scholarly journals Translating evidence into practice: a longitudinal qualitative exploration of allied health decision-making

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Jennifer White ◽  
◽  
Kellie Grant ◽  
Mitchell Sarkies ◽  
Terrence Haines
Keyword(s):  
Decision Making ◽  
Resource Allocation ◽  
Allied Health ◽  
Health Resource ◽  
Health Resource Allocation ◽  
Randomized Controlled ◽  
Group 2 ◽  
Allocation Decisions ◽  
Resource Allocation Decisions ◽  
Health Managers

Abstract Background Health policy and management decisions rarely reflect research evidence. As part of a broader randomized controlled study exploring implementation science strategies we examined how allied health managers respond to two distinct recommendations and the evidence that supports them. Methods A qualitative study nested in a larger randomized controlled trial. Allied health managers across Australia and New Zealand who were responsible for weekend allied health resource allocation decisions towards the provision of inpatient service to acute general medical and surgical wards, and subacute rehabilitation wards were eligible for inclusion. Consenting participants were randomized to (1) control group or (2) implementation group 1, which received an evidence-based policy recommendation document guiding weekend allied health resource allocation decisions, or (3) implementation group 2, which received the same policy recommendation document guiding weekend allied health resource allocation decisions with support from a knowledge broker. As part of the trial, serial focus groups were conducted with a sample of over 80 allied health managers recruited to implementation group 2 only. A total 17 health services participated in serial focus groups according to their allocated randomization wave, over a 12-month study period. The primary outcome was participant perceptions and data were analysed using an inductive thematic approach with constant comparison. Thematic saturation was achieved. Results Five key themes emerged: (1) Local data is more influential than external evidence; (2) How good is the evidence and does it apply to us? (3) It is difficult to change things; (4) Historically that is how we have done things; and (5) What if we get complaints? Conclusions This study explored implementation of strategies to bridge gaps in evidence-informed decision-making. Results provide insight into barriers, which prevent the implementation of evidence-based practice from fully and successfully occurring, such as attitudes towards evidence, limited skills in critical appraisal, and lack of authority to promote change. In addition, strategies are needed to manage the risk of confirmation biases in decision-making processes. Trial registration This trial is registered with the Australian New Zealand Clinical Trials Registry (ANZCTR) (ACTRN12618000029291). Universal Trial Number (UTN): U1111-1205-2621.

scholarly journals Translating evidence into practice: A longitudinal qualitative exploration of allied health decision making.

2020 ◽  
Author(s):  
Jennifer White ◽  
Kellie Grant ◽  
Mitchell Sarkies ◽  
Terrence Haines
Keyword(s):  
Decision Making ◽  
Resource Allocation ◽  
Focus Groups ◽  
Allied Health ◽  
Policy Recommendation ◽  
Health Resource ◽  
Health Resource Allocation ◽  
Allocation Decisions ◽  
Resource Allocation Decisions ◽  
Health Managers

Abstract BackgroundHealth policy and management decisions rarely reflect research evidence. In response, it is important to determine how to improve evidence-informed decision-making. As part of a broader study exploring implementation science strategies we examined how allied health managers respond to two distinct recommendations and the evidence that supports them. MethodsAllied health managers across Australia and New Zealand who were responsible for weekend allied health resource allocation decisions towards the provision of inpatient service to acute general medical and surgical wards, and sub-acute rehabilitation wards were eligible for inclusion. Consenting participants were randomised to: (1) control group or; (2) Implementation Group 1: received an evidence-based policy recommendation document guiding weekend allied health resource allocation decisions, or (3) Implementation Group 2: received the same policy recommendation document guiding weekend allied health resource allocation decisions with support from a knowledge broker. Serial focus groups were conducted with a sample of over 80 allied health managers recruited to Implementation Group 2 only. Out of 6 waves of recruitment, up to four focus groups were conducted with each wave during the 12 months study period. In total 17 health services participated in serial focus groups according to their allocated wave, over a 12-month study period. Data were analysed using an inductive thematic approach with constant comparison. Thematic saturation was achieved.ResultsResults provide insights into resource allocation and decision-making, including the interplay between barriers and facilitators concerning implementation of recommendations outlined in evidence-based policy recommendation document. Five key themes emerged: (1) Local data trumps, or is more influential; (2) How good is the evidence and does it apply to us; (3) It is difficult to change things; (4) Historically that’s how we have done things; and (5) What if we get complaints?ConclusionsThis study explored implementation of strategies to bridge gaps in evidence-informed decision-making. Results provide insight into barriers, which prevent the implementation of evidence base practice from fully, and successfully occurring such as attitudes towards evidence, limited skills in critical appraisal, and lack of authority to promote change. In addition, strategies are needed to manage the risk of confirmation biases in decision-making processes.

