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中国卫生技术评估决策转化研究

更新时间:2015-10-13  |  点击数:14585

一、项目名称

中国卫生技术评估决策转化研究

Title of projectResearch on Knowledge Translation from Health Technology Assessment to Health Policy-making in China (CMB, OC11-067)

 

二、研究者

PI name:Yingyao Chen

Name of PI’s institution:School of Public Health, Fudan University

Address of PI’s institution:138, Yi Xue Yuan Road, Shanghai, 200032, China

 

Collaborating Institutions:

Name of institution: Laurentian University

Contact person: Raymond W Pong

Address: Ramsey Lake Road, Sudbury, Ontario, CANADA P3E 2C6

 

Name of institution: Tulane University, School of Public Health and Tropical Medicine

Contact person: Lizheng Shi

Address: 1440 Canal Street, Suite 1900, New Orleans, LA 70112, USA

 

Name of institution: Zhejiang University

Contact person: Hengjin Dong

Address: 866, Yuhangtang Rd, Hangzhou 310058, China

 

三、标书摘要

 Background/rationale

How to improve Health Technology Assessment (HTA) knowledge translation (KT) and how to strengthen the application of HTA evidence to policy-making are important issues for those involved in health system restructuring to consider in China.

 

Overall goal and objectives

This study will analyze HTA development and utilization, examine enabling and impeding factors that influence HTA knowledge translation by quantitative and qualitative methods, and provide evidence-based recommendations for improving the use of HTA evidence to inform health policy-making in China.

 

Objectives

1) To describe the current status of HTA development in China, focusing on knowledge translation from HTA to health policy-making, using drugs, high-cost medical devices, and hi-tech medical equipment as case studies;

2) Under a broader framework of health research knowledge translation, to examine enabling and impeding factors that affect the translation of HTA evidence to policy-making;

3) To explore how health research knowledge translation models and approaches used in other countries could be adapted and applied to the HTA situation in China.

 

Methods

The study has two stages, a pilot-study stage and a main-study stage. The study will employ literature review, institutional survey, survey of HTA researchers and policy-makers, and individual interviews as main data collection methods. Instruments will be developed, including institutional survey questionnaires for HTA agencies/units, central government and provincial government departments; questionnaires for HTA researchers and policy makers; semi-structured interview protocols for policy-makers, researchers, and others, and the theoretical framework of HTA-related KT to policy making.

 

Outcome measures

1) A research report;

2) A theoretical framework for HTA-related KT to policy making;

3) Approaches and strategies to improve translation of HTA evidence to policy-making;

4) 10 Chinese articles in domestic core journals and 3 English articles in SCI journals;

5) A national knowledge dissemination meeting.

 

Implications

The study will propose a series of approaches and strategies designed to improve HTA-related KT and facilitate access to quality health services for people in China.

 

四、研究成果:

1、研究报告中英文摘要

中 文 摘 要

 

【研究背景】

随着我国医药卫生体制改革的不断深入,卫生技术作为完善建设四大体系(即公共卫生体系、医疗服务体系、医疗保障体系及药品供应保障体系)的核心要素引起各方的广泛关注。卫生技术同其他科学技术的发展和应用一样,具有两重性,它的发展一方面增强了诊断和防治疾病的能力、改善了人类健康水平,另一方面也可能带来一些消极影响和不良后果,如卫生技术的副反应,医疗费用的不合理快速增长,以及伦理与社会问题等。

在此背景下,卫生技术评估(health technology assessment, HTA)应运而生,对卫生技术的技术特性、临床安全性、有效性、经济学特性和社会适应性进行全面系统的评价,其主要目的就是为决策者提供信息,提高卫生资源配置的效率,发挥卫生技术带来的提升诊疗质量、改善健康结果等益处,同时限制甚至避免卫生技术可能带来的消极影响。

然而,目前国内虽然开展了一些卫生技术评估研究,产出了相应研究结果,有些甚至为卫生技术相关政策的制订发挥了重要作用。但也有许多知识成果未能转化为政策或投入实践,这不仅使研究结果无法解决实际工作中的问题,而且也不利于发现既有研究结果中存在的问题并加以改进。在此背景下,加强卫生技术评估研究成果向卫生政策的转化(knowledge translation, KT)、使其充分发挥决策支持作用,将有利于促进科学决策与循证决策,保障卫生技术的发展进步真正惠及广大社会公众。

 

【研究目的】

本论文旨在对我国卫生技术评估开展和研究结果转化现状进行描述分析,通过定性和定量研究相结合的方法深入挖掘影响卫生技术评估与政策结合、向卫生政策转化的促进和阻碍因素,为促进我国卫生技术评估研究结果的决策转化提出措施和建议。

 

