A Study On Hospital-Based Health Technology Assessment In Traditional Chinese Medicine

BackgroundHospital-based health technology assessment(HB-HTA)is based on the specific environment of the hospital,through conducting the health technology assessment activities,to systematically and comprehensively evaluate various health technologies from dimensions such as technical characteristics,effectiveness,safety,economy and social adaptability,etc.combined with the actual scenario,to help hospitals make scientific management decisions and meet the decision-making at the hospital level.HB-HTA has a history for many years in the international community and has accumulated a wealth of experience.The results of its conducted can help hospital managers develop relevant policies,make clinical decisions,improve quality of health care,and optimize the use of medical resources.In recent years,China has successively introduced methodological theories and tools related to HB-HTA,and carried out national level practice.However,the development of the field of traditional Chinese medicine is almost in a blank state.Traditional Chinese medicine(TCM)is a unique health resource in China.As the main provider of TCM services,TCM hospital are characteristic medical institutions in China,including a wide range of TCM health technologies.The efficiency of TCM hospital health resource allocation has a significant impact on the quality and efficiency of TCM services.Therefore,it is particularly necessary to conduct health technology assessment in TCM medical institutions and establish evidence-based scientific decision-making systems.Chinese patent medicines(CPMs)is one of the common treatment methods of TCM.TCM hospitals are the main positions of TCM characteristic therapies such as Chinese patent medicines.In combination with the hospital’s own characteristics,a comprehensive and systematic evaluation of CPMs is carried out based on the concept of HB-HTA providing high-quality decision-making evidence for the selection of CPMs in TCM hospitals,optimizing the drug catalog structure of TCM hospitals,and promoting the clinical rational use of CPMs.ObjectivesThis study systematically analyzed the research status of HB-HTA and drug selection in medical institutions,and conducted a questionnaire survey on relevant practitioners who may participate in the health technology assessment activities of TCM hospitals in the future to understand the development status of health technology assessment in TCM hospitals.Finally,the selection of CPMs was taken as an example to carry out exploratory research.A selection index system(list)of CPMs for TCM hospitals was constructed,providing reference for health technology assessment of TCM hospitals in the future.Methods1 Present research status of hospital-based health technology assessment and drug selection in medical institutions at China and abroadBy method of bibliometrics,CNKI,Wanfang,VIP,SinoMed database,Web of Science,Cochrane Library,PubMed,Embase,Guidelines International Network,Practice Guideline REgistration for TransPAREncy,HTA database,JD,Dangdang,Taobao,Amazon,Duxiu and Google were searched.Include literature,guides,tools,and books on HB-HTA as the research topic.Export the records included in the eight databases from NoteExpress to Refworks CiteSpace 2021 format,analyze the author,institution,and keyword nodes using CiteSpace 6.1,and analyze the publication trends,literature types,research topics of literatures on HB-HTA using Excel.The results are presented in charts.By method of scoping review,CNKI,CBM,VIP,Wanfang,Embase,Cochrane Library,Web of Science and PubMed were searched,and the research on guidelines,tools,methods related to drug selection in medical institutions was included.Then extracted and analyzed data to provide a basis for the construction of CPMs selection indicators in TCM hospitals.2 Investigation on the current situation of health technology assessment in TCM hospitalsBy the method of convenient sampling and snowball sampling,we investigated the relevant practitioners(clinical medical staff,pharmacists,administrative staff and scientific research personnel,etc.)who may carry out health technology assessment in TCM hospitals in the future.The survey covered 34 provincial-level administrative regions in China.The work units involving TCM hospitals,universities and scientific research units and government agencies.Through systematically reviewing China and foreign literature and data,a survey questionnaire was compiled.According to the pre-survey feedback,the questionnaire was improved to form the final questionnaire,which was distributed and recovered through the ’Questionnaire Star’ platform.The questionnaire includes 4 dimensions and 39 questions.The collected survey data were exported from the ’questionnaire star’ platform and analyzed by IBM SPSS Statistics 26.0 software.Single factor analysis of variance was used to analyze the differences in recognition among different populations,and the counting data was presented using frequency and component ratio.3 Exploring the selection criteria of CPMs in TCM hospitals based on HB-HTABased on the drug selection tools and methods