scholarly journals Application of DMAIC Cycle and Modeling as Tools for Health Technology Assessment in a University Hospital

2021 ◽  
Vol 2021 ◽  
pp. 1-11
Author(s):  
Alfonso Maria Ponsiglione ◽  
Carlo Ricciardi ◽  
Arianna Scala ◽  
Antonella Fiorillo ◽  
Alfonso Sorrentino ◽  
...  
Keyword(s):  
Oral Cavity ◽  
Health Technology Assessment ◽  
Technology Assessment ◽  
Oral Hygiene ◽  
Oral Cavity Cancer ◽  
Length Of Hospital Stay ◽  
Health Technology ◽  
Cancer Surgery ◽  
University Hospital ◽  
Step Procedure

Background. The Health Technology Assessment (HTA) is used to evaluate health services, manage healthcare processes more efficiently, and compare medical technologies. The aim of this paper is to carry out an HTA study that compares two pharmacological therapies and provides the clinicians with two models to predict the length of hospital stay (LOS) of patients undergoing oral cavity cancer surgery on the bone tissue. Methods. The six Sigma method was used as a tool of HTA; it is a technique of quality management and process improvement that combines the use of statistics with a five-step procedure: “Define, Measure, Analyze, Improve, Control” referred to in the acronym DMAIC. Subsequently, multiple linear regression has been used to create two models. Two groups of patients were analyzed: 45 were treated with ceftriaxone while 48 were treated with the combination of cefazolin and clindamycin. Results. A reduction of the overall mean LOS of patients undergoing oral cavity cancer surgery on bone was observed of 40.9% in the group treated with ceftriaxone. Its reduction was observed in all the variables of the ceftriaxone group. The best results are obtained in younger patients (−54.1%) and in patients with low oral hygiene (−52.4%) treated. The regression results showed that the best LOS predictors for cefazolin/clindamycin are ASA score and flap while for ceftriaxone, in addition to these two, oral hygiene and lymphadenectomy are the best predictors. In addition, the adjusted R squared showed that the variables considered explain most of the variance of LOS. Conclusion. SS methodology, used as an HTA tool, allowed us to understand the performance of the antibiotics and provided variables that mostly influence postoperative LOS. The obtained models can improve the outcome of patients, reducing the postoperative LOS and the relative costs, consequently increasing patient safety, and improving the quality of care provided.

scholarly journals A Health Technology Assessment in Maxillofacial Cancer Surgery by Using the Six Sigma Methodology

2021 ◽  
Vol 18 (18) ◽  
pp. 9846
Author(s):  
Carlo Ricciardi ◽  
Giovanni Dell’Aversana Orabona ◽  
Ilaria Picone ◽  
Imma Latessa ◽  
Antonella Fiorillo ◽  
...  
Keyword(s):  
Health Technology Assessment ◽  
Technology Assessment ◽  
Six Sigma ◽  
Length Of Hospital Stay ◽  
Health Technology ◽  
Cancer Surgery ◽  
Future Research ◽  
P Value ◽  
Six Sigma Methodology ◽  
American Society

Squamous cell carcinoma represents the most common cancer affecting the oral cavity. At the University of Naples “Federico II”, two different antibiotic protocols were used in patients undergoing oral mucosa cancer surgery from 2006 to 2018. From 2011, there was a shift; the combination of Cefazolin plus Clindamycin as a postoperative prophylactic protocol was chosen. In this paper, a health technology assessment (HTA) is performed by using the Six Sigma and DMAIC (Define, Measure, Analyse, Improve, Control) cycle in order to compare the performance of the antibiotic protocols according to the length of hospital stay (LOS). The data (13 variables) of two groups were collected and analysed; overall, 136 patients were involved. The American Society of Anaesthesiologist score, use of lymphadenectomy or tracheotomy and the presence of infections influenced LOS significantly (p-value < 0.05) in both groups. Then, the groups were compared: the overall difference between LOS of the groups was not statistically significant, but some insights were provided by comparing the LOS of the groups according to each variable. In conclusion, in light of the insights provided by this study regarding the comparison of two antibiotic protocols, the utilization of DMAIC cycle and Six Sigma tools to perform HTA studies could be considered in future research.