【研究方法】

1、资料收集方法

(1)文献回顾

通过系统文献回顾,重点收集国内外发表的有关知识转化理论模型、知识转化测量及相关影响因素的文献和灰色文献,为研究提供基础信息。

(2)专家咨询

在调查问卷初稿形成后,通过咨询本研究领域相关的国内外专家,对调查问卷的内容、结构、表达措辞等进行适当调整及修改完善。

(3)问卷调查

主要为研究人员和决策人员调查,调查内容包括所在机构开展卫生技术评估研究或资助卫生技术评估研究的情况、对卫生技术评估研究结果转化的支持机制情况、在卫生技术评估研究开展过程中的相互沟通交流情况、研究结果的产出情况、对卫生技术评估报告的认知、态度和运用于决策的情况等。

(4)个人访谈

通过与目标人群的定性访谈(包括焦点组访谈和个人深入访谈),明确卫生技术评估在政策制定过程中的应用状况、影响因素、存在问题和改进意见等。在访谈中,研究将注意访谈对象的广泛性和代表性。

2、样本选择

(1)问卷调查对象的确定与选择

本研究针对的卫生技术评估研究人员应符合以下条件:1)就职于国内开设有社会医学与卫生事业管理或药事管理的大学,或者设有卫生技术评估或药物经济学评价或循证医学部门的专业协会和专业研究机构;2)近三年内开展过针对药物、医疗器械、卫生材料、医疗方案、医学信息系统、后勤支持系统和行政管理体系等卫生技术的功效、安全性、成本和效益(效果)及社会影响(伦理、道德等)的评价研究。

本研究针对的卫生技术管理决策人员主要包括在国家卫生和计划生育委员会、国家食品药品监督管理总局、人力资源和社会保障部,及其附属司局处室、以及各地方的相应卫生、食品药品监督、社会保障部门的承担卫生技术管理工作的决策人员。

(2)访谈对象的选择

分别邀请卫生技术评估研究人员中的关键知情者,以及国家卫生和计划生育委员会、国家食品药品监督管理局、人力资源和社会保障部、国家发改委及物价管理等部门的官员、省级政府相关部门官员,进行个人深入访谈或焦点组访谈,了解我国卫生技术评估开展和利用、技术评估和政策结合与转化的现状。

访谈对象的数量根据饱和原则确定。

3、资料分析方法

(1)描述性分析方法

根据问卷调查收集的数据,对我国卫生技术评估研究开展和研究结果决策转化的现状进行描述分析。

(2)探索性因子分析

以主成分分析(principal component analysis, PCA)进行探索性因子分析(explorative factor analysis, EFA),并采用最大方差法(Varimax)进行分析,以特征值大于l作为因子个数选择的标准。

(3)信度分析

利用纠正项目的总相关系数(Corrected- Item Total Correlation, CITC)进行测量条款的净化,以0.3作为净化测量条款的标准,并利用Cronbach’s α系数检验测量条款的内部一致性信度。

(4)效度分析

效度分析主要运用结构方程模型(Structural equation modeling, SEM)的验证性因子分析(confirmatory factor analysis, CFA)对量表模型进行拟合优度检验,以验证因子的测量模型是否合理。

(5)单因素分析

采用F检验,比较不同人口社会学特征的调查对象在HTA决策转化水平上的差异;采用相关分析,检验HTA研究质量、机构的转化支持力等因子与HTA决策转化水平的相关关系。

(6)多因素分析

通过结构方程模型的路径分析和多元线性回归模型,分别从研究人员和决策人员角度,以利用情况为因变量,以人口社会学特征、所在机构对决策转化的支持情况、个人对转化的认知态度等为自变量,确定HTA研究结果决策转化的影响因素。 

(7)定性研究分析技术

对定性访谈方法收集到的有关HTA研究开展情况和研究结果决策转化情况等信息,借助Nvivo软件进行编码、标引和分析。

 

【研究结果】

1、卫生技术评估研究结果决策转化的理论框架

    从理论分析入手,明确知识转化及相关表述的确切含义,并提出卫生技术评估研究结果决策转化的理论框架。该理论框架旨在为挖掘卫生技术评估决策转化的影响因素提供指导,并在所有影响因素中重点探究卫生技术评估的研究方和决策方的影响因素。

2、调查问卷和定性访谈提纲

    基于本研究理论框架和前期研究中的调查工具,结合国内卫生技术评估工作实际情况,并经过专家咨询,形成分别针对卫生技术评估研究者和卫生技术管理决策者的调查问卷和定性访谈提纲。通过调查工具修订和正式调查的样本检验,对调查问卷初稿进行修改和定稿,实证调查结果显示,定稿问卷具有较好的信度和效度。

3、我国卫生技术评估研究开展情况

对研究方问卷调查结果显示:只有不到20%的研究人员认为所在机构对决策转化的支持力度较大;在课题进行的目标设定、方法制定、具体实施、结果分析、报告撰写等阶段,均有40%~50%的研究人员联系决策人员进行了较为充分的沟通交流,但在课题成果传播阶段,只有约20%的研究人员与决策人员进行了较为充分的沟通;对自身开展HTA研究的科学性、时效性、实用性等方面,均有60%左右的研究人员认为较好或很好。定性访谈结果另外显示:目前研究者最常采用的HTA研究产出传播方式为提交报告和在学术期刊发表文章;而大多数访谈对象认为目前HTA研究产出的总体质量有待提高。