Criteria Used for Priority-Setting for Public Health Resource Allocation in Low- and Middle-Income Countries: A Systematic Review

2019 ◽  
Vol 35 (6) ◽  
pp. 474-483 ◽  
Author(s):  
Gunjeet Kaur ◽  
Shankar Prinja ◽  
P.V.M. Lakshmi ◽  
Laura Downey ◽  
Deepshikha Sharma ◽  
...  
Keyword(s):  
Public Health ◽  
Systematic Review ◽  
Resource Allocation ◽  
Priority Setting ◽  
Health Resource ◽  
Middle Income ◽  
Middle Income Countries ◽  
Health Resource Allocation ◽  
Allocation Decisions ◽  
Resource Allocation Decisions

AbstractObjectivesThis systematic review aimed to identify criteria being used for priority setting for resource allocation decisions in low- and middle-income countries (LMICs). Furthermore, the included studies were analyzed from a policy perspective to understand priority setting processes in these countries.MethodsSearches were carried out in PubMed, Embase, Econlit, and Cochrane databases, supplemented with pre-identified Web sites and bibliographic searches of relevant papers. Quality appraisal of included studies was undertaken. The review protocol is registered in International Prospective Register of Systematic Reviews PROSPERO CRD42017068371.ResultsOf 16,412 records screened by title and abstract, 112 papers were identified for full text screening and 44 studies were included in the final analysis. At an overall level, cost-effectiveness 52 percent (n = 22) and health benefits 45 percent (n = 19) were the most cited criteria used for priority setting for public health resource allocation. Inter-region (LMICs) and between various approaches (like health technology assessment, multi-criteria decision analysis (MCDA), accountability for reasonableness (AFR) variations among criteria were also noted. Our review found that MCDA approach was more frequently used in upper middle-income countries and AFR in lower-income countries for priority setting in health. Policy makers were the most frequently consulted stakeholders in all regions.Conclusions and RecommendationsPriority-setting criteria for health resource allocation decisions in LMICs largely comprised of cost-effectiveness and health benefits criteria at overall level. Other criteria like legal and regulatory framework conducive for implementation, fairness/ethics, and political considerations were infrequently reported and should be considered.

scholarly journals Application of A Framework to Guide Policy on Healthcare Resource Allocation Decisions to Data Linkage Projects

2020 ◽  
Vol 5 (5) ◽  
Author(s):  
Ian Olver
Keyword(s):  
Resource Allocation ◽  
Data Linkage ◽  
Health Data ◽  
Decision Makers ◽  
Data Sets ◽  
Policy Decisions ◽  
The Public ◽  
Health Resource Allocation ◽  
Allocation Decisions ◽  
Resource Allocation Decisions

IntroductionData linkage of population data sets often across jurisdictions or linking health data sets or health data with non-health data often involves balancing ethical principles such as privacy with beneficence as represented by the public good. Similar ethical dilemmas occur in health resource allocation decisions. The NHMRC have published a framework to guide policy on health resource allocation decisions that could be applied to ensure the justification of data linkage projects that is defensible as in the interest of the public good. Objectives and ApproachThe four main conditions for legitimacy of policy decisions about access to healthcare in a democracy with a public health system and limited resources wereexamined for their relevance to decisions about the use of public data and linking data sets. ResultsPublic policy decisions must be defensible and responsive to the interests of those affected. Decision-makers should articulate their reasoning and recommendations so that citizens can judge them. While the context of policy decisions will differ, their legitimacy depends upon (1) the transparency of the reasoning which should be free from conflicts of interest, the basis for decisions recorded and report widely, (2) the accountability of the decision-makers to the wider community, (3) the testability of the evidence used to inform the decision-making, which usually means that it will stand up to independent review and(4) the inclusive recognition of those the decision affects which often requires that the implications for disadvantaged groups are considered, even if they can’t always be accommodated. These conditions are interrelated but ensure that the good of society in general and not just specific dominant groups are accommodated. Conclusion / ImplicationsIt these principles are applied to decisions about data linkage projects they have clear applicability in society accepting data linkage projects having balanced the good against the ethical risks involved.

