title: Development, implementation and evaluation of an evidence-based program for introduction of new health technologies and clinical practices in a local healthcare setting.
abstract: BACKGROUND
  This paper reports the process of establishing a transparent, accountable, evidence-based program for introduction of new technologies and clinical practices (TCPs) in a large Australian healthcare network. Many countries have robust evidence-based processes for assessment of new TCPs at national level. However many decisions are made by local health services where the resources and expertise to undertake health technology assessment (HTA) are limited and a lack of structure, process and transparency has been reported.
  
  
  METHODS
  An evidence-based model for process change was used to establish the program. Evidence from research and local data, experience of health service staff and consumer perspectives were incorporated at each of four steps: identifying the need for change, developing a proposal, implementation and evaluation. Checklists assessing characteristics of success, factors for sustainability and barriers and enablers were applied and implementation strategies were based on these findings. Quantitative and qualitative methods were used for process and outcome evaluation. An action research approach underpinned ongoing refinement to systems, processes and resources.
  
  
  RESULTS
  A Best Practice Guide developed from the literature and stakeholder consultation identified seven program components: Governance, Decision-Making, Application Process, Monitoring and Reporting, Resources, Administration, and Evaluation and Quality Improvement. The aims of transparency and accountability were achieved. The processes are explicit, decisions published, outcomes recorded and activities reported. The aim of ascertaining rigorous evidence-based information for decision-making was not achieved in all cases. Applicants proposing new TCPs provided the evidence from research literature and local data however the information was often incorrect or inadequate, overestimating benefits and underestimating costs. Due to these limitations the initial application process was replaced by an Expression of Interest from applicants followed by a rigorous HTA by independent in-house experts.
  
  
  CONCLUSIONS
  The program is generalisable to most health care organisations. With one exception, the components would be achievable with minimal additional resources; the lack of skills and resources required for HTA will limit effective application in many settings. A toolkit containing details of the processes and sample materials is provided to facilitate replication or local adaptation by those wishing to establish a similar program.
authors.affiliation: School of Public Health and Preventive Medicine, Monash University, Victoria, Australia. claire.harris@monash.edu.|Centre for Clinical Effectiveness, Monash Health, Victoria, Australia. claire.harris@monash.edu.
authors.forename: Claire
authors.initials: C
authors.lastname: Harris
authors.affiliation: Centre for Clinical Effectiveness, Monash Health, Victoria, Australia. marie.garrubba@monashhealth.org.
authors.forename: Marie
authors.initials: M
authors.lastname: Garrubba
authors.affiliation: School of Public Health and Preventive Medicine, Monash University, Victoria, Australia. kelly.allen@monash.edu.|Centre for Clinical Effectiveness, Monash Health, Victoria, Australia. kelly.allen@monash.edu.
authors.forename: Kelly
authors.initials: K
authors.lastname: Allen
authors.affiliation: Medicine Program, Monash Health, Victoria, Australia. richard.king@monashhealth.org.
authors.forename: Richard
authors.initials: R
authors.lastname: King
authors.affiliation: Medical Services, Alfred Health, Victoria, Australia. c.kelly@alfred.org.au.
authors.forename: Cate
authors.initials: C
authors.lastname: Kelly
authors.affiliation: Legal Office, Monash Health, Victoria, Australia. malar.thiagarajan@monashhealth.org.
authors.forename: Malar
authors.initials: M
authors.lastname: Thiagarajan
authors.affiliation: Consumer Representative, Monash Health, Victoria, Australia. bevcastleman@ozemail.com.au.
authors.forename: Beverley
authors.initials: B
authors.lastname: Castleman
authors.affiliation: Medical Services and Quality, Monash Health, Victoria, Australia. wayne.p.ramsey@gmail.com.
authors.forename: Wayne
authors.initials: W
authors.lastname: Ramsey
authors.affiliation: Centre for Clinical Effectiveness, Monash Health, Victoria, Australia. dfarjou@gmail.com.
authors.forename: Dina
authors.initials: D
authors.lastname: Farjou
mesh_terms: D057186:Comparative Effectiveness Research / Q000191:economics / Q000458:organization & administration; D003365:Costs and Cost Analysis; D003657:Decision Making; D003695:Delivery of Health Care; D004059:Diffusion of Innovation; D055317:Evidence-Based Practice / Q000191:economics / Q000458:organization & administration*; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D020380:Needs Assessment / Q000191:economics / Q000458:organization & administration; D013673:Technology Assessment, Biomedical / Q000191:economics / Q000458:organization & administration*; D014739:Victoria