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PubMed1998

Ensuring adequate payment for the use of new technology.

To ensure that proper reimbursement is obtained for utilization of a new technology, providers should demonstrate to payers the long-term cost-effectiveness of the new technology. Providers need to determine the incremental costs incurred in using the technology and various payers' payment rates for such use. If preliminary analysis shows that reimbursement for the technology may be insufficient, providers then should conduct a detailed analysis of the new technology. This analysis should assemble comparative data of internal and external performance benchmarks from various sources, including state, regional, and national databases. In addition, providers should assess the long-term savings achieved by using the new technology, such as reductions in hospital readmissions and repeated procedures. Managed care payers are likely to find such data persuasive in determining whether to increase payment rates for a new device or therapy.

Angioplasty, Balloon, Coronary↗
PubMed1998

Healthcare technology assessment: methods, framework, and role in policy making.

UNLABELLED: This activity is designed for healthcare organization managers and clinicians, particularly those involved in technology-related decisions, including coverage decisions, technology acquisition, practice guideline development, and evidence-based medicine. GOAL: To provide a basic understanding of the principles, methods, and systematic framework of healthcare technology assessment. OBJECTIVES: 1. Understand the role of healthcare technology assessment in policy making and the technical properties and impact assessed. 2. Become familiar with the categories and basic attributes of methods used in healthcare technology assessment. 3. Comprehend the ten-step framework for conducting a healthcare technology assessment.

Data Collection↗
PubMed1989

Health care technology assessment and adoption: a case study.

Today's progressive hospital and health care system managers look to new ways to retain or augment their market share and to position themselves in their service areas. Since diffusion of new technologies into health care is market driven, informed decisions on the adoption of certain emerging patient care technologies can place a health care organization in a favorable financial position. There is a compelling need for hospital management and the governing board to collaborate with their medical staff on the development of an acceptable process to quickly identify and implement appropriate new technologies into the patient care environment. This joint effort is vital to ensure the integration of sound clinical values and objectives with planned institutional business strategies. Mount Carmel Health, a multifaceted health care corporation in central Ohio, has met the challenge of managing patient needs, physician interests, and limited hospital resources by forming a unique entity within the organization for the effective assessment and adoption of the latest medical technology. The division, which is called the Advanced Treatment and Bionics Institute (ATBI), is charged with assessing the latest clinical technologies and managing a hospital's adoption of the most appropriate ones. It serves to organize and streamline the identification, acquisition, adoption, and implementation of innovative treatment technologies at Mount Carmel hospitals.

Academies and Institutes↗
PubMed1999

Positron emission tomography: establishing priorities for health technology assessment.

BACKGROUND: Positron emission tomography (PET) is an expensive diagnostic imaging technology. Despite the long history of PET development, the costs and effectiveness of its use in routine clinical practice remain unknown. Against this background of uncertainty regarding the clinical role of PET, the UK Standing Group on Health Technology requested a review of its current and potential role which would enable research priorities in this area to be established. OBJECTIVES: This 3-month project had two explicit objectives: (1) to review the state of knowledge regarding the clinical applications of PET; (2) to determine the key health technology assessment (HTA) research questions relating to the use of PET in the UK. METHODS: A literature review to ascertain the state of knowledge regarding the clinical applications of PET and a three-round Delphi study to inform the key HTA research questions relating to the use of PET in the UK were undertaken. The results of an earlier systematic review, published by the Veteran's Health Administration (VHA) in the USA in 1996, were used as the starting point for the literature review. The VHA review was updated and extended by means of MEDLINE and Cochrane Library database searches. Participants in the Delphi study were selected by discussion with five individuals in the UK with an interest in, and awareness of, developments in PET. As a result of their suggestions, 43 individuals were initially invited to participate, of whom two did not feel appropriately qualified. Questionnaires were sent by facsimile to all invited participants, who were asked to return the completed forms by facsimile within a week. The content and structure of the Delphi study was informed by the results of the literature review. The responses and comments of the participants were a major source of information for this report. RESULTS: Clinical applications for PET have been advocated in three broad disease groups: oncology, cardiology and neuropsychiatric disorders. There are currently four PET modalities that need to be considered when assessing its potential clinical role in the UK: full ring PET scanners operating in two or three dimensions (available at five sites); partial ring rotating PET scanners (one currently operating in the UK); coincidence imaging with modified gamma camera technology; and high-energy collimator imaging of 511 keV photons with modified gamma camera technology. There is a paucity of available evidence relating to the cost-effectiveness of the various PET modalities in all of the clinical indications for which the technology is currently being advocated. In addition, many existing reports on the diagnostic accuracy of PET are limited because they are liable to bias and often relate only to very small patient numbers. The results of the Delphi study indicated that the four most important research priorities for the NHS, in descending order of their importance, are: (1) the relative cost-effectiveness of (a) full ring PET, (b) gamma camera PET using coincidence imaging and (c) existing diagnostic strategies to determine staging prior to operative intervention for lung cancer; (2) partial ring PET compared with full ring PET in oncology (3) the relative cost-effectiveness of (a) full ring PET, (b) gamma camera PET using coincidence imaging and (c) existing diagnostic strategies to stage and monitor treatment response in breast cancer; (4) the relative cost-effectiveness of (a) gamma camera PET using coincidence imaging and (b) 511 keV collimated positron imaging for assessing myocardial viability when selecting patients for revascularisation surgery. Vignettes describing each of the research priorities are provided in the main report. CONCLUSIONS: The findings of this project, which was undertaken rapidly in order to inform HTA research prioritization in the UK, provide a contemporary overview of the potential clinical role for PET in the NHS. Evidence is needed that using PET as a diagnostic