Resource allocation and economic evaluation in Australia's healthcare system

2011 ◽  
Vol 35 (3) ◽  
pp. 278 ◽  
Author(s):  
Abdolvahab Baghbanian ◽  
Ian Hughes ◽  
Freidoon A. Khavarpour
Keyword(s):  
Decision Making ◽  
Resource Allocation ◽  
Economic Evaluation ◽  
Cost Effectiveness ◽  
Decision Makers ◽  
Economic Evaluations ◽  
Healthcare Decision ◽  
Effectiveness Analysis ◽  
Allocation Decisions ◽  
Resource Allocation Decisions

Objective. To explore dimensions and varieties of economic evaluations that healthcare decision-makers do or do not use. Design. Web-based survey. Setting and participants. A purposive sample of Australian healthcare decision-makers was recruited by direct invitation through email. All were invited to complete an online questionnaire derived from the EUROMET 2004 survey. Results. A total of 91 questionnaires were analysed. Almost all participants were involved in financial resource allocations. Most commonly, participants based their decisions on patient needs, effectiveness of interventions, cost of interventions or overall budgetary effect, and policy directives. Evidence from cost-effectiveness analysis was used by half of the participants. Timing, ethical issues and lack of knowledge about economic evaluation were the most significant barriers to the use of economic evaluations in resource allocation decisions. Most participants reported being moderately to very familiar with the cost-effectiveness analysis. There was a general impression that evidence from economic evaluations should play a larger role in the future. Conclusions. Evidence from health economic evaluations may provide valuable information in some decisions; however, at present, it is not central to many decisions. The study suggests that, for economic evaluation to be helpful in real-life policy decisions, it has to be placed into context – a context which is complex, political and often resistant to voluntary change. What is known about the topic? There are increasing calls for the use of evidence from formal economic evaluations to improve the quality of healthcare decision making; however, it is widely acknowledged that such evidence, as presently constituted, is underused in its influence on allocation decisions. What does this paper add? This study highlights that resource allocation decisions cannot be purely based on the use of technical, economic data or systematic evidence-based reviews. In order to exploit the full potential value of economic evaluations, researchers need to make better sense of decision contexts at specific times and places. What are the implications for practitioners? The study has the potential to expand researchers and policy-makers’ understanding of the limited use of economic evaluation in decision-making. It produces evidence that decision-making in Australia’s healthcare system is not or cannot be a fully rational bounded process. Economic evaluation is used in some contexts, where information is accurate, complete and available.

scholarly journals What Factors Do Allied Health Take Into Account When Making Resource Allocation Decisions?

2017 ◽  
Vol 7 (5) ◽  
pp. 412-420 ◽  
Author(s):  
Haylee Lane ◽  
Tamica Sturgess ◽  
Kathleen Philip ◽  
Donna Markham ◽  
Jennifer Martin ◽  
...  
Keyword(s):  
Resource Allocation ◽  
Allied Health ◽  
Allocation Decisions ◽  
Resource Allocation Decisions

CASE STUDIES THAT ILLUSTRATE DISINVESTMENT AND RESOURCE ALLOCATION DECISION-MAKING PROCESSES IN HEALTH CARE: A SYSTEMATIC REVIEW

2013 ◽  
Vol 29 (2) ◽  
pp. 174-184 ◽  
Author(s):  
Julie Polisena ◽  
Tammy Clifford ◽  
Adam G. Elshaug ◽  
Craig Mitton ◽  
Erin Russell ◽  
...  
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Resource Allocation ◽  
Case Studies ◽  
Resource Allocation Decision ◽  
Cochrane Library ◽  
Fee For Service ◽  
Allocation Decision ◽  
Allocation Decisions ◽  
Resource Allocation Decisions

Objective:Technological change accounts for approximately 25 percent of health expenditure growth. To date, limited research has been published on case studies of disinvestment and resource allocation decision making in clinical practice. Our research objective is to systematically review and catalogue the application of frameworks and tools for disinvestment and resource allocation decision making in health care.Methods:An electronic literature search was executed for studies on disinvestment, obsolete and ineffective technologies, and priority healthcare setting, published from January 1990 until January 2012. Databases searched were MEDLINE, MEDLINE In-Process and Other Non-Indexed Citations, Embase, The Cochrane Library, PubMed, and HEED.Results:Fourteen case studies on the application of frameworks and tools for disinvestment and resource allocation decisions were included. Most studies described the application of program budgeting and marginal analysis (PBMA), and two reports used health technology assessment (HTA) methods for coverage decisions in a national fee-for-service structure. Numerous healthcare technologies and services were covered across the studies. We describe the multiple criteria considered for decision making, and the strengths and limitations of these frameworks and tools are highlighted.Conclusions:Disinvestment and resource allocation decisions require evidence to ensure their transparency and objectivity. PBMA was used to assess resource allocation of health services and technologies in a fixed budget jurisdiction, while HTA reviews focused on specific technologies, principally in fee-for-service structures. Future research can review the data requirements and explore opportunities to increase the quantity of available evidence for disinvestment and resource allocation decisions.

