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Multi-criteria Decision Model for Assessing Health Service Information Technology Network Support Using the Analytic Hierarchy Process
Oddershede Herrera, Astrid;Carrasco González, Rolando;Barham Abu-Muhor, Esperanza;
Computación y Sistemas , 2008,
Abstract: this paper presents a multi-criteria decision making (mcdm) model for evaluating an information and communication technology (ict) network system in health care .the competing goals existing in health institutions need a special treatment, thus the mcdm approach is essential for identifying ict network quality of service (qos) requirements and implications. a pilot study based on user perception is explored involving three categories of hospitals in chile. data is collected considering various health sector representatives. the main contribution is the proposed decision methodology to develop criteria for evaluating qos issues of an ict network system within a healthcare environment using the analytical hierarchy process (ahp). the results provides a framework to make decisions concerning an information technology networked system, characterizing end users and their needs and enabling tradeoffs in agreement with the institution objectives.
Antiviral combination therapy with interferon/peginterferon plus ribavirin for patients with chronic hepatitis C in Germany: a health technology assessment commissioned by the German Agency for Health Technology Assessment
Siebert, Uwe,Sroczynski, Gaby,German Hepatitis C Model (GEHMO) Group,HTA Expert Panel on Hepatitis C
GMS German Medical Science , 2003,
Abstract: Objective: The purpose of this health technology assessment (HTA), commissioned by the German Agency for HTA at the German Federal Ministry of Health and Social Security, was to systematically review the evidence on effectiveness and cost-effectiveness of antiviral treatment (AVT) for initial chronic hepatitis C (CHC) and to apply these data in the context of the German health care system. Methods: A systematic literature search was conducted to identify randomised controlled trials (RCTs), meta-analyses, and HTAs that evaluated initial AVT for CHC. A modified version of the German Hepatitis C Model (GEHMO) -- a decision-analytic Markov model -- was used to determine long-term morbidity, life expectancy, quality of life, costs and cost-effectiveness of different treatment strategies. Model parameters were derived from German databases, international RCTs, and a Cochrane Review. Results: Overall, 9 RCTs, 2 HTA reports, 1 Cochrane review, and 2 meta-analyses examining medical effectiveness of antiviral combination therapy, as well as 7 economic evaluations, met the inclusion criteria. These studies indicate that combination therapy with peginterferon plus ribavirin produced the highest sustained virological response rates (54-61%), followed by interferon plus ribavirin with 38-54%, and interferon monotherapy with 11-21%. Based on international cost-effectiveness studies, interferon plus ribavirin is cost-effective compared to interferon monotherapy. No published articles were available regarding cost-effectiveness of peginterferon plus ribavirin. In our decision analysis, these findings were confirmed and the discounted incremental cost-effectiveness ratio for peginterferon plus ribavirin was € 9,800 per quality-adjusted life-year gained compared to interferon monotherapy (as the next best non-dominated strategy). Sensitivity analyses showed robust results across a wide range of model parameters. Conclusions: This HTA suggests that initial combination therapy prolongs life, improves quality of life, and is cost-effective in patients with CHC. Combination of peginterferon and ribavirin is the most effective and efficient treatment strategy among the examined options.
Challenges to fair decision-making processes in the context of health care services: a qualitative assessment from Tanzania
Elizabeth H Shayo, Ole F Norheim, Leonard EG Mboera, Jens Byskov, Stephen Maluka, Peter Kamuzora, Astrid Blystad
International Journal for Equity in Health , 2012, DOI: 10.1186/1475-9276-11-30
Abstract: The study was carried out in the Mbarali District of Tanzania. A qualitative study design was used. In-depth interviews and focus group discussion were conducted among members of the district health team, local government officials, health care providers and community members. Informal discussion on the topics was also of substantial value.The study findings indicate a substantial influence of gender, wealth, ethnicity and education on health care decision-making processes. Men, wealthy individuals, members of strong ethnic groups and highly educated individuals had greater influence. Opinions varied among the study informants as to whether such differences should be considered fair. The differences in levels of influence emerged most clearly at the community level, and were largely perceived as legitimate.Existing challenges related to individuals’ influence of decision making processes in health care need to be addressed if greater participation is desired. There is a need for increased advocacy and a strengthening of responsive practices with an emphasis on the right of all individuals to participate in decision-making processes. This simultaneously implies an emphasis on assuring the distribution of information, training and education so that individuals can participate fully in informed decision making.
