National Information Center on Health Services Research and Health Care Technology (NICHSR)
HTA 101: Disseminating Findings and Recommendations
To the analysts and other experts who have participated in an HTA, the importance of its findings and recommendations may be self-evident. Dissemination of these findings and recommendations, whether for internal use in the same organization or into the national or international health information mainstream, often is considered as an administrative afterthought.
Worthy HTA messages get lost because of misidentified and misunderstood audiences, poor packaging, wrong transmission media, bad timing, and other factors. Although there is some convergence on the format and content of information to be included in an HTA report, much research is needed regarding how to optimize the dissemination of HTA findings and recommendations (Goldberg 1994, Mittman and Siu 1992, Mittman and Tonesk 1992, Busse 2002).
Dissemination efforts must compete with the burgeoning flow of health-related information being transmitted across diverse channels using increasingly sophisticated means. Advanced communications technologies provide alternative means to transmit more data where and when it can influence decision makers. Marketing, long practiced effectively by health care product companies, offers an evolving, continually researched variety of techniques that are being adapted throughout the health care sector. As the ground shifts in health care organization, delivery and financing, the cast of decision makers constituting the potential users of HTA changes.
There is considerable current controversy regarding various policies and practices of disseminating information about health technologies, particularly by pharmaceutical and other health technology companies. One area is the use of direct-to-consumer advertising by pharmaceutical and other health technology companies, including whether this is to be permitted at all and, if so, what requirements should pertain to the content and format of the message. In particular, while there is strong evidence that these messages increase awareness of prescription drugs, they is far less evidence that they are effective in educating patients about medications for their conditions (Lyles 2002). A second area of controversy concerns whether health technology companies can distribute published and unpublished reports of clinical trials of their products for indications that have not been cleared for marketing by the appropriate authority, e.g., by the US FDA (Stryer 1996). A third area of controversy concerns the conditions under which pharmaceutical and other health technology companies can make claims in their marketing information about the cost-effectiveness of their products, what the rigor of supporting evidence should be, and which agencies should have regulatory oversight for such economic claims (Neumann 2000).
Approaches for disseminating reports of HTAs can be described along three dimensions: target groups (intended audiences), media, and implementation techniques or strategies, as shown in Box 40.
The results of the same HTA may be packaged for dissemination in different formats, e.g., for patients, clinicians, payers, and researchers or policy analysts. Reaching the same decisionmaker may require repeated messages and/or multiple media. The style in which an assessment report is written (e.g., an academic, scholarly tone versus a practical, concrete tone) may affect the receptiveness of researchers, practitioners and others (Kahan 1988).Box 40
Approaches for HTA Report Dissemination
- Clinicians (individuals, specialty/professional organizations)
- Patients/consumers (individuals, organizations)
- Provider organizations (hospitals, clinics, managed care organizations)
- Third party payers (government, private sector)
- Quality assurance and utilization review organizations
- Government policymakers (international, national, state, local)
- Biomedical researchers
- Health care product companies
- News professionals (popular and scientific/professional journalists and editors)
- Educational institutions (schools, continuing professional education programs)
- Printed: direct mail, newspapers and popular journals, scientific/professional journals and newsletters, posters, pocket cards
- Electronic: internet, television, radio, video disks, computer databases (online and disk)
- Word of mouth: informal consultation, formal lectures and presentations, focus groups
Implementation techniques or strategies
- Patient-oriented: mass media campaigns, community based campaigns, interaction with clinicians (including shared decision procedures, interactive video disk), modify insurance coverage (more or less generous benefits, change copayments)
- Clinician-oriented: conferences and workshops; continuing professional education; professional curriculum development; opinion leaders; one-on-one educational visits ("academic detailing"); coverage/reimbursement policy; precertification; mandatory second opinion; drug formulary restrictions; feedback (e.g., on laboratory test ordering relative to criteria/guidelines); reminder systems (e.g., as part of computer-based patient record systems); medical audit/peer review; criteria for board certification/recertification, state licensure, Medicare PRO action, specialty designation, professional/specialty society membership; public availability of performance data (e.g., adjusted mortality rates for certain procedures); defense against sanctions and malpractice action
- Institution-oriented: accreditation, standards (e.g., hospital infection control, clinical laboratories), benchmarking, public availability of performance data
Dissemination should be planned at the outset of an assessment along with other assessment phases or activities. The costs, time and other resources needed for dissemination should be budgeted accordingly. This does not mean that dissemination plans should be rigid; the nature of the findings and recommendations themselves may affect the choice of target groups and the types of messages to be delivered. Dissemination should be designed to influence behavior of decision makers. This is not always straightforward, as research findings concerning what works for HTA dissemination strategies do not point to any universally successful approaches.
There are many approaches to controlling or enhancing access to assessment reports. As noted above, some assessment programs provide their assessments only to paid subscribers or member organizations, or charge fees intended to help recoup the cost of the assessment or provide a profit. While some assessments are public documents made available at no cost via the internet or in public libraries, others are held as proprietary (e.g., company assessments of new products). Access to assessment literature is also mediated by the capacity of bibliographic organizations (e.g., the NLM and commercial database vendors) to index and abstract the literature, and the availability of such information via online databases and other information services. The wording used by assessment report authors for titles and abstracts can influence the indexing that serves as a key to accessing these reports.