Research On Knowledge Translation From Health Technology Assessment To Health Policy-making In China

BackgroundWith the deepening of the healthcare reform in China, health technology has been considered as an important component in improving the national health system, which consists of the health insurance system, medicine delivery system and the delivery scheme of basic health service. Similar to the other scientific technologies, health technology is a double-edged sword. While it can improve the ability to prevent, diagnose, treat, and rehabilitate, it may have some negative side effects, like driving up health care costs and generating ethical and social implications that cannot be ignored.Under the context, HTA has been gaining recognition internationally and has played an increasingly important role in health policy-making. HTA is a multidisciplinary activity that systematically examines the technical performance, safety, clinical efficacy, and effectiveness, cost, cost-effectiveness, organizational implications, social consequences, legal, and ethical considerations of the application of a health technology. HTA provides evidence-based information to help make decisions on the selection and utilization of health technologies, to promote efficient health resource allocation, and to improve the clinical effectiveness. Besides, HTA is also helpful to control cost and eliminate other negative effects.In the case of China, although some HTA study has been conducted and some HTA knowledge has been created, the application of HTA findings to policy-making is not widespread and the integration of HTA in the policy-making processes is still in its infancy. The condition is not only adverse to the solution of actual problems, but also not conducive to the perfection of HTA knowledge. Under this background, strengthening the knowledge translation from HTA to health policy and giving full play to HTA role as the decision-making support, will greatly promote the scientific decision-making and evidence-based decisions and benefit the general public from the progress in the development of health technologies.ObjectivesThis study will analyze HTA development and utilization, examine enabling and impeding factors that influence HTA knowledge translation by quantitative and qualitative methods, and provide evidence-based recommendations for strengthening the knowledge translation from HTA evidence to health policy-making in China.MethodsMethods for data collectionLiterature reviewThis study will use multiple literature search engines to collect studies on KT theoretical model, KT measurement, as well as KT influencing factors. The literature review will provide some information to develop survey and interview instruments.Expert consultationAfter development of the questionnaire draft, experts at home and abroad were consulted to improve the content and structure of the questionnaire, as well as to edit the wording.Questionnaire surveyQuestionnaire survey will mainly focus on HTA researchers and policy-makers. It will collect information, including awareness, attitudes, perceived needs, knowledge, training, and experience of HTA researchers and policy-makers with regard to HTA and KT, and communications and interactions between researchers and policy-makers.Semi-structured key informant interviewSemi-structured key informant interview protocols will also mainly focus on HTA researchers and policy-makers. It will solicit information about the current status of knowledge translation from HTA to the health policy-making, the influencing factors that may affect HTA KT activities and effectiveness, as well as some suggestions for HTA knowledge translation.SamplingHTA researchers included in the questionnaire survey were those who met the following criteria 1) working at HTA agencies/units including both agencies/units with HTA as part of their titles and those with HTA research or related activities, such as academic units focusing on evidence-based medicine, pharnaco-economics, health economics, evidence-based medicine, health care management at universities and research institutions, etc; 2) conducting research that examines the medical, economic, social and ethical implications of the application or use of health technology, such as "the drugs, devices, and medical and surgical procedures used in health care, and the organizational and supportive systems within which such care is provided".Policy-makers included in the questionnaire survey were those who work in the health technology field at central government departments of the Ministry of Health (MoH), the Ministry of Health Resource and Social Security (MoHRSS), and the State Food and Drug Administration (SFDA), as well as the provincial counterparts of MoH, MoHRSS, and SFDA.In-depth interviews will be conducted with key informants of policy-makers and HTA researchers to collect some invisible or intangible information which the structure questionnaire could not detect. The number of interviews to be conducted will be based on the principle of information maturation.Statistical methodsDescriptive analysisWe will analyze current HTA activities and knowledge translation from HTA to health policy-making based on the surveys of researchers and policy-makers.Explorative factor analysisPrincipal component analysis was applied to do explorative factor analysis. By agency of the maximum variance method (Varimax), eigenvalue greater than 1 was set to determine the number of factor.Reliability analysisCorrected-Item Total Correlation (CITC) was used to purify the measurement items. The items with CITC value less than 0.3 will be eliminated. Besides, Cronbach’s a coefficient was applied to test the internal consistency reliability.Validity analysisStructural equation model (SEM) was applied to test the goodness of fit of the scale model and verify whether the factor structure of the model is reasonable.Univariate analysisF-test was applied to compare the difference of HTA knowledge translation among the respondents with different demographic characteristics. Correlation analysis was used to test the association between the factors, such as HTA. research quality, institutional support, and the level of HTA knowledge translation.Multivariate analysisMultivariate liner regression model and SEM path analysis were applied to explore the association between the independent variables (such as’demographic characteristics, HTA research quality, communications and interactions between researchers and policy-makers, individual perception and attitude, and so on) and dependent variable (HTA knowledge translation), respectively for policymakers and HTA researchers.Qualitative analysisQualitative analysis techniques will be used to analyze the interview data. The analysis will use qualitative research software (such as NVivo 7) to analyze the interview transcriptions of HTA activity and HTA knowledge translation.ResultsHTA-KT theoretical frameworkBy clarifying the definition of HTA and knowledge translation and summarizing theoretical results of previous studies, a theoretical framework for knowledge translation from HTA to health policy-making was developed to provide the guidance for investigating influencing factors, especially the factors of HTA researchers, policy-makers and institutions that may affect KT.Questionnaires and