1. Understanding Healthcare Provider and Decision-Maker Perspectives on Health Technology Reassessment: A Qualitative Research Study LESLEY J.J. SORIL, GAIL MACKEAN, TOM W. NOSEWORTHY, FIONA M. CLEMENT PhD Candidate, Department of Community Health Sciences, University of Calgary Health Technology Assessment Unit, O’Brien Institute for Public Health 2016 CADTH SYMPOSIUM

2. DISCLOSURE STATEMENT I have no actual or potential conflict of interest in relation to this topic or presentation

3. BACKGROUND Health technologies are considered major cost- drivers in the Canadian healthcare system Focus on managing the entry or adoption of new technologies into the healthcare system However, there is no standardized process for monitoring health technologies once adopted

4. BACKGROUND Sub-optimal technology use: ◦Overuse or misuse of ineffective or harmful technologies ◦Underuse of effective technologies Comprise patient safety and health, as well as the quality of care Wasting of valuable healthcare resources

5. VALUE FOR MONEY How can we continue to monitor and manage the use of health technologies throughout their lifecycle?

6. Health Technology Reassessment (HTR) Structured, evidence-based assessment of the clinical, economic, social and ethical impacts of a health technology currently used in the healthcare system, to inform its optimal use in comparison to its alternatives

7. TECHNOLOGY SELECTION TECHNOLOGY SELECTION Identification Prioritization 1 DECISION DECISION Evidence Synthesis Policy Development 2 EXECUTION EXECUTION Policy Implementation Monitoring and Evaluation 3 Meaningful Stakeholder Engagement Ongoing Knowledge Exchange and Utilization Proposed HTR Model, HTA Unit University of Calgary (2012)

8. IMPLICATIONS OF HTR GOAL Optimal use of health technologies throughout their lifecycle in the healthcare system

9. IMPLICATIONS OF HTR GOAL Optimal use of health technologies throughout their lifecycle OUTCOMES Decrease use, increase use, no change, or exit of the technology from the system Can identify funds to be reallocated to support investments that provide greater value for money

10. IMPLICATIONS OF HTR GOAL Optimal use of health technologies throughout their lifecycle OUTCOMES Decrease use, increase use, no change, or exit of the technology from the system Can identify funds to be reallocated to support investments that provide greater value for money EXPECTATIONS Improvements in patient outcomes, and quality, safety, appropriateness of care

11. THE FIELD OF HTR HTR is in its infancy, with few documented accounts internationally Practical implementation experience with HTR emerging in Canada Prime opportunity to study the HTR process

12. Place your screenshot here ALBERTA HEALTH SERVICES Provincial healthcare delivery organization in Alberta

13. Place your screenshot here STRATEGIC CLINICAL NETWORKS Remit to conduct HTR activities in Alberta

14. STUDY OBJECTIVE To understand stakeholder perspectives on the concept of HTR and its integration into the Alberta healthcare system

15. METHODOLOGY Sampling Purposive sampling strategy, with both maximum variation and snowball sampling Participants Healthcare providers and decision-makers (i.e. administrators, operational leaders) in AHS involved in or with knowledge of HTR Data Collection Semi-structured telephone interviews were conducted from May-August 2014 Relevant documents were also reviewed Data Analysis Qualitative research software (HyperResearch) was used to support the management and analysis of the interview data Emerging Themes Constant comparative analysis was employed to identify key themes and to articulate relationships between them

16. RESULTS: Study Participants RESPONDENT CATEGORYRESPONDENT TYPEFREQUENCY SCN Affiliates Decision-makers*7 Physicians3 Other AHS Affiliates Decision-makers*9 Physicians3 TOTAL22 *Decision-Maker: Administrative or Operational Lead

17. RESULTS: Emerging Themes on the Concept of HTR UnderstandingLanguage Value Proposition

18. LANGUAGE Negativity associated with economic terminology 1 Perceptions of veiled criticism 2 Critical for creating a level set “People get their backs up when they hear disinvest or savings or even waste” 1 “A lot of people go on the defense right away with it. It needs reassessment because you are not doing the right thing” 2

19. UNDERSTANDING Confusing HTR with simply rationing and budget cuts 4 Managing waste in the healthcare system 3 Improving existing processes and clinical practices “It’s about stopping something that has no value or is wasteful or causes harm or all three. Don’t waste resources” 3 “Some people will take any of the words and interpret them as budget cuts and they go automatically to you’re cutting my program” 4

20. VALUE PROPOSITION Recognizing the value of HTR will take time Reinvestment is a key incentive 6 Ensuring benefits to the patient is paramount 5 “The product is pretty to clear to me. Improving health and health care for people“ 5 “If there is money to be saved some of that money should come back to that program to allow reinvestment in other areas of priority” 6

21. Lack of clarity around HTR Varying conceptualizations and expectations Timing and time are critical May not have been considered at the outset Stakeholders generally supportive With recognition that waste must be addressed and improvements can be made

22. STUDY CONSIDERATIONS Alberta HTR experience: transferability limited Credibility of findings still need to be fully established through verification Intended to focus on perceptions of stakeholders at “macro” level, concerning early integration of HTR initiatives into the system

23. THE WAY FORWARD Commitment to advancing the HTR agenda Consistent leadership and broad stakeholder engagement Provide support and education Development of tools and levers to enable change

24. Dr. Gail MacKean Dr. Fiona Clement Dr. Tom Noseworthy HTA Unit, University of Calgary Alberta Innovates Health Solutions (AIHS) lsoril@ucalgary.ca web: https://obrieniph.ucalgary.ca/hta_unit twitter: @lsoril