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Understanding of the role of contextual factors in determining the real value of health technologies is one of the major challenges for the use of Health Technology Assessment (HTA) methodology within hospitals. Moreover, the responsibility of assessing hospital performance is problematic. Although a number of managerial tools are available to appraise outcomes, there is little evidence on the role of contextual variables and how they might contribute to hospital performance.
Based on three extensive literature reviews, a pragmatic framework has been developed to understand interactions between organizational factors and health technologies on hospitals’ performance. Three main causal relationships emerge: (i) direct relationship between contextual factors and performance; (ii) an effect of contextual factors on the capability of technologies to “produce value”; (iii) an influence of organizational factors on clinical evidence-based decision-making. This pragmatic framework was designed within the IMPACT HTA EU Horizon 2020 Research Project.
The contextual dimensions are ascribable to five domains: organizational structure; managerial accounting tools; information, communication and technology (ICT) tools; human resource management (HRM) tools; hospital-based HTA procedures. The impact of contextual factors on technologies’ ability to produce value is highly overlooked in literature. Some effort in this sense exists only in the analysis of health information technologies. Moreover, among the contextual dimensions, only HRM tools have inspired a lively debate. The definition of hospital performance is amenable to multiple domains: accessibility, appropriateness, efficiency, safety and patient centeredness (continuity of care).
Although hospital performance is a pivotal topic in the healthcare sector, a deep understanding of how contextual factors may affect it is missing. The theoretical framework developed provides a tool to understand the multiple dimensions able to affect hospital performance. On one hand contextual dimensions may provide a direct effect on hospital performance. On the other, they may affect the extent to which technologies are capable of producing value.
Organizational aspects influence the behavior of healthcare professionals and managers, and may help to overcome the barriers in the implementation of new health technologies. However, the organizational domain is often under-represented or absent when Health Technology Assessment (HTA) reports are built. The objective of this study was to to explore the organizational assessment in HTA and build a new framework for applicative experience after the comparison with the European Network for HTA (EUnetHTA's) CoreModel 3.0.
A literature review was performed by extracting full HTA reports through INAHTA (International Network of Agencies for Health Technology Assessment) members websites, HTA agencies and snowball search, and the aspects relating to the organizational assessment were analyzed. A quantitative and qualitative analysis was performed on the retrieved reports and the results were compared with a framework of five domains and fifteen subdomains from EUnetHTA's CoreModel 3.0. A Multiple Correspondence Analysis was carried out in order to evaluate the power of CoreModel and identify new common domains to guide the organizational assessments in HTA reports.
The assessments of organizational issues in the reports were significantly heterogeneous and less common than inclusion of other classic assessments. When included, domains and subdomains of the CoreModel were not covered homogeneously by the organizational assessments (representation level varied from 19 percent to 62 percent). The statistical analysis performed on the current data and the subsequent clustering of items offered the possibility to develop a new methodology based on three new composite indicators.
This ongoing study analyzed the relevance of organizational assessments in current literature and the challenges of promoting an international approach to the matter. In this sense, according to the current state of the research, we proposed a new methodology to cover the most relevant aspects of organizational appraisal according to new, more homogeneous domains and a less context-oriented approach to encourage health professionals to perform organizational analysis and better fulfill the needs of future HTA research.
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