Female↗
PubMed1999

Assessment and regulation of health care technology. The Dutch experience.

OBJECTIVES: To evaluate the characteristics, methods, and results of the Dutch Investigative Medicine Program ("ontwikkelingsgeneeskunde") in policy and health care. METHODS: Project database analyses of the initial 9 years of the program; description of characteristics, methods, and effects of the program. RESULTS: By the end of 1997, 53 projects had been completed, including implementation in health care policy. In 20 of 53 cases the program worked as an instrument to prevent the introduction of ineffective, inefficient, or even harmful medical interventions. In most other cases the program assisted with proper placement or appropriate application of new technologies. Apart from new or emerging technologies, already existing technologies are evaluated. CONCLUSION: The Dutch Investigative Medicine Program ("ontwikkelingsgeneeskunde") of the Sickness Funds Council is an effective collaboration of health care providers, medical science, health economics, and a regulatory body in empirical technology assessment. It is also an example not only of a substantial contribution of technology assessment to decision making in practice and policy but also of a means of regulation of health care by the very activity of technology assessment itself. It appears that the program has evolved into an instrument to rationalize health care and health care policy, although some further possible improvements are identified.

Decision Making, Organizational↗
PubMed2000

Technology development and implementation in the public health institutions: a strategic and pedagogical task for the learning organization.

The article presents two overall problem issues for IT in the health sector. A strategic problem: Which organization structure and which work routines should be enhanced by technology? A pedagogical problem: How does the personnel learn to think, act and express work through IT-tools? The suggested solution is to put technology development and implementation together within a theoretical frame for the learning organization where reciprocal demands and terms exist for both the IT-tools and the personnel. The personnel makes demands to which goals should be reached through technology and technology demands that the personnel is acquainted with hardware and software. As a communication system, technology offers new possibilities of realizing other forms of cooperation. The suggested solution is a synthesis between the strategy for organization development through technology and the implementation of IT as a learning process for the personnel. The synthesis between the mutual demands of the organization and its personnel provides for IT-tools which are in concordance with the principal values of the health practice rather than merely economic and management values. The analysis builds on a qualitative, in-depth investigation of IT-implementation in the secondary sector. The investigation indicated that the use of IT is a learning process which requires three types of knowledge and that continued IT-development in the organization requires a new fourth knowledge.

Attitude to Computers↗
PubMed2001

Apheresis technologies and clinical applications: the 2000 International Apheresis Registry.

The developments in apheresis technologies and techniques and their clinical applications worldwide are technologically, sociologically, and economically driven. In the past, apheresis survey statistics have highlighted both the differences by geographical region in clinical practices and in the types of technologies utilized. While a national view of apheresis is critically important, an international view of apheresis may be more representative overall of this therapeutic modality than national results that are highly dependent on the local economics and the available technologies. These regional differences have provided a basis for the scientific and clinical assessments of these apheresis technologies and their clinical outcomes and have impacted the marketing and business developments of new technologies worldwide. The results of the International Apheresis Registry for 2000 reporting on 39 centers on 4 continents are presented. This survey collected data on 1,080 patients for a total of 15,257 treatments. Information gathered included patient demographics, medical history, treatment diagnoses, treatment specifics (type, methodology, access type, anticoagulants, drugs, equipment usage), side effects, clinical response, and payment provider. As in the prior International Apheresis Registry for 1983, the survey results highlighted the regional differences in apheresis usage and treatment specifics, indicating that an international overview of apheresis may be more representative of the impact of this therapeutic modality.

Adult↗
PubMed2002

Reducing global NOx emissions: developing advanced energy and transportation technologies.