for medical institutions included in Study 1,indicators at all levels of the selection list of CPMs in TCM hospitals were constructed by combining the characteristics of CPMs and the needs of hospital.The indicators were assigned weights by the method of analytic hierarchy process.Then we constructed the hierarchical structure model and two-by-two comparison judgment matrices based on the evaluation index system of CPMs selection for TCM hospitals.With reference to T.L.Saaty’s relative importance ranking table,the pairwise comparison between the factors of the first and second indexes was set to mark the scoring table dimension and the weight of each scoring dimension,the designed scoring sheet was distributed to the scoring team members through the "Questionnaire Star" platform to collect the scoring information.The number of each scoring dimension under the same pairwise comparison index was counted.The geometric mean value of the pairwise comparison data was calculated one by one.Nine final judgment matrices were constructed according to the geometric mean value,and the weight coefficient of each index was calculated by the sum-product method.SPSSAU online data analysis software was used to calculate the weight of each index and the maximum feature vector of each matrix,at the same time,the consistency check is carried out.According to the weight results obtained at the same level,the final combined weight of the first and second indexes in the total system is calculated,and the score values of each index in our evaluation index system are determined according to the weight.Results1 Present research status of hospital-based health technology assessment and drug selection in medical institutions at China and abroadThrough literature research of HB-HTA,a total of 155 literatures,9 books and 9 databases were included.In domestic researches,"health technology evaluation" and"hospital management" are the earliest keywords to appear.In recent years,research hotspots have been "rational drug use","new technology access","index system",etc.The earliest keywords appearing in foreign literature are "health policy","health technology assessment",and "hospital policy".In recent years,research hotspots have been "decision making","economic evaluation","multi-criteria",etc.The earliest included studies were published in 2005,and the attention gradually increased.The type of publication is mainly evaluation examples,and drugs were the most common evaluation object.Mini-HTA is the most common among the organizational management models of HTA.There are many countries carrying out HB-HTA globally,with Italy having the highest number of publications in abroad.There are no research about TCM hospitals conducting HTA.Through literature research of the current status of drug selection in medical institutions,a total of 23 articles were included,involving 23 methods or tools related to drug selection in medical institutions.Among the 14 domestic methods or tools,the earliest one was published in 2012,involving different levels of hospitals,different drug categories,and different evaluation perspectives.The main content of domestic tools covers(1)county-level hospital or township hospital,(2)different types of drugs such as antibiotics,children’s antipyretic ibuprofen preparations,hypoglycemic drugs and CPMs,(3)evaluating from the perspective of pharmacoeconomics,(4)the universal tool for drug selecting in domestic medical institutions.The drug selection tools for 9 foreign medical institutions come from Europe,the Americas,Asia and Africa.The earliest one was published in 1955.The tool content includes the formulation criteria for hospital formulary,the management and update of the hospital formulary,and the drug evaluation tools.2 Investigation on the current situation of health technology assessment in traditional Chinese medicine hospitalsA total of 244 questionnaires were collected,and the qualified rate of questionnaire filling were 100%.The survey subjects included 113 males(46.31%)and 131 females(53.69%),with an average age of 42.48 ± 8.56 years old.The majority of them had master’s or doctoral degrees,with 184 individuals(75.41%).The number of people originating from North China is the highest(53,21.72%),while the number of people from Northeast China and Hong Kong,Macao,and Taiwan is the lowest,183(75.00%)of the occupational backgrounds are mainly clinical medical staff and pharmacists,with more titles in the senior and deputy senior categories,accounting for 37.30%and 31.56%respectively.The vast majority of personnel have been in the profession for more than 10 years(168 people,68.85%),and about half(124 people,50.82%)have held administrative positions.In the daily work of the survey subjects,190 people were involved in research on a certain type of disease(77.87%),117 people were involved in drug research(47.95%),and 86.07%of the respondents participated in training related to clinical epidemiology,evidence-based medicine,clinical research,and GCP.In the awareness survey,137 people had a good understanding of the basic content of HB-HTA,with a relatively high overall level of cognition and scattered scores.There is no