Integrating local data into hospital-based healthcare technology assessment: two case studies.
OBJECTIVE
Health technology assessment (HTA) programs influence practice on a broad scale through reimbursement decisions or national guidelines. Hospital-based HTA programs inform clinical decisions at the local level. Typically, they do this by adapting general HTA to their local setting, or by creating new HTA. However, unlike payer-based HTA organizations, hospital-based HTA organizations can also integrate local data into their reports.


METHODS
We describe two examples of local data integrated into hospital-based HTA. In the first, qualitative data were used to select a new cardiac catheterization lab. In the second, quantitative data was used to inform a decision on whether to continue telemedicine services to critical care units. Local evidence sources included equipment service records, and interviews with physicians, technicians, and administrative staff in the first example, and the hospital's administrative and claims databases in the second example.


RESULTS
In each case, there was little evidence from the peer-reviewed literature that could be applied to the decision. In the first example, staffing patterns and local preferences had considerable bearing on technology choices. In the second example, local outcomes data from administrative records were decisive.


CONCLUSIONS
Hospital-based HTA using local data can fill gaps in the published evidence, and also improve the generalizability of evidence to the local setting. To take advantage of local evidence, health systems should encourage the development of hospital-based HTA centers, seek out local preference data, and maintain databases of patient outcomes and utilization of services.
Mitchell
Matthew D
MD
University of Pennsylvania Health System, Philadelphia, Pennsylvania 19104, USA. mdmitchell@uphs.upenn.edu
Williams
Kendal
K
Brennan
Patrick J
PJ
Umscheid
Craig A
CA
D000046:Academic Medical Centers; D017023:Coronary Angiography; D006739:Hospital Administration; D019451:Information Management; D019982:Organizational Case Studies; D010414:Pennsylvania; D011682:Purchasing, Hospital; D013673:Technology Assessment, Biomedical / Q000458:organization & administration*; D017216:Telemedicine