽管如此，实施系统化确定优先事项和资源分配决策的工具一直具有挑战性。本研究回答了两个问题：（1）在高收入国家的医院环境中实施优先事项确定工具的障碍和促进因素是什么？（2）它们的保真度如何？使用Cochrane方法进行了一项系统综述，纳入了2000年后发表的关于医院相关优先事项确定工具的研究，这些研究报告了实施的障碍或促进因素。使用实施研究综合框架（CFIR）对障碍和促进因素进行分类。使用优先事项确定工具的标准评估保真度。在三十项研究中，十项报告了项目预算编制和边际分析（PBMA），十二项报告了多标准决策分析（MCDA），六项报告了与卫生技术评估（HTA）相关的框架，两项报告了临时工具。在所有CFIR领域都概述了障碍和促进因素。报告了一些不常观察到的实施因素，如“先前成功应用工具的证据”、“对干预的知识和信念”或“外部政策和激励措施”。相反，一些结构没有产生任何障碍或促进因素，包括“干预来源”或“同伴压力”。PBMA研究的保真度标准满足率在86%至100%之间，MCDA在36%至100%之间，HTA在27%至80%之间。然而，保真度与实施无关。本研究首次采用实施科学方法。研究结果为希望在医院环境中使用优先事项确定工具的组织提供了障碍和促进因素的概述，是这些组织的起点。这些因素可用于评估实施准备情况或作为过程评估的基础。通过我们的研究结果，我们旨在提高优先事项确定工具的采用率并支持其可持续使用。