Globally, energy demand is projected to continue to increase well into the future. As a result, global NOx emissions are projected to continue on an upward trend for the foreseeable future as developing countries increase their standards of living. While the US has experienced improvements in reducing NOx emissions from stationary and mobile sources to reduce ozone, further progress is needed to reduce the health and ecosystem impacts associated with NOx emissions. In other parts of the world, (in developing countries in particular) NOx emissions have been increasing steadily with the growth in demand for electricity and transportation. Advancements in energy and transportation technologies may help avoid this increase in emissions if appropriate policies are implemented. This paper evaluates commercially available power generation and transportation technologies that produce fewer NOx emissions than conventional technologies, and advanced technologies that are on the 10-year commercialization horizon. Various policy approaches will be evaluated which can be implemented on the regional, national and international levels to promote these advanced technologies and ultimately reduce NOx emissions. The concept of the technology leap is offered as a possibility for the developing world to avoid the projected increases in NOx emissions.

Air Pollution↗
PubMed1992

How attractive does a new technology have to be to warrant adoption and utilization? Tentative guidelines for using clinical and economic evaluations.

Because economic evaluations of health care services are being published with increasing frequency it is important to (a) evaluate them rigorously and (b) compare the net benefit of the application of one technology with that of others. Four "levels of evidence" that rate economic evaluations on the basis of their methodologic rigour are proposed. They are based on the quality of the methods used to estimate clinical effectiveness, quality of life and costs. With the use of the magnitude of the incremental net benefit of a technology, therapies can also be classified into five "grades of recommendation." A grade A technology is both more effective and cheaper than the existing one, whereas a grade E technology is less or equally effective and more costly. Those of grades B through D are more effective and more costly. A grade B technology costs less than $20,000 per quality-adjusted life-year (QALY), a grade C one $20,000 to $100,000/QALY and a grade D one more than $100,000/QALY. Many issues other than cost effectiveness, such as ethical and political considerations, affect the implementation of a new technology. However, it is hoped that these guidelines will provide a framework with which to interpret economic evaluations and to identify additional information that will be useful in making sound decisions on the adoption and utilization of health care services.

Canada↗
PubMed1992

[Health technology in Mexico].

The features of the health technology cycle are presented, and the effects of the demographic, epidemiologic and economic transition on the health technology demand in Mexico are discussed. The main problems of science and technology in the context of a decreasing scientific and technological activity due to the economic crisis and the adjustment policies are also analyzed: administrative and planning problems, low impact of scientific production, limitations of the Mexican private sector, and the obstacles for technology assessment. Finally, this paper also discusses the main support strategies for science and technology implemented by the Mexican government during the 1980s and the challenges and opportunities that lie ahead.

Epidemiology↗
PubMed2005

High rate anaerobic thermophilic technologies for distillery wastewater treatment.

In this paper, performance of two high rate technologies, upflow anaerobic fixed-film reactor and fluidized bed laboratory-scale, treating distillery wastewater (wine vinasses) at anaerobic thermophilic conditions have been compared. The results obtained show that the stationary packed bed, with a corrugated plastic support, operated under stable conditions at organic loading rates (OLR0) around 20 kgCOD/m3/d, gives maximal total CODr of 76% at OLR0 of 6.29 kgCOD/m3/d; the fluidized bed reactor, operated on open pore sintered-glass media, gives total CODr of 96% at OLR0 of 5.88 kgCOD/m3/d. The anaerobic fluidized bed technology is more effective than the upflow anaerobic fixed-film technology due, fundamentally, to this technology favouring the transport of microbial cells from the bulk to the surface and enhancing the contact between the microorganism-substrate phases, In this sense, the stationary packed bed technology is adequate for the treatment of easily biodegradable wastewater, or for the cases where elevated percentages of CODr removal are not required, while the fluidized bed technology is especially suitable for treatment of hazardous wastes with recalcitrant compositions.

Bacteria, Anaerobic↗
PubMed1992

Next-generation technologies. Impact on the work load of the pathologist.

Technologies emerging and evolving in the 1990s, particularly in molecular biology, therapeutics, computerization, and information management, will alter the type of work and work load of the pathologist. In general, new technologies will increase the work load of pathologists. However, the extent to which new medical technologies affect pathology will be modulated by socioeconomic factors, given the relationship between new technology and increased medical costs. Pathologists may choose to embrace many new technologies and should play an active role in technology assessment to ensure the appropriate use of new diagnostic procedures.

Pathology↗
PubMed2005

Global medicine technology.

In little more than a decade, linkages between health care technologies of different cultures and continents have merged, resulting in global medicine technology. The next generation of young scientists and clinicians from both the research and clinical communities are merging established ancient technologies from outside the U.S. with modern medical technology and forging new ground in an increasingly challenging health care climate. Presently researchers, clinicians and communities are active in finding ways of using global medical technology to attack our most difficult and chronic (therefore expensive) health care problems. Using recent inventions, such as the fMRI, researchers and clinicians are understanding how and why they work. This chapter briefly discusses key ideas in the movement towards global medical technology: healthcare culture, mind-brain-body dialogue, and self-care including a self care exercise for the spine.