对决策方问卷调查结果显示:各有50%和40%的决策人员认为目前所在机构与HTA研究机构之间已有较为通畅的沟通渠道和较为密切的交流联系,另有近1/3的决策人员认为所在机构对新出现的HTA研究结果较为关注;但是,只有10%~15%的决策人员认为所在机构开展较多HTA相关培训或者对HTA研究项目有较多资助。与研究方问卷调查显示结果相类似,许多决策人员已经参与到HTA研究过程的多个阶段中,但对最后的课题成果传播阶段的参与相对较少(只有25%的决策人员认为在课题成果传播阶段与研究方进行了较充分的沟通交流);对HTA研究的科学性、时效性、实用性等方面,均有30%~40%的决策人员认为特定方面较好或很好。定性访谈结果另外显示:绝大多数决策人员更偏好HTA研究结果以研究报告和摘要的形式展示、或采取提交政策简报的形式。

4我国卫生技术评估研究结果决策转化现状

对研究方问卷调查结果显示:HTA研究结果的决策转化体现出一定阶梯性,即较基础的学术传播、形式传播阶段,完成的情况较多(约有30%~40%的研究人员表示较常完成相应转化);越往高级别的政策采纳、促成行动等转化阶段则完成的情况越少(约15%研究人员表示较常完成相应转化)。定性访谈结果也显示:许多访谈对象的HTA研究结果“较少部分形成政策文件”或者“有所借鉴,但还未形成政策”。

对决策方问卷调查结果显示:各有40%-50%的决策人员认为自己在较多情况下能够“阅读并充分理解HTA研究结果”、“参考借鉴HTA研究结果进行决策”、“采纳HTA研究结果用以形成政策”,但只有20%左右的决策人员认为相关政策较多获得推广;而且在定性访谈中,很多决策者明确表示“HTA研究结果运用于政策的情况还较少”、“HTA运用的范围、深度和影响有待于加强或提高”。

5、决策转化影响因素

    对研究方的结构方程模型路径分析结果显示:“研究人员和决策方之间的沟通交流”、“专业职称水平”、“HTA研究质量”、“所在研究机构转化支持机制”、“对HTA的认可度和使用能力”对HTA研究结果决策转化有显著正向作用;定性访谈结果也显示,研究人员认为“与决策方的沟通交流”、以及与HTA研究质量有关的“HTA研究与决策需要的相关度”、“语言范式、文本格式与需方一致性”等是影响HTA研究结果决策转化的较主要因素。

对决策方的多元线性回归模型分析结果显示:“对HTA决策中发挥作用的预期”、“与研究方之间的沟通交流”、“所在决策机构转化支持程序”对HTA研究结果决策转化有显著正向作用;定性访谈结果也显示,决策人员认为“对HTA的认可度和使用能力”、“与研究方之间的沟通交流”、“机构的决策机制和程序”和“经费投入”等是影响HTA研究结果决策转化的较主要因素。

 

【结论与建议】

虽然国内已开展一定数量的卫生技术评估研究,其中一些研究结果已经在决策支持方面发挥了重要作用甚至已转化为具体的政策。但总体而言,我国卫生技术评估研究结果的转化水平还较低,在决策中发挥的作用也较为有限。

为了提高我国卫生技术研究的决策转化水平,进一步促进科学决策、循证决策,需要在宏观制度设计、以及研究方和决策方的个人和机构层面作出相应改善。

第一,在宏观制度设计层面,应构建卫生技术管理的科学决策机制,要求在进行卫生技术管理相关决策时,必须以HTA或相关评估的科学证据作为依据,以此为HTA研究结果的决策转化提供有力的制度支撑;制订卫生技术评估指南,以利于优化评估设计、规范评估方法运用、扩大研究结果传播;并逐步加大对HTA研究的支持力度。

第二,研究者层面,可通过系统专业教育、继续教育培训等理论学习,以及深入了解评估技术的研发、生产、利用各环节的实践情况,不断提高理论和实践水平;在课题研究开展的全过程保持与决策者较为密切的沟通交流,以共同解决出现的问题,保证课题研究设计科学合理、课题的研究结果与决策需要保持高度相关;并注意根据研究结果传播的目标人群特征采用合适的产出方式,以促进对研究结果的决策转化。

    第三,研究机构层面,应适当调整研究人员的考核激励办法,将评估标准向研究结果的转化利用、以及在实践中的实际应用价值等方面适当倾斜;逐步建立转化培训等转化支持机制、建立严格的卫生技术评估研究考核管理机制;同时,强化与决策机构的沟通交流协作,进一步提高研究课题与社会需要、决策需要的相关度,促进研究结果在实践中的转化利用。

第四,决策者层面,应充分认识到卫生技术评估研究结果等科学证据在指导决策方面的重要意义,在实际工作中应进一步落实科学决策;通过参加卫生技术评估相关理论知识的继续教育和学习培训,不断提高运用卫生技术评估研究结果的能力;积极参与HTA研究过程中,加强与研究方沟通交流,共同解决课题研究中出现的问题,并向研究者反馈课题研究结果在具体实践中遇到的问题,以促进研究结果的进一步完善,并在决策过程和实践过程中发挥更大的作用。

 

【关键词】   卫生技术评估;知识转化;决策;中国

 

   

 

Research on Knowledge Translation from Health Technology Assessment to Health Policy-making in China

 

ABSTRACT

 

Background

With the deepening of the healthcare reform in China, health technology has been considered as an important component in improving the national health system, which consists of the health insurance system and health delivery system. Similar to the other scientific technologies, health technology is a double-edged sword. While it can improve the ability to prevent, diagnose, treatment, and rehabilitation, it may have some negative side effects, like driving up health care costs and generating ethical and social implications that cannot be ignored.