scholarly journals Randomized distributed access to mutually exclusive resources

2005 ◽  
Vol 2005 (1) ◽  
pp. 1-18 ◽  
Author(s):  
Moshe Dror ◽  
Bruce Hartman ◽  
Gary Knotts ◽  
Daniel Zeng
Keyword(s):  
Decision Making ◽  
Resource Allocation ◽  
Access To Resources ◽  
Computational Overhead ◽  
Multiagent Resource Allocation ◽  
Decentralized Decision Making ◽  
Resource Requirements ◽  
Allocation Decisions ◽  
Resource Allocation Decisions

Many systems consist of a set of agents which must acquire exclusive access to resources from a shared pool. Coordination of agents in such systems is often implemented in the form of a centralized mechanism. The intervention of this type of mechanism, however, typically introduces significant computational overhead and reduces the amount of concurrent activity. Alternatives to centralized mechanisms exist, but they generally suffer from the need for extensive interagent communication. In this paper, we develop a randomized approach to make multiagent resource-allocation decisions with the objective of maximizing expected concurrency measured by the number of the active agents. This approach does not assume a centralized mechanism and has no need for interagent communication. Compared to existing autonomous-decentralized-decision-making (ADDM)-based approaches for resource-allocation, our work emphasizes achieving the highest degree of agent autonomy and is able to handle more general resource requirements.

EVALUATION CRITERIA OF PATIENT AND PUBLIC INVOLVEMENT IN RESOURCE ALLOCATION DECISIONS: A LITERATURE REVIEW AND QUALITATIVE STUDY

2017 ◽  
Vol 33 (2) ◽  
pp. 270-278 ◽  
Author(s):  
Zahava R.S. Rosenberg-Yunger ◽  
Ahmed M. Bayoumi
Keyword(s):  
Decision Making ◽  
Resource Allocation ◽  
Literature Review ◽  
Public Involvement ◽  
Stakeholder Involvement ◽  
Evaluation Criteria ◽  
Patient And Public Involvement ◽  
Noticeable Effect ◽  
Allocation Decisions ◽  
Resource Allocation Decisions

Objectives: We developed specific evaluation criteria to assess patient and public involvement in resource allocation decisions in health care.Methods: We reviewed the literature from health and other sectors relevant to stakeholder involvement and conducted twenty-seven key informant interviews with stakeholders knowledgeable about patient and public involvement in Canadian drug resource allocation decisions. We used an inductive qualitative thematic approach to analyze the interviews with codes and categories developed directly from individuals’ interview transcripts.Results: Integrating respondents’ comments and the literature review, we identified nine evaluation criteria of patient and the public involvement in healthcare resource allocation decision making: clarity regarding rationale and roles of patient and public members, sufficient support, adequate representation of relevant views, fair decision-making processes, legitimacy of committee processes, adequate opportunity for participation, meaningful degree of participation, noticeable effect on decisions, and considerations of the efficiency of patient and public involvement.Conclusions: Our results will help to develop methods to evaluate patient and public involvement in healthcare decision making.

How Do Allied Health Professionals Define and Apply Equity When Making Resource Allocation Decisions?

2018 ◽  
Vol 48 (2) ◽  
pp. 349-364
Author(s):  
Haylee Lane ◽  
Tamica Sturgess ◽  
Kathleen Philip ◽  
Donna Markham ◽  
Jill Walsh ◽  
...  
Keyword(s):  
Resource Allocation ◽  
Thematic Analysis ◽  
Health Professionals ◽  
Allied Health ◽  
Real Life ◽  
Working Party ◽  
Ethnographic Study ◽  
Allied Health Professionals ◽  
Allocation Decisions ◽  
Resource Allocation Decisions

An ethnographic study was conducted in 2 stages to understand how allied health professionals define and apply equity when making resource allocation decisions. Participants were allied health managers and clinicians from Victoria, Australia. Stage 1 included 4 semi-structured forums that incorporated real-life case studies, group discussions, and hypothetical scenarios. The project’s steering committee began a thematic analysis during post-forum discussions. Stage 2 included a key stakeholder working party that further discussed the concept of equity. The forum recordings were transcribed verbatim, and a detailed thematic analysis ensured the initial thematic analysis was complete. Several domains of equity were discussed. Participants would readily identify that equity was a consideration when making resource decisions but were generally silent for a prolonged period when prompted to identify what they meant when using this term. The findings indicate that asking allied health professionals to directly state how they define and apply equity to their decision-making could be too difficult a task, as this did not elicit rich and meaningful discussions. Future research should examine individual domains of equity when applied to resource allocation decisions.

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