Session 3.1 – Evidence informed priority setting

Thursday October 30 8:30-10:00

Introducing an Evidence-Informed Decision Making Approach in Community Care in the Interior Health Authority (IH) of B.C.

(Abstract 0043)

Evelyn Cornelissen1, Alan Davidson1, Colin Reid1, Cam Donaldson4, Stuart Peacock3, Paul Hasselback2, Tom Fulton2, Anne-Marie Broemeling2
1University of British Columbia - Okanagan, Canada, 2Interior Health Authority, Canada, 3British Columbia Cancer Research Center, Canada, 4Newcastle University, United Kingdom

Background & Objective: Financing and sustainability are key issues for decision makers. We present findings from a study of how decision makers in a British Columbia community care setting learn and use an explicit, evidence-informed approach to priority-setting and resource allocation.

Methods: Using action research methodology we investigated the adoption and use of a systematic priority-setting approach to inform resource allocations for the 2008/09 budget in the Interior Health Authority Community Care portfolio. Researchers supported decision makers in determining and using both local and research evidence, and locally-generated criteria, to identify priorities for service redesign. Twenty interviews and one focus group were conducted with decision makers pre-implementation (2007) and again post-implementation (2008).

Results: Pre-implementation, respondents wanted a more structured approach to align priority setting with strategic objectives rather than historical drivers such as acute-care decongestion and cost-minimization. An interdisciplinary group assessed proposals for redesign using criteria including accessibility, quality, cost, client choice and innovation. Post-implementation interviews identified challenges including mid-implementation changes in personnel and strategic direction. All participants viewed involvement of a public member at the decision making table as positive.

Policy Implications: This work adds to a growing body of literature on the use of evidence-driven approaches to support decision makers when facing resource scarcity. These approaches facilitate ‘knowledge-to-action’ regarding the integration of evidence into decision-making practice. Collaboration between researchers and managers in practice enhances knowledge sharing and improves understanding of each others’ contexts.

A Multi-Criteria Method of Analysis for Data Informed Priority Setting

(Abstract 0022)

Sylvie Cantin, Denis A. Roy
Agence de la santé et des services sociaux de la Montérégie, Canada

In order to support strategic planning in a regional health system in full transformation, a multi-criteria decision support methodology for priority setting has been developed. This methodology allows for the integration of the best available information, including evidence-based data, by using multiple-choice questions. In the form of user-friendly graphs, the method informs decision-making on the basis of four criteria: 1) the population's health needs, 2) the potency of the proposed interventions, 3) their current level of deployment and 4) the availability of resources.

Up to now, the method has been used on a voluntary basis by three organizations for characterizing potential interventions in order to support decision-makers in selecting the most promising interventions for the enhancement of their population’s health and well-being. Nearly 450 persons have been directly or indirectly involved in the use of the method. Qualitative data has been collected from 59 of them during Fall 2007 using individual and group interviews with the aim of documenting the characteristics of the method.

The presentation will expose the multi-criteria method employed as well as the opinions collected regarding its strengths and limits. The results indicate that, in addition to facilitating a more objective deliberation process, the method brings about convergence among actors and organizations and provides legitimacy. They also stress that time must be invested for getting the best benefits. Finally, the added value which the decision-makers grant to the informational power of the method will be discussed.

Turning Evidence Based Guidelines into Practice - Can Resource Impact Analyses Help?

(Abstract 0063)

P Truman1, J Craig1
1NHS QIS, United Kingdom, 2YHEC, United Kingdom

Background: for fifteen years, the Scottish Intercollegiate Guidelines Network (SIGN) has issued guidelines to bridge the gap between research and clinical practice to improve health care of patients. In 2007 it published clinical guidelines on coronary heart disease. The Guideline Steering Group commissioned a demonstration project to determine the implications of implementing the guidelines taking into account:

• clinical benefit;
• resources required;
• related costs.

Objective: to evaluate whether providing resource information can achieve more rapid implementation of key recommendations in clinical guidelines.

Methods: Resource impact tools were developed by SIGN/NHS QIS which:
a) prioritised recommendations requiring major changes in clinical practice;
b) identified clinical benefits, resources required and associated costs to implement the recommendations;
c) considered ‘what if ‘ options to identify implementation strategies, recognising all recommendations cannot be implemented immediately

The York Health Economics Consortium was commissioned to undertake an independent evaluation of the uptake of the resource impact tools.

Results: The resource impact tools estimated that implementation could cost NHS Scotland £70m annually, require 140 staff but reduce mortality by 7,000 over 5 years.

The evaluation established that the tools were welcomed by healthcare planners. Such tools are a necessary but not sufficient step to ensure implementation which remains subject to local prioritisation initiatives. Further support for planners, engaging a broader range of stakeholders and improving presentation to make tools more adaptable to local needs were recommended.

Policy Implications: SIGN is considering the implications of the evaluation for the development of similar tools alongside future guidelines.

The Application of a Model for Priority Setting - An Example from Swedish Rehabilitation Care

(Abstract 0042)

Mari Broqvist
The National Centre for Priority Setting in Health Care, Sweden

Practical experience of priority setting in local county councils, health care authorities and professional organizations in Sweden has resulted in a broad agreement on a common model for priority setting. This model represents a pragmatic approach to realising the intent of the Swedish parliament’s resolutions on priority setting, from 1997. Since 2005 the model has been applied within physiotherapy and occupational therapy in order to gain more consensuses in priority setting. Many of the rehabilitation staff in one local authority has been engaged in this project and 30 different ranking lists will soon be published on the Intranet.

We have studied the staff’s perceptions of the priority-setting process and how the use of the model in rehabilitation care has been accepted. Data has been collected through participant observation, interviews and questionnaires.

The presentation will focus on the perceived strengths and weaknesses of the priority-setting process, but also on what was done to solve the problems that arose. This study reveals the importance of clarifying the goals and practical usage of systematic priority setting. Moreover it proved important to establish a mutual interpretation of central concepts in the model, such as the severity of an illness, patient benefits and cost-effectiveness. A manual has been developed for this purpose. Although the model was tested in the field of rehabilitation, this project has something to teach all those working with practical priority setting in health care.