 

Under the context, HTA has been gaining recognition internationally and has played an increasingly important role in health policy-making. HTA is a multidisciplinary activity that systematically examines the technical performance, safety, clinical efficacy, and effectiveness, cost, cost-effectiveness, organizational implications, social consequences, legal, and ethical considerations of the application of a health technology. HTA provides evidence-based information to help make decisions on the selection and utilization of health technologies, to promote efficient health resource allocation, and to improve the clinical effectiveness. Besides, HTA is also helpful to control cost and eliminate other negative effects.

 

In the case of China, although some HTA studies have been conducted and some HTA knowledge has been created, the application of HTA findings to policy-making is not widespread and the integration of HTA in the policy-making processes is still in its infancy. The condition is not only adverse to the solution of actual problems, but also not conducive to the perfection of HTA knowledge. Under this background, strengthening the knowledge translation from HTA to health policy and giving full play to HTA role as the decision-making support, will greatly promote the scientific decision-making and evidence-based decisions, as well as benefit the general public from the progress in the development of health technologies.

 

 

Objectives

This study will analyze HTA development and utilization, examine enabling and impeding factors that influence HTA knowledge translation by quantitative and qualitative methods, and provide evidence-based recommendations for strengthening the knowledge translation from HTA evidence to health policy-making in China.

 

 

Methods

 

Methods for data collection

Literature review

This study used multiple literature search engines to collect studies on KT theoretical model, KT measurement, as well as KT influencing factors. The literature review provided some information to develop survey and interview instruments.

Expert consultation

After development of the questionnaire draft, experts at home and abroad were consulted to improve the content and structure of the questionnaire, as well as to edit the wording.

Questionnaire survey

Questionnaire survey mainly focused on HTA researchers and policy-makers. It collected information, including awareness, attitudes, perceived needs, knowledge, training, and experience of HTA researchers and policy-makers with regard to HTA and KT, and communications and interactions between researchers and policy-makers.

Semi-structured key informant interview

Semi-structured key informant interview protocols also mainly focused on HTA researchers and policy-makers. It solicited information about the current status of knowledge translation from HTA to the health policy-making, the influencing factors that may affect HTA KT activities and effectiveness, as well as some suggestions for HTA knowledge translation.

 

Sampling

HTA researchers included in the questionnaire survey were those who met the following criteria: 1) working at HTA agencies/units including both agencies/units with HTA as part of their titles and those with HTA research or related activities, such as academic units focusing on evidence-based medicine, pharmaco-economics, health economics, evidence-based medicine, health care management at universities and research institutions, etc; 2) conducting research that examines the medical, economic, social and ethical implications of the application or use of health technology, such as “the drugs, devices, and medical and surgical procedures used in health care, and the organizational and supportive systems within which such care is provided”.

 

Policy-makers included in the questionnaire survey were those who work in the health technology field at central government departments of the Ministry of Health (MoH), the Ministry of Health Resource and Social Security (MoHRSS), and the State Food and Drug Administration (SFDA), as well as the provincial counterparts of MoH, MoHRSS, and SFDA.

 

In-depth interviews were conducted with key informants of policy-makers and HTA researchers to collect some invisible or intangible information which the structure questionnaire could not detect. The number of interviews to be conducted was based on the principle of information maturation.

 

Statistical methods

Descriptive analysis

We analyzed current HTA activities and knowledge translation from HTA to health policy-making based on the surveys of researchers and policy-makers.

Explorative factor analysis

Principal component analysis was applied to do explorative factor analysis. By agency of the maximum variance method (Varimax), eigenvalue greater than 1 was set to determine the number of factor.

Reliability analysis

Corrected- Item Total Correlation (CITC) was used to purify the measurement items. The items with CITC value less than 0.3 will be eliminated. Besides, Cronbach’s α coefficient was applied to test the internal consistency reliability.

Validity analysis

Structural equation model (SEM) was applied to test the goodness of fit of the scale model and verify whether the factor structure of the model is reasonable.

Univariate analysis

F-test was applied to compare the difference of HTA knowledge translation among the respondents with different demographic characteristics. Correlation analysis was used to test the association between the factors, such as HTA research quality, institutional support, and the level of HTA knowledge translation.

