MAST: a model for HTA-basedassessment of telemedicineapplicationsANNA KOTZEVA, on behalf of the MAST Working groupCatalan ...
Contents1. MAST as a multidisciplinary assessment model    Background    Development process    Aim and structure of th...
Background Telemedicine is considered as a possible solution to the  challenges of healthcare systems Critique of existi...
BackgroundPromotion of assessment of telemedicine-based services                  MethoTelemed project (2009)    Aiming to...
Development of MASTComprehensive process                         MAST                    (Manual & Toolkit)
AimMAST can be used when the assessment aims to describeeffectiveness and contribution of telemedicine to qualityof care a...
How does MAST ensure amultidisciplinary assessment?
Structure and elements of MASTThe framework suggests 3 stages of assessment:   I. Preceding considerations   II. Multidisc...
I. Preceding considerations This stage is about “setting the context” Various aspects have to be taken into consideratio...
II. Multidisciplinary assessment     WHAT should be assessed?             1. Health problem and characteristics of the app...
II. Multidisciplinary assessmentHOW it should be assessed? Study design - Aim for highest possible level of evidence Out...
III. Transferability assessment Answers the question:                                       ?Can results be generalized t...
Empirical test of MAST in theRENEWING HEALTH project Project overview Experiences and results so far   Tools to support...
Empirical test of MAST in theRENEWING HEALTH project Project overview Experiences and results so far   Tools to support...
 Funded by the European Community   ICT Policy Support Program, Competitiveness and Innovation Framework Program So far,...
General objective: To produce evidence and decision support for the EU health policies and the regional authorities regard...
Empirical test of MAST in theRENEWING HEALTH project Project overview Experiences and results so far   Tools to support...
Application of MAST in practice stimulates its  further development and improvementA number of tools were developed to sup...
• Clinical study protocols   1        • Minimum dataset of common outcomes   2        • Clinical database and guidance on ...
Training Open seminars     Berlin, May 2010      Introduction to the framework, 80 participants      www.mast-model.info...
Collaboration and users feedback European projects  RENEWING HEALTH http://www.renewinghealth.eu/ (21 trials)            ...
Collaboration and users feedback European regions adopting MAST as a general framework  for telemedicine assessment    N...
In conclusion… Advantages of MAST    Multidisciplinary and very comprehensive    Based on scientific evidence, on crite...
In conclusion… Empirical test of MAST is ongoing (>25 trials use it currently) Based on the results a revision will be m...
Thank you!Anna Kotzevaakotzeva@aatrm.catsalut.catKristian KidholmKristian.Kidholm@ouh.regionsyddanmark.dk     www.renewing...
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MAST: a model for HTA-based assessment of telemedicine applications

  1. 1. MAST: a model for HTA-basedassessment of telemedicineapplicationsANNA KOTZEVA, on behalf of the MAST Working groupCatalan Agency for Health Information, Assessment and Quality, SpainHTAi Annual meeting, June 2012, Bilbao
  2. 2. Contents1. MAST as a multidisciplinary assessment model  Background  Development process  Aim and structure of the model2. Empirical test of MAST in the RENEWING HEALTH project  Project overview  Experiences and results so far3. Conclusions
  3. 3. Background Telemedicine is considered as a possible solution to the challenges of healthcare systems Critique of existing evidence for telemedicine Hailey et al. 2002: Lack of clinical outcomes Whitten et al. 2002: Economic studies do not meet standards Hersh et al. 2006: Few studies are well designed Lack of high quality evidence on the effectiveness oftelemedicine as a main barrier for its wider implementation
  4. 4. BackgroundPromotion of assessment of telemedicine-based services MethoTelemed project (2009) Aiming to provide a structured framework for assessing the effectiveness and contribution to quality of care of telemedicine applications Based on users’ and stakeholders’ needs
  5. 5. Development of MASTComprehensive process MAST (Manual & Toolkit)
  6. 6. AimMAST can be used when the assessment aims to describeeffectiveness and contribution of telemedicine to qualityof care and to produce basis for decision makingAssessment defined as:A multidisciplinary process that summarizes and evaluatesinformation about the clinical, economic, organizational andsocio-ethical issues related to the use of telemedicine, in asystematic, unbiased and robust manner. *based on EUnetHTA Core Model
  7. 7. How does MAST ensure amultidisciplinary assessment?
