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Integration of health technology assessment recommendations into organizational and clinical practice: A case study in Catalonia

Published online by Cambridge University Press:  28 March 2006

Marie-Pierre Gagnon ,
Emília Sánchez  and
Joan M. V. Pons
Marie-Pierre Gagnon
Affiliation:
University of Calgary and CHUQ–Hopital St-François d'Assise
Emília Sánchez
Affiliation:
Catalan Agency for Health Technology Assessment and Research
Joan M. V. Pons
Affiliation:
Catalan Agency for Health Technology Assessment and Research
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Abstract

Objectives: Evaluating the impact of recommendations based upon health technology assessment (HTA) represents a challenge for both HTA agencies and healthcare policy makers. This research sought to understand factors affecting the uptake of HTA recommendations to support decision making with respect to the introduction of three health technologies.

Methods: Using a multidimensional framework, based upon a combination of theoretical models, a case study was conducted. A total of twenty-eight semistructured interviews were done with physicians from fifteen hospitals and other stakeholders in Catalonia. Interview content was analyzed iteratively and classified according to theoretical dimensions and contextual factors.

Results: At the sociopolitical level, factors related to the organization and financing of the health system were found to affect the utilization of HTA recommendations. At the healthcare organization level, existing collaborations between the hospital and the HTA agency favored the integration of recommendations into practices. Formalism in the organization also influenced the utilization of HTA recommendations. At the professional level, the high degree of autonomy of specialists, the importance of peers and collegial control, and the definition of professional roles and responsibilities influenced physicians' willingness to integrate HTA recommendations into their practice.

Conclusions: This study offers a comprehensive framework to understand the complex dynamics that affect adoption of health technologies in organizational and professional practices. The findings suggest some avenues to promote the integration of HTA recommendations into practices and, thus, increase the utilization of scientific evidence to support decision making in health care.

Keywords

Health technology assessmentKnowledge disseminationInstitutional theoryOrganizational theoryProfessional theory
Type
GENERAL ESSAYS
Information
International Journal of Technology Assessment in Health Care , Volume 22 , Issue 2 , April 2006 , pp. 169 - 176
Copyright
© 2006 Cambridge University Press