Multivariate analysis

Multivariate liner regression model and SEM path analysis were applied to explore the association between the independent variables (such as demographic characteristics, HTA research quality, communications and interactions between researchers and policy-makers, individual perception and attitude, and so on) and dependent variable (HTA knowledge translation), respectively for policymakers and HTA researchers.

Qualitative analysis

Qualitative analysis techniques were used to analyze the interview data. The analysis used qualitative research software (such as NVivo 7) to analyze the interview transcriptions of HTA activity and HTA knowledge translation.

 

Results

 

HTA-KT theoretical framework

By clarifying the definition of HTA and knowledge translation and summarizing theoretical results of previous studies, a theoretical framework for knowledge translation from HTA to health policy-making was developed to provide the guidance for investigating influencing factors, especially the factors of HTA researchers, policy-makers and institutions that may affect KT.

 

Questionnaires and interview protocols

Based on the HTA-KT theoretical framework and the survey tools of previous researches, the questionnaire and interview protocols were developed after expert consultation. The questionnaires were modified and finalized after revision and sample test. The result of the empirical study shows that the finalized questionnaire has good reliability and validity.

 

The current status of HTA activity

As demonstrated by questionnaire survey of HTA researchers, less than 20% of HTA researchers perceived that their institution provided fairly great support for HTA knowledge translation. With regard to the communication and interaction with policymakers, between 40% and 50% of HTA researchers has fairly good communication with policymakers in the stages of topic selection, methods formulation, implementation, data analysis and report writing. However, only 20% of HTA researchers reported fairly good communication in the stage of results transmission. Regarding the HTA research quality, approximately 60% of the HTA researchers considered the scientific nature, timeliness and practicality fairly good. Additionally, the qualitative interview showed that scientific report and publication in academic journal were the most commonly output form of HTA studies. Also, the overall quality of HTA research needs to be improved.

 

To the results of questionnaire survey of policy-makers, about half of the policy-makers consider the communication with researchers fairly good and 40% of the policy-makers think close contact has been developed between the research unit and policy-making department. Also, about one third of the policy-makers perceive that the department they work in has paid close attention the new HTA evidence. However, less than 15% of the policy-makers consider that their institutions have provided enough train and research funding support for HTA studies. Similar to the results of questionnaire survey of HTA researchers, a large part of policy-makers have participated in the stages of HTA study. However, only 25% of policy-makers have fairly good communication with HTA researchers in the stage of HTA results transmission. Regarding to the scientific nature, timeliness and practicality of HTA research, between 30% and 40% of the policy-makers perceived it good. In addition, the qualitative interview illustrated that research report, summary abstract and policy brief were the most preferred output form by a majority of policy-makers.

 

The current status of HTA knowledge translation

The “ladder-like” characteristic of knowledge translation was illustrated by the result of questionnaire survey of HTA researchers. Namely, some primary stages of knowledge translation were relatively easier to complete than some advanced stages. For instance, about 40% of HTA researchers reported that they often published HTA results in academic journal or submitted HTA results to the policy-makers, while only 15% of HTA researchers have research evidence adopted in policy-making or applied in wider scope. The results of qualitative interview also showed that a large part of HTA researchers only have a handful of HTA results applied as references or evidences for policy document.

 

Between 40% and 50% of policy-makers reported that they are capable to read and fully understand the HTA results. The same proportion of policy-makers have used HTA results as references of decision-making or adopted HTA results to policy formulation. However, only 20% of them perceived that the policy based on HTA evidence had wider application. Furthermore, many policy-makers declared in qualitative interview that “HTA has not yet played a significant role in health policy-making in China” and “HTA is largely an academic exercise with little real impact on health policy”.

 

Influencing factors of HTA knowledge translation

To HTA researchers, the results of SEM path analysis demonstrated that “communication with policy-makers”, “academic title”, “quality of HTA research”, “KT support scheme of working department” and “the ability of applying HTA evidence” associated positively with HTA knowledge translation. The results of qualitative interview also demonstrated that “communication and interaction” and some research-quality-related factors (e.g. “relevance to policy-making”, “in easy-to-understand language”) were important factors influence HTA knowledge translation.

To policy-makers, the results of multivariate linear regression analysis illustrated that “expect of HTA importance in policy-making”, “communication with HTA researchers” and “KT support scheme of working department” associated positively with HTA knowledge translation. These factors were also reported as important KT influencing factors in the qualitative interview.

 

 

Conclusions and suggestions

Although some HTA research has been conducted and some HTA results have played important roles in policy-making, the overall level of HTA knowledge translation is still low and the impact of HTA research still needs to be expanded.

 

In order to improve the HTA knowledge translation and further promote scientific and evidence-based decision-making, some improvements need to be made at the institutional level and individual level of research and decision-making, as well as the design of macro-mechanism.

Firstly, mechanism of scientific decision-making needs to be established. It is suggested to make some concerned decisions with the HTA evidence, which will provide robust support for utilizing HTA evidence in health policy-making. Besides, the HTA guidance should be issued to optimize the design of technology assessment, standardize the application of assessment methodologies, and expand the transmission of HTA results.

