June 26, 2012
Summary: As patients live longer, many states, community-based coalitions, and health care providers have begun to focus on the quality—and quantity—of medical care provided at the end of life. The resulting programs have provided physicians with techniques for delivering bad news, managing transitions to palliative care, and handling requests for therapies that are likely to be futile. They’ve also helped to elicit patient preferences, leading to lower utilization in some locations.
Posted in Mass Media Articles, READ Portal | Tagged with Decision making, Palliative care, Quality of care | No Comments
May 9, 2012
“Background: Finding measures to enhance the dissemination and implementation of their recommendations has become part of most health technology assessment (HTA) bodies’ preoccupations. The Quebec government HTA organization in Canada observed that some of its projects relied on innovative practices in knowledge production and dissemination. A research was commissioned in order to identify what characterized these practices and to establish whether they could be systematized.
Methods: An exploratory case study was conducted during summer and fall 2010 in the HTA agency in order to determine what made the specificity of its context, and to conceptualize an approach to knowledge production and dissemination that was adapted to the mandate and nature of this form of HTA organization. Six projects were selected. For each, the HTA report and complementary documents were analyzed, and semi-structured interviews were carried out. A narrative literature review of the most recent literature reviews of the principal knowledge into practice frameworks (2005-2010) and of articles describing such frameworks (2000-2010) was undertaken.
Results and discussion: Our observations highlighted an inherent difficulty as regards applying the dominant knowledge translation models to HTA and clinical guidance practices. For the latter, the whole process starts with an evaluation question asked in a problematic situation for which an actionable answer is expected. The objective is to produce the evidence necessary to respond to the decision-maker’s request. The practices we have analyzed revealed an approach to knowledge production and dissemination, which was multidimensional, organic, multidirectional, dynamic, and dependent on interactions with stakeholders. Thus, HTA could be considered as a knowledge mobilization process per se.
Conclusions: HTA’s purpose is to solve a problem by mobilizing the types of evidence required and the concerned actors, in order to support political, organizational or clinical decision-making. HTA relies on the mediation between contextual, colloquial and scientific evidence, as well as on interactions with stakeholders for recommendation making. Defining HTA as a knowledge mobilization process might contribute to consider the different orders of knowledge, the social, political and ethical dimensions, and the interactions with stakeholders, among the essential components required to respond to the preoccupations, needs and contexts of all actors concerned with the evaluation question’s issues.”
Posted in Journal Articles, READ Portal | Tagged with Canada, Decision making, Health technology, Technology | No Comments
April 12, 2012
- Assessing how much confidence to place in different types of research evidence is key to informing judgements regarding policy options to address health systems problems.
- Systematic and transparent approaches to such assessments are particularly important given the complexity of many health systems interventions.
- Useful tools are available to assess how much confidence to place in the different types of research evidence needed to support different steps in the policy-making process; those for assessing evidence of effectiveness are most developed.
- Tools need to be developed to assist judgements regarding evidence from systematic reviews on other key factors such as the acceptability of policy options to stakeholders, implementation feasibility, and equity.
- Research is also needed on ways to develop, structure, and present policy options within global health systems guidance.
- This is the third paper in a three-part series in PLoS Medicine on health systems guidance.
Posted in Journal Articles, READ Portal | Tagged with Decision making, Evidence-based | No Comments
February 1, 2012
“Making decisions about the appropriate allocation of scarce healthcare resources is a necessary but difficult task. It involves consideration of a number of decision criteria, processing disparate streams of information and balancing individual and group/jurisdictional perspectives, not to mention ethical principles. This complex process demands transparency, consistency, and accountability to be perceived as legitimate by the public and healthcare providers and to increase the likelihood of making good decisions…
Consistent healthcare decisionmaking requires systematic consideration of decision criteria and evidence available to inform them. This can be tackled by combining multicriteria decision analysis (MCDA) and Health Technology Assessment (HTA). The objective of this study was to field-test a decision support framework (EVIDEM), explore its utility to a drug advisory committee and test its reliability over time. (The study found that by) promoting systematic consideration of all decision criteria and the underlying evidence, the framework allows a consistent approach to appraising healthcare interventions. Further testing and validation are needed to advance MCDA approaches in healthcare decision-making.”
Posted in Journal Articles, READ Portal | Tagged with Decision making, Health technology, Health technology assessment | No Comments
January 26, 2012
“Four healthcare finance leaders share their strategies for creating a road map for change that leads to cost efficiencies and accountability as cornerstones of a new culture. (The main lesson is that) to drive the major organizational changes needed in a reform era, healthcare finance leaders should:
- Establish a vision of where the change in strategy affects their organizations’ direction and gain acceptance from staff about shared goals;
- Create partnerships with fellow executives to understand the metrics of the organization and promote a team approach for change:
- Define clear measures of success so staffers can understand business goals and their roles in organization:
- Communicate the progress that has been made in meeting goals and provide guidance when milestones have been missed.”