  8. 8. Structure and elements of MASTThe framework suggests 3 stages of assessment: I. Preceding considerations II. Multidisciplinary Assessment III. Transferability of results
  9. 9. I. Preceding considerations This stage is about “setting the context” Various aspects have to be taken into consideration:  Maturity of the technology  Selection of appropriate comparator/s  Level on which the assessment should be carried out – single hospital, region, state  Number of patients included in the assessment  Existing legislation and reimbursement policy for telemedicine- based services
  10. 10. II. Multidisciplinary assessment WHAT should be assessed? 1. Health problem and characteristics of the application Descriptive 2. Clinical effectivenessDOMAINS 3. Safety Evaluation by outcome 4. Patient perspectives (systematic review OR 5. Economic aspects empirical study) 6. Organisational aspects 7. Socio-cultural, ethical and legal aspects Descriptive
  11. 11. II. Multidisciplinary assessmentHOW it should be assessed? Study design - Aim for highest possible level of evidence Outcome measures should be: • patient-important outcomes • based on scientific literature to enable comparison • validated instruments
  12. 12. III. Transferability assessment Answers the question: ?Can results be generalized to other settings?This consideration has to be made within each of the domains! Examples of limitations for direct transferability of results:  Country-specific reimbursement conditions  Healthcare price/hour  Values and culture influence user preferences and hence, satisfaction with the new service
  13. 13. Empirical test of MAST in theRENEWING HEALTH project Project overview Experiences and results so far  Tools to support study design, reporting & analysis  Training  Close collaboration and feedback from users
  14. 14. Empirical test of MAST in theRENEWING HEALTH project Project overview Experiences and results so far  Tools to support study design, reporting & analysis  Training  Close collaboration and feedback from users
  15. 15.  Funded by the European Community ICT Policy Support Program, Competitiveness and Innovation Framework Program So far, the largest pragmatic RCT in the area of telemedicine DM 7158 patients COPD 3 diseases CVD 84 centers 21 pilots 9 RCTs 9 European regions 10 clusters 1 observ.
  16. 16. General objective: To produce evidence and decision support for the EU health policies and the regional authorities regarding the future deployment of telemedicine services in those fields where these can lead to improved care and reduced cost. RENEWING HEALTH Project is not envisioned to produce scientific evidence on clinical outcomes of telehealth, BUTa broader knowledge on benefits of telemedicine services through a number of multidisciplinary outcomes
  17. 17. Empirical test of MAST in theRENEWING HEALTH project Project overview Experiences and results so far  Tools to support study design, reporting & analysis  Training  Close collaboration and feedback from users
  18. 18. Application of MAST in practice stimulates its further development and improvementA number of tools were developed to support study design, data management, analysis and reporting of results
  19. 19. • Clinical study protocols 1 • Minimum dataset of common outcomes 2 • Clinical database and guidance on coding 3 and monitoring • Guide for analysis and reporting of results 4Ensures quality and comparability of data
  20. 20. Training Open seminars  Berlin, May 2010 Introduction to the framework, 80 participants www.mast-model.info  Treviso, Feb 2012 Guidance on data analysis and reporting of results, 60 participants Dissemination  Kidholm et al. A model for assessment of telemedicine applications - MAST. Int J Tech Ass Health Care, 28:1, Jan 2012  Communications  Website forthcoming!!!
  21. 21. Collaboration and users feedback European projects RENEWING HEALTH http://www.renewinghealth.eu/ (21 trials) http://www.incasa-project.eu/news.php (5 trials) INTEGRATED HOME CARE http://www.integratedhomecare.eu/ Recommended by: British Thoracic Society (statement on respiratory care) National Danish Strategy for Telemedicine
  22. 22. Collaboration and users feedback European regions adopting MAST as a general framework for telemedicine assessment  Norbotten (Sweden)  Veneto (Italy)  Basque country (Spain) Development of a French version MEETIC: Modèle pour lEvaluation (Economique) de la Télémédecine Recherche Clinique Santé Publique, Paris
  23. 23. In conclusion… Advantages of MAST  Multidisciplinary and very comprehensive  Based on scientific evidence, on criteria for quality and on stakeholders’ needs  Establishes a common standard for all stages of study development (design, data collection, analysis and reporting) Limitations of MAST  Time consuming  Only relevant in assessment of mature telemedicine applications  Doesn’t give indications for prioritization when resources are limited  More operational criteria are needed ON THE WAY TO MAST 2
  24. 24. In conclusion… Empirical test of MAST is ongoing (>25 trials use it currently) Based on the results a revision will be made So far MAST has been a useful and comprehensive framework for study design, data collection and assessment, and ensures comparability of results for telemedicine studies in different cultural contexts Based on the validation we hope MAST will be established as the first widely accepted methodology for the evaluation of complex telemedicine interventions
  25. 25. Thank you!Anna Kotzevaakotzeva@aatrm.catsalut.catKristian KidholmKristian.Kidholm@ouh.regionsyddanmark.dk www.renewinghealth.eu
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