 

Secondly, the HTA researchers could continuously promote their theoretical level by many kinds of trainings. Also, their practical experience could be rich after fully understanding the practice environment of certain technology. It is suggested to keep communication with policy-makers during the overall process of research implementation, in order to timely solve the upcoming problems and ensure high quality of HTA research. Additionally, to facilitate the knowledge translation of HTA research, it is also advised to adopt appropriate output format to meet the demand of target population.

 

Thirdly, the research institutions need to moderately adapt the incentive scheme to reward the researchers having research outcome implemented in societal practice. It is advised to establish the mechanism for supporting KT, as well as the management mechanism for ensuring research quality. In addition, it is also very important to strengthen the communication between HTA research units and health policy-making department, in order to promote the HTA relevance to policy-making and facilitate the HTA evidence utilization in policy-making.

 

Fourthly, the policy-makers need to fully realize the great importance of HTA evidence in supporting health policy-making. It is suggested for policy-makers to participate in HTA train to strengthen the capability of applying HTA evidence. It is also advised to participate in HTA research and keep communication with HTA researchers during the overall process of research implementation, in order to concertedly solve the upcoming problems, improve the HTA knowledge and further expand the impact of HTA evidence on health policy-making.

 

 

Key words:

Health technology assessment;  Knowledge translation;  policy-making;  China

 

Classification number:  R197.1

 

2、发表文章清单

 

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[2] 耿劲松,陈英耀,刘文彬,等.发展我国卫生技术评估的构想:基于评估能力视角[J].中国卫生质量管理,2015,22(1):65-67.

[3] 吴博生,陈英耀,耿劲松,等.韩国卫生技术评估的发展应用以及对我国的启示[J].中国卫生质量管理,2015,22(1):68-71.

[4] 刘文彬,陈英耀,茅艺伟,等.我国卫生技术评估研究质量影响因素的定性研究[J].中国卫生质量管理,2015,22(2):87-90.

[5] 茅艺伟,陈英耀,唐檬,等.我国卫生技术评估决策转化现状及影响因素的定性研究[J].中国卫生质量管理,2015,22(2):91-94.

[6] 茅艺伟,陈英耀,唐檬,等.国内部分卫生技术评估机构现状分析[J].中国卫生质量管理,2015,22(3):77-80.

[7] 唐檬,陈英耀,茅艺伟,等.中国卫生技术评估决策转化的动阻力分析[J].中国卫生质量管理,2015,22(3):81-83.

[8] 魏艳,陈英耀,刘文彬,等.影响卫生技术评估研究成果决策转化因素的作用机制研究[J].中国卫生资源,2015,(4):278-282.

 

[9] 耿劲松,陈英耀,吴博生,等.胰岛素注射笔相对于传统注射器治疗糖尿病效果的系统评价[J].中国全科医学,2014,17(2):173-176.

[10] 厉传琳,陈英耀,钱序,等.产前诊断和筛查技术服务规制的必要性和关键环节[J].中国妇幼保健,2014,29(33):5366-5368.

[11] 唐檬,耿劲松,刘文彬,等.全球卫生技术评估发展的历史与经验[J].中国医院管理,2014,34(4):6-9.

[12] 唐檬,茅艺伟,刘文彬,等.决策者视角的中国卫生技术评估决策转化情况分析[J].中国医院管理,2014,34(4):10-13.

[13] 茅艺伟,唐檬,刘文彬,等.研究者视角的中国卫生技术评估决策转化现状分析[J].中国医院管理,2014,34(4):14-17.

[14] 耿劲松,陈英耀,黄媛,等.无创产前基因检测技术筛查胎儿18和13三体综合征的效果评价[J].中国妇幼保健,2014,29(17):2768-2771.

[15] 刘文彬,唐檬,茅艺伟,等.卫生技术评估研究结果产出方式的偏好分析[J].中国医院管理,2014,34(4):17-20.

[16] 茅艺伟,陈英耀,唐檬,等.澳大利亚卫生技术评估的应用[J].中国卫生资源,2014,(6):484-486.

[17] 耿劲松,陈英耀,吴博生,等.无创产前基因检测技术筛查胎儿21三体综合征的效果评价[J].中国妇幼保健,2014,29(16):2582-2585.

[18] 郭祖德,刘文彬,陈英耀,等.国家医保药物目录遴选的临床证据支持:以甲类抗高血压药物为例[J].中国卫生政策研究,2014,7(8):24-28.

[19] 耿劲松,陈英耀,吴博生,等.卫生技术评估应用于决策的方法探析[J].中国卫生资源,2014,(4):262-264.

[20] 吴博生,耿劲松,黄媛,等.叶酸预防神经管畸形经济学效果的系统评价[J].中国妇幼保健,2014,29(16):2644-2647.

[21] 池迅由之,刘文彬,陈英耀,等.卫生技术评估决策转化的影响因素[J].中国卫生资源,2014,(4):265-267.

[22] 吴博生,耿劲松,黄媛,等.药物经济学评价在韩国医保报销决策中的应用[J].中国卫生资源,2014,(4):270-273,290.