interview protocolsBased on the HTA-KT theoretical framework and the survey tools of previous researches, the questionnaire and interview protocols were developed after expert consultation. The questionnaires were modified and finalized after revision and sample test. The result of the empirical study shows that the finalized questionnaire has good reliability and validity.The current status of HTA activityAs demonstrated by questionnaire survey of HTA researchers, less than 20% of HTA researchers perceived that their institution provided fairly great support for HTA knowledge translation. With regard to the communication and interaction with policymakers, between 40% and 50% of HTA researchers has fairly good communication with policymakers in the stages of topic selection, methods formulation, implementation, data analysis and report writing. However, only 20% of HTA researchers reported fairly good communication in the stage of results transmission. Regarding the HTA research quality, approximately 60% of the HTA researchers considered the scientific nature, timeliness and practicality fairly good. Additionally, the qualitative interview showed that scientific report and publication in academic journal were the most commonly output form of HTA studies. Also, the overall quality of HTA research needs to be improved.To the results of questionnaire survey of policy-makers, about half of the policy-makers consider the communication with researchers fairly good and 40% of the policy-makers think close contact has been developed between the research unit and policy-making department. Also, about one third of the policy-makers perceive that the department they work in has paid close attention the new HTA evidence. However, less than 15% of the policy-makers consider that their institutions have provided enough train and research funding support for HTA studies. Similar to the results of questionnaire survey of HTA researchers, a large part of policy-makers have participated in the stages of HTA study. However, only 25% of policy-makers have fairly good communication with HTA researchers in the stage of HTA results transmission. Regarding to the scientific nature, timeliness and practicality of HTA research, between 30% and 40% of the policy-makers perceived it good. In addition, the qualitative interview illustrated that research report, summary abstract and policy brief were the most preferred output form by a majority of policy-makers.The current status of HTA knowledge translationThe "ladder-like" characteristic of knowledge translation was illustrated by the result of questionnaire survey of HTA researchers. Namely, some primary stages of knowledge translation were relatively easier to complete than some advanced stages. For instance, about 40% of HTA researchers reported that they often published HTA results in academic journal or submitted HTA results to the policy-makers, while only 15% of HTA researchers have research evidence adopted in policy-making or applied in wider scope. The results of qualitative interview also showed that a large part of HTA researchers only have a handful of HTA results applied as references or evidences for policy document.Between 40% and 50% of policy-makers reported that they are capable to read and fully understand the HTA results. The same proportion of policy-makers have used HTA results as references of decision-making or adopted HTA results to policy formulation. However, only 20% of them perceived that the policy based on HTA evidence had wider application. Furthermore, many policy-makers declared in qualitative interview that "HTA has not yet played a significant role in health policy-making in China" and "HTA is largely an academic exercise with little real impact on health policy".Influencing factors of HTA knowledge translationTo HTA researchers, the results of SEM path analysis demonstrated that "communication with policy-makers", "academic title", "quality of HTA research", "KT support scheme of working department" and "the ability of applying HTA evidence" associated positively with HTA knowledge translation. The results of qualitative interview also demonstrated that "communication and interaction" and some research-quality-related factors (e.g. "relevance to policy-making", "in easy-to-understand language") were important factors influence HTA knowledge translation.To policy-makers, the results of multivariate linear regression analysis illustrated that "expect of HTA importance in policy-making", "communication with HTA researchers" and "KT support scheme of working department" associated positively with HTA knowledge translation. These factors were also reported as important KT influencing factors in the qualitative interview.Conclusions and suggestionsAlthough some HTA research has been conducted and some HTA results have played important roles in policy-making, the overall level of HTA knowledge translation is still low and the impact of HTA research still needs to be expanded.In order to improve the HTA knowledge translation and further promote scientific and evidence-based decision-making, some improvements need to be made at the institutional level and individual level of research and decision-making, as well as the design of macro-mechanism.Firstly, mechanism of scientific decision-making needs to be established. It is suggested to make some concerned decisions with the HTA evidence, which will provide robust support for utilizing HTA evidence in health policy-making. Besides, the HTA guidance should be issued to optimize the design of technology assessment, standardize the application of assessment methodologies, and expand the transmission of HTA results.Secondly, the HTA researchers could continuously promote their theoretical level by many kinds of trainings. Also, their practical experience could be rich after fully understanding the practice environment of certain technology. Tt is suggested to keep communication with policy-makers during the overall process of research implementation, in order to timely solve the upcoming problems and ensure high quality of HTA research. Additionally, to facilitate the knowledge translation of HTA research, it is also advised to adopt appropriate output format to meet the demand of target population.Thirdly, the research institutions need to moderately adapt the incentive scheme to reward the researchers having research outcome implemented in societal practice. It is advised to establish the mechanism for supporting KT, as well as the management mechanism for ensuring research quality. In addition, it is also very important to strengthen the communication between HTA research units and health policy-making department, in order to promote the HTA relevance to policy-making and facilitate the HTA evidence utilization in policy-making.Fourthly, the policy-makers need to fully realize the great importance of HTA evidence in supporting health policy-making. It is suggested for policy-makers to participate in HTA train to strengthen the capability of applying HTA evidence. It is also advised to participate in HTA research and keep communication with HTA researchers during the overall process of research implementation, in order to concertedly solve the upcoming problems, improve the HTA knowledge and further expand the impact of HTA evidence on health policy-making.