Evidence-based decision-making within the context of globalization: A “Why–What–How” for leaders and managers of health care organizations
Véronique Lapaige
Risk Management and Healthcare Policy , 2009, DOI: http://dx.doi.org/10.2147/RMHP.S4845
Abstract: ence-based decision-making within the context of globalization: A “Why–What–How” for leaders and managers of health care organizations Other (15023) Total Article Views Authors: Véronique Lapaige Published Date March 2009 Volume 2009:2 Pages 35 - 46 DOI: http://dx.doi.org/10.2147/RMHP.S4845 Véronique Lapaige Canadian Health Services Research Foundation Fellow; PRO-ACTIVE Research Program (Participatory and Evaluative Research Program to Optimize Workplace Management: Application of Knowledge, Transfer of Expertise, Innovative Interventions, Training Transformational Leaders) Pavillon Ferdinand-Vandry, CIFSS (Centre intégré de formation en sciences de la santé), Laval University, Quebec City, Quebec Canada Abstract: In the globalized knowledge economy, the challenge of translating knowledge into policy and practice is universal. At the dawn of the 21st century, the clinicians, leaders, and managers of health care organizations are increasingly required to bridge the research-practice gap. A shift from moving evidence to solving problems is due. However, despite a vast literature on the burgeoning field of knowledge translation research, the “evidence-based” issue remains for many health care professionals a day-to-day debate leading to unresolved questions. On one hand, many clinicians still resist to the implementation of evidence-based clinical practice, asking themselves why their current practice should be changed or expanded. On the other hand, many leaders and managers of health care organizations are searching how to keep pace with the demand of actionable knowledge. For example, they are wondering: (a) if managerial and policy innovations are subjected to the same evidentiary standards as clinical innovations, and (b) how they can adapt the scope of evidence-based medicine to the culture, context, and content of health policy and management. This paper focuses on evidence-based health care management within the context of contemporary globalization. In this paper, our heuristic hypothesis is that decision-making process related changes within clinical/managerial/policy environments must be given a socio-historical backdrop. We argue that the relationship between research on the transfer of knowledge and its uptake by clinical, managerial and policy target audiences has undergone a shift, resulting in increasing pressures in health care for intense researcher-practitioner collaboration and the development of “integrative KT platforms” at the crossroads of different fields (the field of knowledge management and the field of knowledge translation). The objectives of this paper are: (a) to provide an answer to the questions that health professionals ask most frequently about “Why” and “How” to bridge the know-do gap, (b) to illustrate by a Canadian example how the PRO-ACTIVE program helps in closing the evidence-based practice gap.
Barriers and opportunities for evidence-based health service planning: the example of developing a Decision Analytic Model to plan services for sexually transmitted infections in the UK
Catherine RH Aicken, Nigel T Armstrong, Jackie A Cassell, Neil Macdonald, Angela C Bailey, Sandra A Johnson, Catherine H Mercer
BMC Health Services Research , 2012, DOI: 10.1186/1472-6963-12-202
Abstract: Drawing on our experiences from stakeholder consultations, where we presented the potential utility of a DAM for planning local health services for sexually transmitted infections (STIs) in the UK, and the evidence it could use to inform decisions regarding different combinations of service provision, in terms of their costs, cost-effectiveness, and public health outcomes, we discuss the barriers perceived by stakeholders to the use of DAMs to inform service planning for local populations, including (1) a tension between individual and population perspectives; (2) reductionism; and (3) a lack of transparency regarding models, their assumptions, and the motivations of those generating models.Technological advances, including improvements in computing capability, are facilitating the development and use of models such as DAMs for health service planning. However, given the current scepticism among many stakeholders, encouraging informed critique and promoting trust in models to aid health service planning is vital, for example by making available and explicit the methods and assumptions underlying each model, associated limitations, and the process of validation. This can be achieved by consultation and training with the intended users, and by allowing access to the workings of the models, and their underlying assumptions (e.g. via the internet), to show how they actually work.Constructive discussion and education will help build a consensus on the purposes of STI services, the need for service planning to be evidence-based, and the potential for mathematical tools like DAMs to facilitate this.