Overview of information retrieval in a hospital-based health technology assessment center in a Swedish region

2021 ◽  
Vol 37 (1) ◽  
Author(s):  
Ida Stadig ◽  
Therese Svanberg
Keyword(s):  
Information Retrieval ◽  
Literature Review ◽  
Health Technology Assessment ◽  
Technology Assessment ◽  
Full Text ◽  
Health Technology ◽  
University Hospital ◽  
Literature Searching ◽  
Medical Library ◽  
Full Text Screening

Abstract Objectives This article aims to provide a brief review of information retrieval and hospital-based health technology assessment (HB-HTA) and describe library experiences and working methods at a regional HB-HTA center from the center's inception to the present day. Methods For this brief literature review, searches in PubMed and LISTA were conducted to identify studies reporting on HB-HTA and information retrieval. The description of the library's involvement in the HTA center and its working methods is based on the authors’ experience and internal and/or unpublished documents. Results Region Västra Götaland is the second largest healthcare region in Sweden and has had a regional HB-HTA center since 2007 (HTA-centrum). Assessments are performed by clinicians supported by HTA methodologists. The medical library at Sahlgrenska University Hospital works closely with HTA-centrum, with one HTA librarian responsible for coordinating the work. Conclusion In the literature on HB-HTA, we found limited descriptions of the role librarians and information specialists play in different units. The librarians at HTA-centrum play an important role, not only in literature searching but also in abstract and full-text screening.

OP69 Hospital-based Health Technology Assessment Is Applicable To Investment Decision-Making Process

2017 ◽  
Vol 33 (S1) ◽  
pp. 30-31
Author(s):  
Tuija Ikonen ◽  
Heli Lähteenmäki
Keyword(s):  
Decision Making ◽  
Health Technology Assessment ◽  
Technology Assessment ◽  
Ad Hoc ◽  
Investment Decision ◽  
Tertiary Care ◽  
Health Technology ◽  
University Hospital ◽  
Investment Planning ◽  
Budget Planning

INTRODUCTION:Hospital mangers need information for decision making (1). Hospital-based health technology assessment (HTA) methods were tested out to support the budget planning of investments for a new building to be constructed for diagnostic and teaching units at a publicly funded tertiary care university hospital. The hospital board nominated an ad hoc working group to reassess all investment proposals for devices, equipment and furniture for the diagnostic or teaching units that intended to move into the new building. The need for assessment was obliged when the submitted proposals of the units exceeded two-fold the initially allocated investment budget.METHODS:Depending on the level of expenditure, all proposals were assessed by one of the following processes: (i) Proposals over EUR250,000 were evaluated by three to five person expert groups using multi-domain assessment adapting Hospital-based HTA-principles; (ii) Proposals between EUR50,000 and EUR250,000 were returned to the units for miniHTA-assessments by clinicians who submitted the initial proposals and (iii) All proposals below EUR50,000 were prioritized by the units to cut the expenditure by at least 25 percent, with a special emphasis on synergistic use of devices and equipment among the units.RESULTS:The expert groups suggested significant reductions to the proposals, including the withdrawal of a Magnetic Resonance Imaging (MRI)-unit considered to be suboptimally located. Furthermore, the need for a new scanner was declined by promoting adherence to evidence-based diagnostic guidelines and more efficient utilization of existing scanners. Self-assessed MiniHTAs revealed proposals that were unnecessary or the specifications for devices needed re-adjustments. Prioritization revealed excess numbers of devices, for instance the number of cold storage appliances could be reduced. Altogether, the investment proposals were cut by over EUR3.8 million to reach the initial budgetary allocation.CONCLUSIONS:Innovative and flexible usage of hospital-based HTA methodology can be applied to budget planning and evaluation of investment proposals to support decision making. Based on encouraging results, hospital-based HTA was accepted to become a part of hospital strategy as a tool for the annual investment planning.

scholarly journals VP192 Importance Of Contextual Data In Producing Health Technology Assessment Recommendations

2017 ◽  
Vol 33 (S1) ◽  
pp. 238-239
Author(s):  
Thomas Poder ◽  
Christian Bellemare
Keyword(s):  
Health Technology Assessment ◽  
Technology Assessment ◽  
Scientific Literature ◽  
Health Technology ◽  
Outcome Data ◽  
University Hospital ◽  
Level Of Evidence ◽  
Contextual Data ◽  
Technology Acquisition ◽  
Clinical Complications

INTRODUCTION:Available data in the scientific literature is not always sufficient to make a clear Health Technology Assessment (HTA) recommendation without any other source of data. Contextual data and local expertize are an important source of data that cannot be ignored in HTA process. Despite a lack of evidence in the scientific literature, a technology can be recommended in a given context. We illustrate this by a case study about biplane angiography for vascular neurointervention.METHODS:A systematic review was conducted. The level of evidence was assessed by the grid of Downs and Black. An analysis of the context in our setting was also conducted. The main outcomes were: radiation doses, clinical complications, procedure times, purchase cost, impact on teaching programs, confidence of clinicians in the technology, quality of care, and volume of activity. A committee constituted of managers, clinical experts, physicians, physicists and HTA experts was created to produce a recommendation about biplane technology acquisition.RESULTS:A list of 257 citations was obtained yielding 9 eligible articles for analysis. Despite the lack of evidence found in the literature (median of Downs and Black: 3/32), the biplane system appears to reduce ionizing radiation and medical complications as well as shorten procedure time. Contextual data indicated that biplane system could improve operator's confidence, which could translate into reduced risk, especially for complex procedures. We estimate that a minimum of 50 cases can be done in our context (University hospital center covering a population of 306,322 people) with a higher level of patient safety. In addition, the biplane system can support our institution in advanced procedures teaching program.CONCLUSIONS:Given on the advantages provided by the biplane technology in our setting, the committee has recommended its acquisition. However, this technology should be implemented with a responsibility in collecting outcome data to optimize clinical protocol in doses of ionizing delivered.