Biomedical Technology↗
PubMed1991

Technology assessment in medicine: methods, status and trends.

The contribution of medical technologies to the rising costs of health care is generating increasing enthusiasm for application of methods for assessing the impact of the technologies on health care cost and quality. Various assessment methods are available, ranging from rigorous Randomized Controlled Clinical Trials to informal Opinion Surveys of practitioners experienced with the technologies. Between these extremes are techniques such as Performance Analysis, Case Series, Case Studies, Metanalysis and Consensus Development. In the United States several institutions are involved in the technology assessment process. These institutions include government agencies, third-party carriers, advisory groups, and professional organizations. Currently these institutions emphasize variables such as safety, effectiveness and, less frequently, cost-effectiveness as criteria of technology assessment. However, outcome measures such as morbidity and mortality statistics and 'quality of life' parameters are receiving increased attention as more penetrating criteria for technology assessment.

Cost-Benefit Analysis↗
PubMedDate not supplied

[Ethical problems of medial technology].

Ethical problems are constantly arising in medical practice, especially in connection with the use of cutting-edge technology for diagnosis and treatment. The high cost of these resources means that they have to be used selectively, and at that point decisions are made about who should and should not get to use them. In recent years there have been increasing charges of improper use of these new technologies, coupled with increasing discussion of the costs and the benefits. Unfortunately, the use of such technology tends to spread indiscriminately and, as a result, to add to the cost of health care. Given this situation, it is essential to examine the relevance of the new diagnostic and treatment methods, the causes of technological abuse, the ethical aspects of the use of medical technology, and even the relationship between technology and society.

Ethics, Medical↗
PubMed1987

Technology assessment and quality assurance.

While quality of care activities and technology assessment have important aspects in common, they are also different in significant ways. Quality of care activities will generally come later in the life cycle of a technology and should be primarily concerned with benefit. Technology assessment activities are broader in their concerns and deal with all stages in the life cycle of a technology. Information from technology assessment has significant implications for improving decision making in health care. Quality of care activities themselves can profit from the growing body of information available from technology assessment.

Forecasting↗
PubMed1995

[The elderly on technology: usage ease of usage, interest and ascribed usefulness].

This article discusses an explorative survey conducted in the Netherlands among a group of 1099 older people (> 55 years) and a reference group of people (n = 174) younger than 55 years. The participants were asked to complete an extensive questionnaire and to indicate their experience and attitudes towards modern technical facilities. The results show that the elderly use technology less frequently compared with the reference group. Compared with the reference group there is also a delay in use of technology after the introduction. An important point is that although for many participants our sample the impact of various technologies on their lives is not as great as for the younger, working people, there is a wide range of knowledge and interest in technology. The attitudes of the elderly towards new and modern technology are positive, especially in the group of the 'younger elderly' (between 55-64 years). Due to the selective composition of the group under investigation, the results cannot be generalized to the Dutch population. Taking this methodological weakness into account, the results are interesting and indicate directions for follow-up research concerning ageing and technology.

Adolescent↗
PubMed1995

Hospital adoption of medical technology: an empirical test of alternative models.

OBJECTIVE: This study examines hospital motivations to acquire new medical technology, an issue of considerable policy relevance: in this case, whether, when, and why hospitals acquire a new capital-intensive medical technology, magnetic resonance imaging equipment (MRI). STUDY DESIGN: We review three common explanations for medical technology adoption: profit maximization, technological preeminence, and clinical excellence, and incorporate them into a composite model, controlling for regulatory differences, market structures, and organizational characteristics. All four models are then tested using Cox regressions. DATA SOURCES: The study is based on an initial sample of 637 hospitals in the continental United States that owned or leased an MRI unit as of 31 December 1988, plus nonadopters. Due to missing data the final sample consisted of 507 hospitals. The data, drawn from two telephone surveys, are supplemented by the AHA Survey, census data, and industry and academic sources. PRINCIPAL FINDING: Statistically, the three individual models account for roughly comparable amounts of variance in past adoption behavior. On the basis of explanatory power and parsimony, however, the technology model is "best." Although the composite model is statistically better than any of the individual models, it does not add much more explanatory power adjusting for the number of variables added. CONCLUSIONS: The composite model identified the importance a hospital attached to being a technological leader, its clinical requirements, and the change in revenues it associated with the adoption of MRI as the major determinants of adoption behavior. We conclude that a hospital's adoption behavior is strongly linked to its strategic orientation.

Capital Expenditures↗