Decision-analytic modeling to evaluate the long-term effectiveness and cost-effectiveness of HPV-DNA testing in primary cervical cancer screening in Germany
Sroczynski, Gaby,Schnell-Inderst, Petra,Mühlberger, Nikolai,Lang, Katharina
GMS Health Technology Assessment , 2010,
Abstract: Background: Persistent infections with high-risk types of human papillomavirus (HPV) are associated with the development of cervical neoplasia. Compared to cytology HPV testing is more sensitive in detecting high-grade cervical cancer precursors, but with lower specificity. HPV based primary screening for cervical cancer is currently discussed in Germany. Decisions should be based on a systematic evaluation of the long-term effectiveness and cost-effectiveness of HPV based primary screening. Research questions: What is the long-term clinical effectiveness (reduction in lifetime risk of cervical cancer and death due to cervical cancer, life years gained) of HPV testing and what is the cost-effectiveness in Euro per life year gained (LYG) of including HPV testing in primary cervical cancer screening in the German health care context? How can the screening program be improved with respect to test combination, age at start and end of screening and screening interval and which recommendations should be made for the German health care context? Methods: A previously published and validated decision-analytic model for the German health care context was extended and adapted to the natural history of HPV infection and cervical cancer in order to evaluate different screening strategies that differ by screening interval, and tests, including cytology alone, HPV testing alone or in combination with cytology, and HPV testing with cytology triage for HPV-positive women. German clinical, epidemiological and economic data were used. In the absence of individual data, screening adherence was modelled independently from screening history. Test accuracy data were retrieved from international meta-analyses. Predicted outcomes included reduction in lifetime-risk for cervical cancer cases and deaths, life expectancy, lifetime costs, and discounted incremental cost-effectiveness ratios (ICER). The perspective of the third party payer and 3% annual discount rate were adopted. Extensive sensitivity analyses were performed in order to evaluate the robustness of results and identify areas of future research. Results: In the base case analysis screening resulted in a 53% to 97% risk reduction for cervical cancer with a discounted ICER between 2,600 Euro/LYG (cytology alone every five years) and 155,500 Euro/LYG (Annual cytology age 20 to 29 years, and annual HPV age 30 years and older). Annual cytology, the current recommended screening strategy in Germany, was dominated. In sensitivity analyses variation in the relative increase in the sensitivity of HPV testing as compared to cyto
Evaluación económica en salud y toma de decisiones en el contexto sanitario cubano Economic assessment in health care and the decision-making in the health care context
Ana María Gálvez González,Anaí Garcia Fari?as,Carmen Portuondo Sánchez,Cristina Lara Bastanzuri
Revista Cubana de Salud Pública , 2012,
Abstract: Objetivo: identificar cuáles son los factores que fortalecen y los que limitan el adecuado uso de las evaluaciones económicas en función de la toma de decisiones en el contexto sanitario cubano. Métodos: se seleccionó un conjunto de profesionales vinculados a la toma de decisiones en diferentes ámbitos del Sistema Nacional de Salud. Se realizaron grupos focales para cada nivel identificado y entrevistas de profundidad a directivos, médicos, profesores e investigadores escogidos para conocer sus criterios al respecto. Resultados: se encontraron factores de carácter práctico, metodológico y administrativo que fortalecen y otros que limitan el desarrollo de la evaluación económica en el país. Conclusiones: se propone un conjunto de acciones para fortalecer el uso de la evaluación económica en salud en el proceso de toma de decisiones en Cuba. Objective: to identify the factors that strengthen and those factors that limit the adequate use of economic assessment as a function of the decision-making process in the Cuban health care system. Methods: there was selected a group of professionals linked to the decision-making process at various contexts of the national health care system. Focal groups for each identified level were organized in addition to making in-depth interviews to chosen managers, physicians, professors and researchers to find their criteria on this issue. Results: practical, methodological and administrative factors that either strengthen or limit the development of economic assessment nationwide were identified. Conclusions: a number of actions were put forward to strengthen the use of economic assessment in health in the decision-making process in Cuba.