[23] 黄媛,陈英耀,耿劲松,等.唐氏综合征筛查策略的经济学系统评价[J].中国妇幼保健,2014,29(15):2311-2314.

[24] 黄媛,陈英耀,吴博生,等.法国卫生技术评估的发展历程与经验总结[J].中国卫生资源,2014,(4):268-270.

[25] 吴博生,耿劲松,黄媛,等.复合维生素预防出生缺陷的效果评价[J].中国妇幼保健,2014,29(14):2298-2300.

 

[26] 陈英耀,刘文彬,唐檬,等. 我国卫生技术评估与决策转化研究概述[J]. 中国卫生政策研究,2013,7:1-6.

[27] 刘文彬,陈英耀,茅艺伟,等. 我国卫生技术评估研究成果向决策转化的理论模型构建[J]. 中国卫生政策研究,2013,07:7-12.

[28] 茅艺伟,陈英耀,刘文彬,等. 支架相关卫生技术评估研究是否对中国卫生政策有影响:基于文献研究的结果[J]. 中国卫生政策研究,2013,07:13-19.

[29] 唐檬,陈英耀,茅艺伟,等. 我国髋关节置换相关卫生技术评估与政策的关系:研究是否影响政策制定[J]. 中国卫生政策研究,2013,07:20-27.

 

3、参加国际会议情况

 

北京卫生体系研究全球论坛

 

 

 

Satellite session form

 

Name of organization       National Key Lab of Health Technology Assessment, School of Public Health, Fudan University

Country                      China

 

Name of contact person   Yingyao Chen

Email                           yychen@shmu.edu.cn

Telephone number    86-21-54237279

 

Full title of the session       Knowledge Translation:  From Health Technology Assessment to Health Policy-making

Preferred time and date    Oct 31, 2012

• The nature of the organization hosting the satellite session

National Key Lab of Health Technology Assessment (KLHTA) at Fudan University, is an active HTA agency with multiple expertise in China. Its mission is to conduct HTA research, education and training, collaboration and exchange, and technical services. It was designated as a WHO Collaborating Center for Health Technology Assessment and Management in 2007. This HTA agency is not only to facilitate HTA development in China in the context of health care reform, but also to participate into the global actions of HTA in the region or in the world.

 

• The purpose of the satellite session
In this session we present preliminary observations from a recently-launched study entitled “Knowledge Translation from Health Technology Assessment to Health Policy-making” supported by the China Medical Board (CMB).

Both “hardware” and “software” of Health technology often refer to “the drugs, devices, and medical and surgical procedures used in health care,” and “the organizational and supportive systems within which such care is provided’’, respectively. Health Technology Assessment (HTA) is a comprehensive form of policy research that examines the effectiveness of a technology and the short- and long-term consequences of use of health technology. HTA provides evidence-based information to help make decisions on the selection and utilization of health technologies, to promote efficient health resource allocation, improved quality of outcomes, and cost control. HTA has been gaining recognition internationally and has played an increasingly important role in health policy-making around the world. And yet countries embrace HTA quite differently.  It turns out that conducting HTA is one thing, and making use of the HTA results to influence health policy-making is another. Unless the knowledge gained from HTA can reach policymakers and be used by them in decision-making, HTA is largely an academic exercise with little real impact on health policy. There are some successful experiences of knowledge translation (KT) from HTA to policy-making in some countries while the integration of HTA in the policy-making processes is still in development in many other countries, both industrialized and developing countries.

This session will present case studies of KT from HTA to health policy in Australia, Canada, China and United States, and preliminary findings of HTA to policy in one study site in China. It is hypothesized that individual actors and institutional characteristics present the predisposing, enabling, and needs factors that affect HTA KT activities and effectiveness. By presenting four cases, we hope to try to “triangulate” in order to better understand what factors are most influential in helping bridge the gap, and how they work to facilitate or impede policy-making. All presentations aim to examine enabling and impeding factors that affect the translation of HTA evidence to policy-making, and propose policy implications to facilitate KT of HTA especially for developing countries.

 

If your session includes speakers in addition to yourself, please list their name(s) and presentation title(s) below:

  1. Introduction to the session (David Hotchkiss PhD, professor of Global Health Systems and Development, School of Public Health and Tropical Medicine, Tulane University)  5 min

2.      Between Ivory Tower and Executive Suite: Some Canadian Initiatives in Linking Researchers and Policy-makers (Raymond W. Pong, PhD, professor, Centre for Rural and Northern Health Research and Northern Ontario School of Medicine, Laurentian University, Ontario, Canada.)   10 min

4.      Knowledge Translation (KT) in United States: From Cost-effectiveness to Comparative Effectiveness? (Lizheng Shi, PhD, associate professor, Department of Global Health Systems and Development, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA.)  10 min

5.      Has Health Technology Assessment (HTA) been accepted as a policy instrument in China? (Yingyao Chen, PhD, professor, National Key Lab of Health Technology Assessment, Fudan University, Shanghai, P. R. China.)   15 min    