scholarly journals Comparing Two Approaches for Thyroidectomy: A Health Technology Assessment through DMAIC Cycle

Healthcare ◽  
2022 ◽  
Vol 10 (1) ◽  
pp. 124
Author(s):  
Carlo Ricciardi ◽  
Adelmo Gubitosi ◽  
Donatella Vecchione ◽  
Giuseppe Cesarelli ◽  
Francesco De Nola ◽  
...  
Keyword(s):  
Health Technology Assessment ◽  
Total Thyroidectomy ◽  
Technology Assessment ◽  
Statistical Tests ◽  
Length Of Hospital Stay ◽  
Health Technology ◽  
Endocrine Surgery ◽  
Surgical Approaches ◽  
New Device ◽  
Significant Difference

Total thyroidectomy is very common in endocrine surgery and the haemostasis can be obtained in different ways across surgery; recently, some devices have been developed to support this surgical phase. In this paper, a health technology assessment is conducted through the define, measure, analyse, improve, and control cycle of the Six Sigma methodology to compare traditional total thyroidectomy with the surgical operation performed through a new device in an overall population of 104 patients. Length of hospital stay, drain output, and time for surgery were considered the critical to qualities in order to compare the surgical approaches which can be considered equal regarding the organizational, ethical, and security impact. Statistical tests (Kolmogorov–Smirnov, t test, ANOVA, Mann–Whitney, and Kruskal–Wallis tests) and visual management diagrams were employed to compare the approaches, but no statistically significant difference was found between them. Considering these results, this study shows that the introduction of the device to perform total thyroidectomy does not guarantee appreciable clinical advantages. A cost analysis to quantify the economic impact of the device into the practice could be a future development. Healthy policy leaders and clinicians who are requested to make decisions regarding the supply of biomedical technologies could benefit from this research.

scholarly journals A health technology assessment between two pharmacological therapies through Six Sigma: the case study of bone cancer

2020 ◽  
Vol 32 (6) ◽  
pp. 1507-1524 ◽  
Author(s):  
Carlo Ricciardi ◽  
Alfonso Sorrentino ◽  
Giovanni Improta ◽  
Vincenzo Abbate ◽  
Imma Latessa ◽  
...  
Keyword(s):  
Health Technology Assessment ◽  
Technology Assessment ◽  
Six Sigma ◽  
Maxillofacial Surgery ◽  
Health Technology ◽  
University Hospital ◽  
Healthcare Sector ◽  
Main Theme ◽  
Content Type ◽  
Hospitalization Costs

PurposeHead and neck cancers are multi-factorial diseases that can affect many sides of people's life and are due to a lot of risk factors. According to their characteristics, the treatment can be surgical, use of radiation or chemotherapy. The use of a surgical treatment can lead to surgical infections that are a main theme in medicine. At the University hospital of Naples “Federico II”, two antibiotics were employed to tackle the issue of the infections and they are compared in this paper to find which one implies the lowest length of hospital stay (LOS) and the reduction of infections.Design/methodology/approachThe Six Sigma methodology and its problem-solving strategy DMAIC (define, measure, analyse, improve, control), already employed in the healthcare sector, were used as a tool of a health technology assessment between two drugs. In this paper the DMAIC roadmap is used to compare the Ceftriaxone (administered to a group of 48 patients) and the association of Cefazolin plus Clindamycin (administered to a group of 45 patients).FindingsThe results show that the LOS of patients treated with Ceftriaxone is lower than those who were treated with the association of Cefazolin plus Clindamycin, the difference is about 41%. Moreover, a lower number of complications and infections was found in patients who received Ceftriaxone. Finally, a greater number of antibiotic shifts was needed by patients treated with Cefazolin plus Clindamycin.Research limitations/implicationsWhile the paper enhances clearly the advantages for patients' outcomes regarding the LOS and the number of complications, it did not analyse the costs of the two antibiotics.Practical implicationsEmploying the Ceftriaxone would allow the Department of Maxillofacial Surgery to obtain lower LOS and a limited number of complications/infections for recovered patients, consequently reducing the hospitalization costs.Originality/valueThere is a double value in this paper: first of all, the comparison between the two antibiotics gives an answer to one of the main issues in medicine that is the reduction of hospital-acquired infections; secondly, the Six Sigma through its DMAIC cycle can be employed also to compare two biomedical technologies as a tool of health technology assessment studies.