significant difference in recognition among different professions(F=0.251,P=0.778),and the recognition level in Hong Kong,Macao,and Taiwan is lower than that in other regions.The daily work of the surveyed subjects involves HB-HTA,with the most common being the clinical evaluation of TCM treatment methods.In future demand research,127 people believe that it is very necessary to conduct health technology assessments in TCM hospitals.Among the possible future health technologies,CPMs and Chinese herbal pieces(5.91 points),the evaluation of appropriate technologies of Chinese medicine(5.57 points)have high priority scores.The high demand for effectiveness(235 people)and safety(224 people)of health technology.In the future,there is a relatively high demand for clinical physicians(234 people,95.9%)and the least demand for economic experts(178 people,72.95%)among the required expert teams.The lack of specialized departmental organization and standardized evaluation process system,as well as insufficient talent capacity building,are considered as significant constraints for future development.The support from the national medical department,as well as the inclination of policies,the cultivation of relevant talents,and the high attention paid by hospital management,are very important for the future development of HB-HTA in TCM hospitals.3 Exploring the selection criteria of CPMs in TCM hospitals based on HB-HTAAccording to the included methods and tools for drug selection of China and foreign medical institutions,the index system of CPMs selection list of TCM hospitals is constructed.The list includes eight dimensions of effectiveness,safety,economy,inheritance,innovation,suitability,accessibility,and hospital demand,including 8 first level indicators,24 second level indicators,and 127 third level indicators.After calculating the weights of the first and second level indicators based on the Analytic Hierarchy Process,the weights of the eight first level indicators are effectiveness(0.225),safety(0.299),economy(0.125),inheritance(0.048),innovation(0.048),suitability(0.090),accessibility(0.084),and hospital demand(0.081).Among them,security and effectiveness have the highest weight,while innovation and inheritance have the lowest weight.The CR value range in the consistency test is 0.0～0.025,all<0.1,indicating that the consistency test has passed.According to the weight calculation of indicators at all levels,the scores of the eight first level indicators are effectiveness(22 points),safety(30 points),economy(13 points),inheritance(5 points),innovation(5 points),suitability(9 points),accessibility(8 points),and hospital demand(8 points),respectively.The full score of the list is 100 points.ConclusionHB-HTA has received widespread attention,with more mature development in some developed countries in Europe and America.The start of HB-HTA in China is relatively late compared with foreign countries,and the research in HB-HTA is hot in recent years.Many hospitals have carried out active practice,with drugs as the main evaluation object and accumulated some practical experience.However,there is a lack of relevant research on the health technology assessment of TCM hospitals.Drug selection and evaluation of medical institutions in China is a research hotspot in recent years,and various types of evaluation tools and methods have been released successively.However,the existing CPMs selection tools for medical institutions lack hospital perspective,and it is necessary to further formulate CPMs selection tools and standards suitable for the characteristics of TCM hospitals in the future.Relevant practitioners who may participate in conducting health technology assessments in TCM hospitals in the future have a certain degree of recognition of the basic knowledge of HB-HTA,and most of their daily work related to HB-HTA.Half of them have participated in the clinical comprehensive evaluation of CPMs.Most people believe that it is necessary to carry out HTA activities in TCM hospitals in the future.They can give priority to the evaluation of technologies with TCM characteristics,such as CPMs,Chinese herbal pieces,and TCM appropriate technology.In the evaluation,the specific conditions of TCM hospitals and the TCM characteristics of health technology should be considered.In the future,there may be challenges such as the lack of organizational system and talent shortage,and the support of national policies can play a crucial role in promoting its development.Taking CPMs,which is widely used in the health technology of TCM,as an example,to carry out exploratory research on health technology assessment of TCM hospitals.Based on HB-HTA,integrate the evaluation needs from the perspective of TCM hospitals and the theoretical characteristics of TCM into the evaluation index system of CPMs.It can help TCM hospitals to build a scientific medication catalog,support clinical medication decisions of CPMs.And it is necessary to improve the resource allocation efficiency of TCM hospitals and give play to the advantages of TCM treatment.This exploratory research can provide a reference for future TCM hospitals to carry out health technology assessment.