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References

Abbott A. 1988. The system of professions: An essay on the division of expert labor. Chicago: University of Chicago Press;
Barley SR. 1986 Technology as an occasion for structuring: Evidence from observations of CT scanners and the social order of radiology departments. Adm Sci Q. 31: 78– 108.Google Scholar
Carlsson P, Jonsson E, Werko L, Banta D. 2000 Health technology assessment in Sweden. Int J Technol Assess Health Care. 16: 560– 575.Google Scholar
Coleman P, Nicholl J. 2001 The influence of evidence-based guidance on health policy and clinical practice in England. Qual Health Care. 10: 229– 237.Google Scholar
Cranney M, Warren E, Barton S, Gardner K, Walley T. 2001 Why do GPs not implement evidence-based guidelines? A descriptive study. Fam Pract. 18: 359– 363.Google Scholar
Damanpour F. 1991 Organizational innovation: A meta-analysis of effects of determinants and moderators. Acad Manage J. 34: 555– 590.Google Scholar
Denzin NK. 1989. The research act: A theoretical introduction to sociological methods. 3rd ed. Englewood Cliffs, NJ: Prentice Hall;
DiMaggio P, Powell W. 1983 The iron cage revisited: Institutional isomorphism and collective rationality in organizational fields. Am Sociol Rev. 48: 147– 160.Google Scholar
Espallargues M, Sampietro-Colom L, Castells X, et al. [Elaboration of a prioritisation system for patients on waiting lists for cataract surgery and hip and knee arthroplasty]. Agencia d'Avaluació de Tecnologia i Recerca Mèdiques. Servei Català de la Salut. Departament de Sanitat i Seguretat Social. Generalitat de Catalunya; 2003. Available at: http://www.gencat.net/salut/depsan/units/aatrm/pdf/in0301ca.pdf.
Friedson E. 1973. Professionalism reborn. Cambridge: Polity Press;
Gagnon MP, Lamothe L, Fortin JP, et al. 2005 Telehealth adoption in hospitals: An organisational perspective. J Health Organ Manage. 19: 32– 56.Google Scholar
Granados A, Jonsson E, Banta HD, et al. 1997 EUR-ASSESS Project subgroup report on dissemination and impact. Int J Technol Assess Health Care. 13: 220– 286.Google Scholar
Granados A. 1999 Health technology assessment and clinical decision making: Which is the best evidence? Int J Technol Assess Health Care. 15: 585– 592.Google Scholar
Grimshaw JM, Thomas RE, MacLennan G, et al. 2004 Effectiveness and efficiency of guideline dissemination and implementation strategies. Health Technol Assess. 8: iii– iv, 1– 207.Google Scholar
Hailey D. 1993 The influence of technology assessments by advisory bodies on health policy and practice. Health Policy. 25: 243– 254.Google Scholar
Hivon M, Lehoux P, Denis J-L, Tailliez S. 2005 Use of health technology assessment in decision making: Coresponsibility of users and producers? Int J Technol Assess Health Care. 21: 266– 275.Google Scholar
Huberman AM, Miles MB. 1994. Qualitative data analysis: An expanded sourcebook. 2nd ed. Thousand Oaks: Sage Publication;
Jacob R, McGregor M. 1997 Assessing the impact of health technology assessment. Int J Technol Assess Health Care. 13: 68– 80.Google Scholar
Jonsson E, Banta D. 1999 Management of health technologies: An international view. BMJ. 319: 1293.Google Scholar
Jorm C, Kam P. 2004 Does medical culture limit doctors' adoption of quality improvement? Lessons from Camelot. J Health Serv Res. 9: 248– 251.Google Scholar
Kimberly JR, Evanisko MJ. 1981 Organizational innovation: The influence of individual, organizational and contextual factors on hospital adoption of technological and administrative innovations. Acad Manage J. 24: 689– 713.Google Scholar
Lapointe L. 1999. [Adoption of clinical information systems by physicians and nurses: A study of individual, sociopolitical and organisational variables]. Doctoral Thesis. École des HEC, University of Montreal: Montreal;
Lehoux P, Blume S. 2000 Technology assessment and the sociopolitics of health technologies. J Health Polit Policy Law. 25: 1083– 1120.Google Scholar
Leys M. 2003 Healthcare policy: Qualitative evidence and health technology assessment. Health Policy. 65: 217– 226.Google Scholar
Marshall M, Harrison S. 2005 It's about more than money: Financial incentives and internal motivation. Qual Saf Health Care. 14: 4– 5.Google Scholar
McGregor M, Brophy JM. 2005 End-user involvement in health technology assessment (HTA) development: A way to increase impact. Int J Technol Assess Health Care. 21: 263– 267.Google Scholar
Meyer JW, Rowan B. 1977 Institutionalized organizations: Formal structures as myth and ceremony. Am J Sociol. 83: 340– 363.Google Scholar
Meyer Goldstein S, Ward PT. 2004 Performance effects of physicians' involvement in hospital strategic decisions. J Serv Res. 6: 361– 372.Google Scholar
Mintzberg H. 1979. The structuring of organizations. Englewood Cliffs, NJ: Prentice Hall;
Pons JMV. 2000. [Continuous subcutaneous infusion of insulin with portable pumps in type 1 diabetes patients]. Barcelona: Agencia d'Avaluació de Tecnologia i Recerca Mèdiques. Servei Català de la Salut. Departament de Sanitat i Seguretat Social. Generalitat de Catalunya; Available at: http://www.gencat.net/salut/depsan/units/aatrm/pdf/in0001ca.pdf.
Posner KL, Gild WM, Winans EV. 1995 Changes in clinical practice in response to reductions in reimbursement: Physician autonomy and resistance to bureaucratization. Med Anthropol Q. 9: 476– 492.Google Scholar
Prasad P, Prasad A. 1994 The ideology of professionalism and work computerization: An institutionalist study of technological change. Hum Relat. 47: 1433– 1458.Google Scholar
Prosser H, Almond S, Walley T. 2003 Influences on GPs' decision to prescribe new drugs: The importance of who says what. Fam Pract. 20: 61– 68.Google Scholar
Rosen R, Gabbay J. 1999 Linking health technology assessment to practice. BMJ. 319: 1292.Google Scholar
Sheldon T, Cullum N, Dawson D, et al. 2004 What's the evidence that NICE guidance has been implemented? Results from a national evaluation using time series analysis, audit of patients' notes, and interviews. BMJ. 329: 999.Google Scholar
Stake RE. 1995. The art of case study research. Thousand Oaks: Sage Publications;
Stevens A, Milne R. 2004 2004 Health technology assessment in England and Wales. Int J Technol Assess Health Care. 20: 11– 24.Google Scholar
Thorne ML. 2002 Colonizing the new world of NHS management: The shifting power of professionals. Health Serv Manage Res. 15: 14– 26.Google Scholar
Woolf SH, Henshall C. 2000 Health technology assessment in the United Kingdom. Int J Technol Assess Health Care. 16: 591– 625.Google Scholar
Yin RK. 1993. Applications of case study research. Applied Social Research Methods Series, 34. Newbury Park: Sage Publications;