Posted in Journal Articles, READ Portal | Tagged with Decision making, Economics, Hospital administration | No Comments
December 15, 2011
“Background: There is an increasing recognition that modelling and simulation can assist in the process of designing health care policies, strategies and operations. However, the current use is limited and answers to questions such as what methods to use and when remain somewhat underdeveloped.
Aim: The aim of this study is to provide a mechanism for decision makers in health services planning and management to compare a broad range of modelling and simulation methods so that they can better select and use them or better commission relevant modelling and simulation work.
Methods: This paper proposes a modelling and simulation method comparison and selection tool developed from a comprehensive literature review, the research team’s extensive expertise and inputs from potential users. Twenty-eight different methods were identified, characterised by their relevance to different application areas, project life cycle stages, types of output and levels of insight, and four input resources required (time, money, knowledge and data).
Results: The characterisation is presented in matrix forms to allow quick comparison and selection. This paper also highlights significant knowledge gaps in the existing literature when assessing the applicability of particular approaches to health services management, where modelling and simulation skills are scarce let alone money and time.
Conclusions: A modelling and simulation method comparison and selection tool is developed to assist with the selection of methods appropriate to supporting specific decision making processes. In particular it addresses the issue of which method is most appropriate to which specific health services management problem, what the user might expect to be obtained from the method, and what is required to use the method. In summary, we believe the tool adds value to the scarce existing literature on methods comparison and selection.”
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Posted in Journal Articles, READ Portal | Tagged with Decision making | No Comments
November 21, 2011
“Integrated health systems are considered part of the solution to the challenge of sustaining Canada’s healthcare system. This systematic literature review was undertaken to guide decision-makers and others to plan for and implement integrated health systems.
This review identified 10 universal principles of successfully integrated healthcare systems that may be used by decision-makers to assist with integration efforts. These principles define key areas for restructuring and allow organizational flexibility and adaptation to local context. The literature does not contain a one-size-fits-all model or process for successful integration, nor is there a firm empirical foundation for specific integration strategies and processes.”
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July 4, 2011
“Senior decision-makers in the Canadian healthcare system have to continuously make significant, and complex, policy and program decisions. However, it appears that, often, the evidence they have available is fairly simple descriptive information, collected for operational purposes. Trying to solve complex problems with fairly simple data may lead to suboptimal decisions. This article presents a new knowledge development system (KDS) that should allow senior decision-makers and others to manage smarter and take their decision-making to the next level. A KDS represents the integration of information systems, and research and analysis, into one system. It can generate sophisticated, strategic information around complex issues, which should ultimately lead to wiser decisions. This article describes the KDS, provides an example of a current KDS and concludes by presenting a self-diagnostic tool for decision-makers to allow them to determine whether their organization could benefit from a KDS.”
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June 8, 2011
“Systematic reviews have the potential to inform decisions made by health policymakers and managers, yet little is known about the impact of interventions to increase the use of systematic reviews by these groups in decision making.
We systematically reviewed the evidence on the impact of interventions for seeking, appraising, and applying evidence from systematic reviews in decision making by health policymakers or managers. Medline, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, Cochrane Methodology Register, Health Technology Assessment Database, and LISA were searched from the earliest date available until April 2010. Two independent reviewers selected studies for inclusion if the intervention intended to increase seeking, appraising, or applying evidence from systematic reviews by a health policymaker or manager. Minimum inclusion criteria were a description of the study population and availability of extractable data.
11,297 titles and abstracts were reviewed, leading to retrieval of 37 full-text articles for assessment; four of these articles met all inclusion criteria. Three articles described one study where five systematic reviews were mailed to public health officials and followed up with surveys at three months and two years. The articles reported from 23% to 63% of respondents declaring they had used systematic reviews in policymaking decisions. One randomised trial indicated that tailored messages combined with access to a registry of systematic reviews had a significant effect on policies made in the area of healthy body weight promotion in health departments.
The limited empirical data renders the strength of evidence weak for the effectiveness and the types of interventions that encourage health policymakers and managers to use systematic reviews in decision making. “
Posted in Journal Articles, READ Portal | Tagged with Decision making, Evidence-based, Policy | No Comments
May 18, 2011
Modern healthcare executives face more issues than ever before. Electronic health records implementation, health reform issues, public relations management, meaningful use criteria, and other such topics are bombarding decision makers from every angle. Trying to prioritize all of the opportunities available can be a constant struggle. Fortunately, taking a visionary approach to these issues can help decision makers overcome this issue. Focusing on a wide view of the organization, having a clear understanding of populations served, and seeing the patients as valued members in the care team, are all strategies that executives can employ to improve organizational performance in the face of dynamic healthcare industry.
Posted in Journal Articles, READ Portal | Tagged with Decision making, e-health | No Comments