B. Factors Influencing Impact

Many factors can affect the impact of HTA reports. Beyond the particular dissemination techniques used, characteristics of the target groups, the environment and the HTAs themselves can influence their impact (Goldberg 1994; Mittman and Siu 1992; Mittman and Tonesk 1992). Examples are shown in Box IX-1. Knowledge about these factors can be used prospectively to improve the impact of HTA.

As described in another chapter of this document, in seeking to maximize the impact of their reports, HTA programs can involve target audiences early, such as in priority setting of assessment topics and determination of assessment questions. Further, they can consider how to properly present their reports and plan their dissemination strategies to reach and influence those various target audiences.

The impact of HTA findings may be increased to the extent that the HTA process is local, i.e., conducted by or involving people in the target decision-making organization, such as a hospital network or major payer agency. Such “local” HTA can increase the utility of HTA findings due to the relevance of the HTA topic (e.g., by having input on topic selection and use of local data), timeliness, and formulating policy reflecting the local values and context (Bodeau-Livinec 2006; McGregor 2005). Findings from HTA that is conducted with rigorous, well-documented methodology on topics that are priorities or otherwise of interest to sponsors with policymaking authority (“policy customers”) are more likely to be adopted and have an impact (Hanney 2007; Raftery 2009).

In summary, the following are ways in which HTA programs can increase the likelihood of their reports having the intended impacts (see, e.g., Hailey 2000; McGregor 2005; Sorensen 2008):

  • Conduct a transparent, credible, unbiased, rigorous, and well-documented HTA process
  • Gain prior commitment, where feasible, from decision makers to use HTA findings
  • Ensure that assessments are designed to address decision makers’ questions
  • Seek to establish formal links between producers and users of HTA
  • Involve key stakeholders throughout the HTA process (e.g., in priority setting, determination of assessment questions) in a transparent, well-managed manner
  • Gain input of representatives of anticipated target audiences and communication experts in planning knowledge transfer strategies, including different formats, languages, media, and related messaging of HTA findings to different target audiences, as appropriate
  • Anticipate the resource requirements, incentives, delivery system characteristics, and other diverse factors that will influence the feasibility of implementing HTA findings
  • Ensure that HTA findings are delivered on a timely basis to inform decision making
  • Promote collaboration and transfer of knowledge and skills across jurisdictions (e.g., across nations, regions, localities)

Box IX-1. Examples of Factors That Can Affect Impact of HTA Reports

Target clinician characteristics

  • Type of clinician: physician, mid-level practitioner, nurse, dentist, etc.
  • Specialty; training
  • Professional activities/affiliations
  • Institutional affiliations (e.g., community hospital, university hospital)
  • Financial, professional. quality incentives to implement findings/recommendations
  • Awareness of performance relative to peers
  • Access to and familiarity with current evidence, practice guidelines
  • Malpractice concerns/exposure

Target provider organization characteristics

  • Hospitals: general versus specialized, size, teaching status, patient mix, for-profit vs. non-profit, distribution of payment sources (e.g., fee-for-service vs. capitation), ownership status, financial status, accreditation, market competition
  • Physicians' offices: group practice vs. solo practice, hospital affiliation, teaching affiliation, board certification, distribution of payment sources, market competition
  • Financial, organizational, or quality incentives to implement findings/recommendations

Target patient characteristics

  • Insurance (type) and cost sharing status (deductible, copayment, etc.)
  • Access to regular primary care provider, other care
  • Health status
  • Health awareness, use of health information media, health literacy
  • Socioeconomic/demographic/cultural factors
  • Home, workplace, other environmental factors
  • Social interaction (family, friends, peers, etc.)

Environmental characteristics

  • Urban, suburban, rural
  • Competition
  • Economic status
  • Third-party payment (e.g., market distribution of fee-for-service vs. bundled payment)
  • State and local laws, regulations
  • Activities of pressure groups/lobbyists, other interest groups
  • Malpractice potential/activity
  • Political factors

Characteristics of HTA findings/recommendations

  • Type/extent of engagement of target audiences/stakeholders in process
  • Timeliness/responsiveness relative to needs of target audiences
  • Reputation/credibility of HTA organization, analysts, expert panels
  • Transparency/rigor of assessment process
  • Quality and strength of evidence base
  • Application of findings: evidence review only; policy implications/recommendations; input to practice guidelines, coverage/reimbursement, technology acquisition, quality standards, etc.
  • Perceived appropriateness of rigidity or flexibility of findings/recommendations
  • Dissemination media, format, content/frequency
  • Proximity to decision makers or policymakers and extent of their obligation (e.g., legal mandate or optional) to implement findings/recommendations
  • Resources required to implement findings/recommendations

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