Static overlays for pressure ulcer prevention: a hospital-based health technology assessment

2020 ◽  
Vol 29 (12) ◽  
pp. S24-S28
Author(s):  
Mette Boeg Horup ◽  
Knaerke Soegaard ◽  
Tue Kjølhede ◽  
Aase Fremmelevholm ◽  
Kristian Kidholm
Keyword(s):  
Health Technology Assessment ◽  
Technology Assessment ◽  
Health Technology ◽  
University Hospital ◽  
Focus Group Interviews ◽  
Pressure Ulcer Prevention ◽  
Before And After ◽  
Group Interviews ◽  
Support Surfaces ◽  
Selection Of

Introduction: At Odense University Hospital (OUH) alternating-air mattresses (AAM) are used in the prevention of pressure ulcers (PU); however, static overlays might be more effective and have lower costs. To investigate the properties and consequences of using static overlays for prevention of PU at OUH, a hospital-based health technology assessment (HTA) was conducted. Methods: Two types of static overlays were tested in an observational study and compared with AAM for patients with a medium–high risk of PU in geriatric and orthopaedic wards at OUH. Incidence of PU was investigated 7 months before (n=720) and 6 months after implementation (n=837). Staff attitudes were examined in a questionnaire survey (n=55) and focus group interviews (n=13). Patients who had tried one of the overlays and the AAM were interviewed (n=12). Results: No statistical difference in PU incidence was found before and after the implementation of overlays (2.5% before, 2.7% after, P=0.874, n=1557) and no patients lying on overlays developed PU (n=123). Staff had mixed attitudes, but the majority preferred having overlays as an option for their patients. Interviewed patients preferred overlays due to less noise and improved mobility. Conclusion: Both types of overlay are effective in PU prevention. However, overlays introduce challenges for staff and clear guidelines for the selection of support surfaces are needed. Overall, it is recommended that static overlays are considered as an alternative to AAM for PU prevention.

scholarly journals Hospital Based Health Technology Assessment: an example from Siena

2015 ◽  
Vol 16 (1) ◽  
pp. 7-13
Author(s):  
Pietro Manzi ◽  
Pietro Barberini ◽  
Fabrizio Dori
Keyword(s):  
Health Technology Assessment ◽  
Technology Assessment ◽  
Ethical Issues ◽  
Social Economic ◽  
Health Technology ◽  
University Hospital ◽  
Evidence Based ◽  
Assessment Methodology ◽  
Healthcare Decision ◽  
Healthcare Decision Making

The Health Technology Assessment (HTA) has emerged in recent years as a useful tool in healthcare decision-making. It is a multidisciplinary process that summarizes information about the medical, social, economic and ethical issues related to the use of a health technology and provides evidence-based information on how to allocate resources. The experience of Siena University Hospital is an example of multidisciplinary hospital-based HTA. In the present paper we summarize the organization of HTA commission and the assessment methodology of the purchase, rental or sale of medical equipment and medical devices. Furthermore we illustrate the data concerning the commission activities in 2013.

Versorgungsforschung in der Klinischen Neuropsychologie – eine Standortbestimmung

2008 ◽  
Vol 19 (4) ◽  
pp. 253-269 ◽  
Author(s):  
Sabine Heel ◽  
Sonja Fischer ◽  
Stefan Fischer ◽  
Tobias Grässer ◽  
Ellen Hämmerling ◽  
...  
Keyword(s):  
Health Technology Assessment ◽  
Technology Assessment ◽  
Health Technology ◽  
Empirische Forschung

Zunächst führt dieser Artikel in die wesentlichen Begrifflichkeiten und Zielstellungen der Versorgungsforschung ein. Er befasst sich dann mit der Frage, wie die einzelnen Teildisziplinen der Versorgungsforschung, (1) die Bedarfsforschung, (2) die Inanspruchnahmeforschung, (3) die Organisationsforschung, (4) das Health Technology Assessment, (5) die Versorgungsökonomie, (6) die Qualitätsforschung und zuletzt (7) die Versorgungsepidemiologie konzeptionell zu fassen sind, und wie sie für neuropsychologische Anliegen ausformuliert werden müssen. In diesem Zusammenhang werden die in den einzelnen Bereichen jeweils vorliegenden versorgungsrelevanten Studienergebnisse referiert. Soweit es zulässig ist, werden Bedarfe für die Versorgungsforschung und Versorgungspraxis in der Neurorehabilitation daraus abgeleitet und Anregungen für die weitere empirische Forschung formuliert. Der Artikel bezieht sich – entsprechend seines Anliegens – ausschließlich auf Studien, die sich mit der Situation der deutschen Neurorehabilitation befassen.

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