Department of Experimental Surgery, Faculty of Medicine, McGill University, Montreal, Quebec, Canada.
Vanier Scholar, Canadian Institutes of Health Research.
JAMA Netw Open. 2023 Nov 1;6(11):e2343703. doi: 10.1001/jamanetworkopen.2023.43703.
There is no decision-making framework in the early-adoption stage of novel surgical technologies, putting the quality of health care and resource allocation of the health care system at risk.
To investigate relevant weighted criteria that decision-makers may use to make an informed decision for the early adoption of innovative surgical technologies.
DESIGN, SETTING, AND PARTICIPANTS: This multi-institutional decision analytical modeling study used a mixed-methods multicriteria decision analysis (MCDA) and had 2 phases. First, a panel of 12 experts validated decision criteria in the literature and identified additional criteria. Second, 33 Canadian experts prioritized the main criteria (domains) using the composition pairwise-comparison weight-elicitation method (analytical hierarchy process model) and ranked their subcriteria using the direct-ranking elicitation method (Likert scale). Data were analyzed, and response consistency was estimated using the consistency ratio. Analysis of variance was used to assess for significant differences between expert responses. The MCDA was conducted at McGill University between 2021 and 2023. Data were collected nationally by inviting experts in Canada.
Criteria domain weights and subcriteria rankings. Priority vectors, which are priority scores analyzed and prioritized from expert responses, were used to rank criteria domains and subcriteria for decision-making on adopting new innovative surgical technologies.
A total of 45 experts (33 male [73.3%] and 12 female [26.7%]) were invited with different levels of education (22 experts with MD or equivalent, 13 experts with master's degree, and 12 experts with PhD degree) and years of experience (4 experts with <10, 12 experts with 11-20, 18 experts with 21-30, and 11 experts with >30 years). Surgeon experts (23 individuals) were from all surgical disciplines, and nonsurgeon experts (22 individuals) were administrative officers in surgical device procurement, health technology assessment experts, and hospital directors. A total of 7 domains and 44 subcriteria were identified. The MCDA model found that clinical outcomes had the highest priority vector, at 0.429, followed by patients and public relevance (0.135). Hospital-specific criteria (priority vector, 0.099), technology-specific criteria (priority vector, 0.092), and physician-specific criteria (priority vector, 0.087) were the next most highly ranked. The lowest priority vectors were for economic criteria, at 0.083, and finally policies and procedures, at 0.075. There was consensus in the responses (consistency ratio = 0.006), and there were no statistically significant differences between expert responses.
This study weighted priority criteria domains in importance and established ranked subcriteria for decision-making of early adoption of surgical technologies. Putting these criteria into a framework may help surgeons and decision-makers make informed decisions for the early adoption of new surgical technologies.
重要性：在新型外科技术的早期采用阶段，没有决策框架，这使得医疗保健的质量和医疗保健系统的资源分配面临风险。
目的：研究决策者可能用于为创新外科技术的早期采用做出明智决策的相关加权标准。
设计、设置和参与者：本多机构决策分析模型研究使用了混合方法多准则决策分析（MCDA），并分为两个阶段。首先，一个由 12 名专家组成的小组在文献中验证了决策标准，并确定了其他标准。其次，33 名加拿大专家使用组成对比较权重 elicitation 方法（层次分析法模型）对主要标准（领域）进行优先级排序，并使用直接排序 elicitation 方法（李克特量表）对其子标准进行排名。使用一致性比率分析数据并估计响应一致性。方差分析用于评估专家响应之间是否存在显著差异。MCDA 在 2021 年至 2023 年期间在麦吉尔大学进行。通过邀请加拿大专家，在全国范围内收集数据。
主要结果和测量：标准领域权重和子标准排名。优先级向量是从专家响应中分析和优先考虑的优先级分数，用于对采用新创新外科技术进行决策的标准领域和子标准进行排名。
结果：共邀请了 45 名专家（33 名男性[73.3%]和 12 名女性[26.7%]），具有不同的教育水平（22 名专家具有医学博士或同等学历，13 名专家具有硕士学位，12 名专家具有博士学位）和工作经验（4 名专家<10 年，12 名专家 11-20 年，18 名专家 21-30 年，11 名专家>30 年）。外科医生专家（23 人）来自所有外科专业，非外科医生专家（22 人）是外科设备采购、卫生技术评估专家和医院主管。确定了 7 个领域和 44 个子标准。MCDA 模型发现临床结果的优先级向量最高，为 0.429，其次是患者和公众相关性（0.135）。医院特定标准（优先级向量，0.099）、技术特定标准（优先级向量，0.092）和医生特定标准（优先级向量，0.087）是下一个最受重视的标准。经济标准的优先级向量最低，为 0.083，最后是政策和程序，为 0.075。响应存在一致性（一致性比率=0.006），并且专家响应之间没有统计学上的显著差异。
结论和相关性：本研究对重要性标准领域进行了优先级加权，并为外科技术的早期采用制定了排名子标准。将这些标准纳入框架可能有助于外科医生和决策者为新外科技术的早期采用做出明智决策。
