B. Basic Dissemination Framework

While HTA report findings can be delivered in various forms and communications media, the mere provision of information often results in little behavior change. More is being learned about techniques to increase the likelihood of changing behavior, such as face-to-face interaction, active involvement of the learner, message repetition, making recommendations explicit and relevant to clinical practice, use of opinion leaders (or “champions”), and influence of peers. As the health care information and communications environment evolves, further insights are needed about clinicians’ motivations and decision making, as well as those of patients and consumers. In the last decade, research findings on the effectiveness of various approaches for disseminating or sharing evidence-based information among clinicians has been assembled in systematic reviews, with identification of areas for further research, e.g., on continuing education (Forsetlund 2009), educational outreach visits (O’Brien 2007), opinion leaders (Flodgren 2011), audit and feedback (Jamtvedt 2006), and ways to promote interprofessional education and collaboration (Reeves 2013; Zwarenstein 2009).

HTA report dissemination can be described using three basic dimensions: target groups, media, and implementation techniques or strategies, as shown in Box VIII-1. HTA reports and documentation derived from those reports can be packaged for dissemination in different formats, e.g., for patients, clinicians, health care facility managers, payers, policymakers, researchers, the public, and news organizations. Reaching and influencing any target audience may require multiple messages and media (Kahan 1988).

Box VIII-1. Options for Dissemination of HTA Findings and Recommendations

• Target groups
• Clinicians (individuals, professional/specialty associations)
• Patients/consumers/general public (individuals, organizations)
• Disease/disorder associations (voluntary/non-profit)
• Provider institutions (hospitals, clinics, laboratories, etc.)
• Third party payers/health plans/drug formularies (government, private sector)
• Government policymakers (international, national, state, local)
• Judicial systems (e.g., for legal challenges to payer coverage policies)
• Journal editors (general/popular, scientific/health/specialty clinical)
• News services/professionals (general/popular, scientific/health/specialty clinical)
• Researchers (biomedical, health services, public health, etc.)
• Life sciences companies (pharmaceuticals, biologics, medical devices, etc.)
• Academic institutions (schools, continuing professional education programs)
• Quality assurance and utilization review organizations

Media

• Printed: scientific/professional journals and newsletters, direct mail, newspapers and popular journals, posters, pocket cards
• Electronic: Internet (including cloud), television, radio, digital video disks, flash drives, webinars, podcasts, other computer databases (online, disk, etc.)
• Social i.e., Internet-based and mobile interactive media, including: collaborative sites (e.g., wikis); blogs, vlogs, and microblogs (e.g., Twitter); social networking (e.g., Facebook, LinkedIn); content communities (e.g., YouTube), crowdsourcing
• Word of mouth: in-person/face-to-face interaction, e.g., informal consultation, formal lectures and presentations, focus groups

Implementation techniques or strategies

• Patient/consumer-oriented: mass media campaigns, community based campaigns, interaction with clinicians (including shared decision procedures, interactive electronic resources), modify insurance coverage (more or less generous benefits, change copayments)
• Clinician-oriented: conferences and workshops; continuing education; professional curriculum development; opinion leaders; one-on-one educational visits (“academic detailing”); coverage/reimbursement policy; practice guidelines; precertification; mandatory second opinion; drug formulary restrictions; audit, peer review, and feedback (e.g., on laboratory test ordering relative to criteria/guidelines); clinical decision-support systems; reminder systems (e.g., as part of computer-based patient record systems); criteria for board certification/recertification, state licensure, specialty designation, professional/specialty society membership; public availability of performance data (e.g., adjusted mortality rates for certain procedures)
• Institution-oriented: accreditation, standards (e.g., hospital infection control, clinical laboratories), benchmarking, public availability of performance data