Analysis On The Status And Influencing Factors Of Knowledge Translation From Health Technology Assessment To Health Policy-making In China From The Perspective Of Policy-makers

[Background]Health technology assessment (HTA), as a tool for the evaluation of technical characteristics, clinical safety, efficacy, economic value and social adaptation of health technology, was conducted to optimize the allocation of health resources and provide references for decision-making. To facilitate the policy-making was one of the main forms of HTA knowledge translation. The degree of HTA knowledge translation was divided into 6 dimensions, including academic translation, nominal translation, cognitive translation, reference translation, adoption and application. Compared with a more mature system of HTA in developed countries, the use of HTA in China was quite limited and decentralized. A variety of researches revealed that the establishment of an evidence-based policy-making system, the attitude of policy-makers, and the collaboration between researchers and policy-makers were key factors for HTA knowledge translation.[Objective]This study aimed to analyze the current status of knowledge translation in China from HTA to health policy-making, explore the factors that may influence HTA knowledge translation, and provide references for improving the use of HTA evidence to inform health policy-making in China.[Methods]A framework of influencing factors was established for further verification, and John Kingdon’s "policy window" theory was introduced for the analysis of the drivers for ageda setting in the process of policy-making. Literature review, expert consultation, questionnaire survey and key stakeholder interviews were conducted for data collection, and thematic framework analysis, descriptive and statistical analysis were made for better understanding of the status and influencing factors.[Results]136 questionnaires were included, with a response rate of 67.0%, and 17 policy-makers were recruited in the interview.By identifying the flow of administrative legislation and the establement of other normative documents, the study showed that evidence was required in the process of ageda setting, drafting and reviewing of administrative legislation, while the establement of other normative documents had no such requirements. Evidence was collected through field researches, expert consultation, and commissioned research projects. A less formal policy-making process may limit the utilization of HTA evidence.The case study of hip replacement demonstrated that the pace of the promotion and application of hip replacement was to some extent parallel with the development of HTA research of this technique. The concordance between the contents of studies and the official documents may be an indication that related evidence was required when formulating national policies of a certain area. The cases of universal newborn hearing screening and genetic disease revealed that cumulated evidence and right timing were both indispensable to open a policy window.Key stakeholder interviews indicated that committee of experts, think tank, and interpersonal relationship were main sources of evidence among policy-makers. Researchers and policy-makers communicated their ideas through irregular meetings at the opening, middle, and concluding of researches. With the promotion of evidence-based policy-making, the demand for evidence increased among policy-makers, with preference for executive summary and policy brief. However, the limited knowledge and relatively poor performance of HTA among policy-makers may have negative impact on the application of HTA evidence. The framework of HTA and evidence-based policy-making should be established. Nine influencing factors were discovered.The questionnaire survey indicated that research outcomes were to some extent embed in the policymakers’mind, accouting for 47.1% of the total sample, and were also adopted by the policy-maker to underpin the policy, while over 50.0% of the policy-makers preferred full report, draft policy paper and executive summary, but in terms of implementation, the result was not so favorable. There was limited training and funding, and 52.9% of the policy-makers considered the application of HTA in their work was limited. However, policy-makers were confident in the future development of HTA, and over 67.6% of them believed that the HTA-imformed policy-making had been heated on in the past few years. And from the perspective of policy-makers, the establishment of an evidence-based policy-making system, the attitude of policy-makers, the. collaboration between researchers and policy-makers, and the quality of HTA evidence were key factors for HTA knowledge translation.[Discussion and Recommendations]In China, HTA evidence had to some extent been applied in the process of policy-making. However, the degree of HTA knowledge translation was limited, with a huge gap between the ideal and reality. The application of HTA in policy-making was still at the initial stage, and further efforts should be made to improve the level and degree of HTA knowledge translation.In the problem stream, the role of HTA in health technology policy-making should be improved, by identifying the strategy to better integrate the time-consuming research with timeliness policies; and the awareness of HTA among the public should be raised;evidence should be sent to the related department.In the policy stream, the funding for HTA should be increased to facilitate the HTA development, and how to increase the efficiency of communication between researchers and policy-makers turned out to be another issue to address. In the politics stream, the evidence-based policy-making in China should be improved, and the ability to use the HTA evidence of policy-makers should be improved.To address the above issue and promote HTA knowledge translation in China, nine recommendations were proposed as follows:1.Establish a data base for HTA outputs, so as to improve the daily accumulation of HTA evidence, and release regular summaries of potential policy plans;2.Develop the therical framework of HTA, and publish the results of HTA through mass media;3.Carry out training on function division and evidence requirements of different departments of government among researchers;4.Establish a semi-open platform to release research needs and provide fundings;5.Invite strategic scientists during the communication between researchers and policy-makers;6.Publish introduction brochure with different cases specific to related departments;7.Publish policy brief according to the different functions of departments;8.Initiate HTA knowledge translation from a specific starting point, and gradually expand the coverage of various types of health technology;9.Introduce knowledge broker to facilitate HTA knowledge translation.