Propuesta de reglas de decisión en las evaluaciones económicas de tecnologías sanitarias para el contexto cubano Proposals of decision rules in economic assessment of health technologies for the Cuban context  [cached]
Antonio Castillo Guzmán,C. Carmen Arocha Mari?o,Ivette Castillo Arocha,Odalys Bravo Téllez
Revista Cubana de Investigaciones Biom??dicas , 2011,
Abstract: INTRODUCCIóN: Aunque las evaluaciones económicas en el sector sanitario cubano han crecido en número y en calidad, con poca periodicidad son utilizadas en la toma de decisiones, ni se solicitan con frecuencia. Una de las posibles causas para no emplearlas es que casi ninguna muestra las reglas de decisión aplicadas por los investigadores para la alternativa que proponen, lo que incrementa la incertidumbre de los encargados de tomar decisiones. OBJETIVO: Presentar un grupo de reglas de decisión en evaluaciones económicas que forman parte de la literatura. RESULTADOS: Se presentan criterios de decisión para evaluaciones económicas de tipo costo efectividad (plano costo efectividad); costo utilidad (considerada una variante de la técnica costo efectividad) emplea como criterio de decisión el plano costo efectividad también; costo beneficio utiliza el valor actual neto, la razón costo beneficio bruta y la tasa interna de rendimiento. CONCLUSIóN: La aplicación de reglas de decisión en las evaluaciones económicas contribuye a la reducción de la incertidumbre en el momento de decidir entre alternativas. INTRODUCTION: Although the economic assessments in the Cuban health sector have increased in number and in quality, they are neither used frequently used in the decision-making nor are frequently requested. One of the potential causes of this non-use is that almost any shows of decision rules applied by researchers for the own alternative increasing the uncertainty of those charged of decisions-making. OBJECTIVE: To present a series of decision rules in economic assessments to be part of the literature. RESULTS: Some decision criteria are presented for economic assessment of cost-effectiveness ( cost-effectiveness plan); cost-usefulness (a variant of cost-effectiveness technique) which uses as decision criterion also the cost-effectiveness plan; cost-benefit uses the net current value, the gross cost-benefit ratio and the performance internal rate. CONCLUSION: The researches related to economic evaluations must to be enclosed by the decision rules on the proposed alternatives, thus it allow to decision-maker to make the choice.
Evidence-based decision-making within the context of globalization: A “Why–What–How” for leaders and managers of health care organizations
Véronique Lapaige
Risk Management and Healthcare Policy , 2009,
Abstract: Véronique LapaigeCanadian Health Services Research Foundation Fellow; PRO-ACTIVE Research Program (Participatory and Evaluative Research Program to Optimize Workplace Management: Application of Knowledge, Transfer of Expertise, Innovative Interventions, Training Transformational Leaders) Pavillon Ferdinand-Vandry, CIFSS (Centre intégré de formation en sciences de la santé), Laval University, Quebec City, Quebec Canada Abstract: In the globalized knowledge economy, the challenge of translating knowledge into policy and practice is universal. At the dawn of the 21st century, the clinicians, leaders, and managers of health care organizations are increasingly required to bridge the research-practice gap. A shift from moving evidence to solving problems is due. However, despite a vast literature on the burgeoning field of knowledge translation research, the “evidence-based” issue remains for many health care professionals a day-to-day debate leading to unresolved questions. On one hand, many clinicians still resist to the implementation of evidence-based clinical practice, asking themselves why their current practice should be changed or expanded. On the other hand, many leaders and managers of health care organizations are searching how to keep pace with the demand of actionable knowledge. For example, they are wondering: (a) if managerial and policy innovations are subjected to the same evidentiary standards as clinical innovations, and (b) how they can adapt the scope of evidence-based medicine to the culture, context, and content of health policy and management. This paper focuses on evidence-based health care management within the context of contemporary globalization. In this paper, our heuristic hypothesis is that decision-making process related changes within clinical/managerial/policy environments must be given a socio-historical backdrop. We argue that the relationship between research on the transfer of knowledge and its uptake by clinical, managerial and policy target audiences has undergone a shift, resulting in increasing pressures in health care for intense researcher-practitioner collaboration and the development of “integrative KT platforms” at the crossroads of different fields (the field of knowledge management and the field of knowledge translation). The objectives of this paper are: (a) to provide an answer to the questions that health professionals ask most frequently about “Why” and “How” to bridge the know-do gap, (b) to illustrate by a Canadian example how the PRO-ACTIVE program helps in closing the evidence-based practice gap.Keywor
The participation of the German L nder in the EU decision-making process  [cached]
Carlo Panara
Revista CIDOB d'Afers Internacionals , 2012,
Abstract: This article sketches out the main features of the German system of regional participation in the EU decision-making process with the aim of identifying the key strengths and weaknesses of that system. The author will be examining whether the model currently in place allows for a sufficiently rapid and effective response to the EU decision-making process, and whether there is a sufficiently balanced representation of regional and federal interests at the EU level. The article will also contain a proposal as to how the German model of regional participation in the EU decision-making process could be further improved.
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