6.      Brief introduction of  methodology and design  of research Knowledge Translation:  From Health Technology Assessment to Health Policy-making. (Yingyao Chen, PhD, professor, National Key Lab of Health Technology Assessment, Fudan University, Shanghai, P. R. China.)   10 min

7.      Q&A Discussion: Chaired by Dr. Hotchkissr [with presenters]    35 min

 

 

 

韩国 HTAi

 

Name of organization       National Key Lab of Health Technology Assessment, School of Public Health, Fudan University

 

Country                      China

 

Name of contact person   Yingyao Chen

 

Full title of the session       Knowledge Translation: from Health Technology Assessment to Health Policy-making in China

 

Background (100 words)

Health Technology Assessment (HTA) seeks to examine the effectiveness of a health technology and its short- and long-term consequences. HTA has been gaining recognition internationally, but countries embrace HTA quite differently. Also, conducting HTA is one thing and using HTA results to influence policy-making is another. Unless the knowledge gained from HTA can be used by policy makers in decision-making, HTA is largely an academic exercise with little real impact on health care and the health system. It is, therefore, important to identify the enabling and impeding factors that influence the knowledge translation (KT) process from HTA to health policy-making.

Panel session description and objectives (150 words)

This session will present findings on HTA KT from our project entitled “Knowledge Translation from Health Technology Assessment to Health Policy-making in China”, which is supported by the China Medical Board, an independent foundation based in the USA. The study employs literature review, institutional survey, survey of HTA researchers and policy-makers, and qualitative interviews at the national and province level. It is hypothesized that the characteristics of individual actors (e.g., HTA researchers and decision-makers) and organizations (e.g., HTA centers and policy-making agencies) often enable or impede HTA KT activities and affect their effectiveness in shaping policies. By analyzing cases and data from our study, we hope to “triangulate” in order to better understand what factors are most influential in bridging the KT gap, and how they work to facilitate or impede policy-making. In addition, we will discuss the policy implications of the findings and their implications for other developing countries.

  1. Introduction to the session (David BantaMD. MPH, Professor Emeritus, Maastricht University, The Netherlands. davidbanta@me.com )

2.      Has HTA been accepted as a policy instrument in China?  Perspectives of policy makers. (Yingyao Chen, PhD, Professor, National Key Lab of Health Technology Assessment, Fudan University, Shanghai, P. R. China. yychen@shmu.edu.cn)

3.  HTA  research and its translation to policy-making in China: Perspectives of HTA researchers (Hengjin Dong, PhD, Professor and Executive Director, Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, Hangzhou, Zhejiang, P.R. China. donghj@zju.edu.cn)

4.      From HTA KT to policy-making in China: A gap analysis. (Lizheng Shi, PhD, Associate Professor, Department of Global Health Systems and Development, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA. lshi1@tulane.edu )

5.      The Chinese experience and its relevance to developing countries: International perspectives (Raymond W. Pong, PhD, Senior Research Fellow, Centre for Rural and Northern Health Research, Laurentian University, Ontario, Canada. rpong@laurentian.ca )

6.      Q&A Discussion: Chaired by Dr. Banta [with presenters]

7.      Wrap Up (Dr. Banta)

 

 

 

2014 HTAi

 

Name of organization       National Key Lab of Health Technology Assessment, School of Public Health, Fudan University

Country                      China

Name of contact person   Yingyao Chen

Full title of the session       Using HTA in China: From Strengthening Patient-centered Care to Enhancing Health System Performance

Background (100 words)

There are many challenges in improving the HTA use and uncertainties about its impact on health systems strengthening in China.  Although some HTA evidence has been used to inform policy decisions (e.g., adoption of assisted human reproductive technology, gamma knife technology, and prenatal screening) in China, use of HTA in the policy-making processes and in guiding patient-centered clinical practices is neither formally developed nor widespread.

Panel session description and objectives (150 words)

The objective of this panel is to describe the development of China’s HTA research, present future perspective of patient-centeredness in HTA applications for health systems strengthening and explore the determinants on knowledge translation from HTA evidence to health policy-making. By qualitative and quantitative analysis, we hope to clearly describe the current status of HTA evidence utilization in China, especially from the future perspective of patient-centeredness. For characteristics of individual actors (e.g., HTA researchers and decision-makers) and organizations (e.g., policy-making agencies) often facilitate or impede HTA utilization in strengthening healthcare systems, qualitative and quantitative analysis will be also applied to better understand what factors are most influential in promoting HTA approaches, and how they interact with the process of policy-making. Taken together, we will propose policy recommendations to foster better utilization of patient engagement and involvement in HTA applications in strengthening the patient-centered healthcare systems.

1. Introduction by Raymond Pong

2. HTA development and potential opportunities in China  by Yingyao Chen

3. For a patient-centered healthcare system —— Case study on climate of patient safety by Di Xue

4. Who cares about cost-effective evidence in adoption of health technologies? by Hengjin Dong

5. Determinants of knowledge translation: From HTA research to health policy-making by Lizheng Shi

6. Q&A and discussion by Raymond Pong

7. Wrap up by Raymond Pong