The ISOR Project

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The ISOR Project

No health without research.
And no research without evaluation
Panel Session - HTAi 2012, Bilbao

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The ISOR Project

  1. 1. The ISOR Project No health without research. And no research without evaluation Panel Session - HTAi 2012, Bilbao Maite Solans-DomènechCatalan Agency for Health Information, Assessment and Quality (CAHIAQ)
  2. 2. Outline of the presentation1. CAHIAQ call in clinical and health services research2. The ISOR project3. Impact on informing decision-making
  3. 3. Outline of the presentation1. CAHIAQ call in clinical and health services research2. The ISOR project3. Impact on informing decision-making
  4. 4. Call in clinical and health servicesresearch• Mission: to fill local knowledge gaps and inform clinical and healthcare decision-makers• Research topic identification and priority-setting designed and implemented to ensure that the knowledge gaps of decision makers are addressed• Ex-ante, ongoing and ex-post evaluations (13 years experience)• There is a scientific committee that monitors the whole process.• Predominance of oriented research with local relevance and informing local decision-making• 7 calls from 1996 to 2008
  5. 5. Call in clinical and health servicesresearch Prioritised Funded projects Amount granted Average Euros/ Call topics N (€) project 1996 15 18 510,860.0 28,381.1 1998 20 19 540,911.0 28,469.0 2000 30 25 841,417.0 33,656.7 2002 35 25 841,417.0 33,656.7 2004 30 22 1.021,721.5 46,441.9 2006 29 18 1.021,721.5 56,762.3 2008 20 14 1,021,214.0 72,943.9 TOTAL 179 141 5,779,261.0 37,622.4
  6. 6. Outline of the presentation1. CAHIAQ call in clinical and health services research2. The ISOR project3. Impact on informing decision-making
  7. 7. Closing the assessment cycle:The ISOR ProjectObjectives: To carry on the evaluation of the impact of research funded by CAHIAQ (accountability) To develop a methodology and/or tool for the assessment of research projects (transfer methods and capacity-building) To contribute to the spreading of these assessment practices beyond CAHIAQ (advocacy)
  8. 8. Closing the assessment cycle:The ISOR ProjectAdoption of the Canadian CAHS-ROI model: Useful common framework for any different type of health research (from basic research to health services) Useful for any stakeholder’s view (from funder to evaluator) Provides a set of generic indicators in the five impact levels: − Advancing knowledge − Capacity building − Informing decision-making − Health benefits − Broad economic and social impacts
  9. 9. Closing the assessment cycle: The ISOR Project Initiation and Diffusion of Health Research Impact Health industry Global Research Healthcare Appropriateness, Improvements in Health Other industries Access, etc. and Well-being Interactions/ ollaborations Research Results Knowledge Pool Health Catalan Health Prevention and Status, Research Treatment Government Function, /Feedbac k Well-being, • Clinical C • Health Services Research Agenda Economic and Social Economic • Population and Prosperity conditions Public Health Int erac cions Determinants of Health Public Information, Groups Research capacity Impacts feed back into inputs for future research PAYBACK Topic identification Primmary Secondary Inputs Outputs Adoption Final OutcomesFRAMEWORK Outputs Process Dissemination Advancing Knowledge Informing Decision Making Economic Benefits Capacity Building Health Benefits Canadian Academy of Health Science. Return on Investment framework 2009
  10. 10. Outline of the presentation1. CAHIAQ call in clinical and health services research2. The ISOR project3. Impact on informing decision-making
  11. 11. Impact on informing decision-makingBottom-up assessment of CAHIAQ Calls Descriptive [based on questionnaires to 70 PI] Case study (respiratory disease research) [based on semi-structured interviews to 8 decision- makers and 15 researchers related to 6 projects]
  12. 12. Impact on informing decision-making Questions to PI (n=70) n (%)Types of changes carried out in practice based 60% PI: (n=40)on the research outcomes• Clinical 29 (58.0) Real changes• Organizational - 12 (24.0) Clinical and/or centre/institution organizational• Patient´s behaviour 5 (10.0) setting.• Public Health management 2 (4.0)• Legal/regulations 2 (4.0)Unknown / No changes in practice. 28 (40.0)Stakeholders or recipients who have used or 70% (n=46)taken into account the research outcomes• Managers and planners 24 (41.4) • Stakeholders in• Clinical professionals 17 (29.3) clinical and health• Investigators/researchers 12 (20.7) services• Scientific Societies 5 (8.6)Not taken into account/ unknown 13 (18.6) • Scientific community • Scientific societies.
  13. 13. Impact on informing decision-making … some “good stories”: “Yes, it has all generated a “After two years ... it [home-based culture... We are essentially a hospitalization] grew as a real clean unit…” service and an integrated care cross- sectional unit was created within the hospital” Almost all projects have induced or may have induced changes in clinical practice or in the organization of health services Changes  Direct / indirect  Contribute to a complex change in clinical practice or healthcare organization
  14. 14. Impact on informing decision-making Scientific publications: scientific articles, communications in congresses Direct transmission to potential users: clinical sessions, … Unconventional or poorly studied ways for the knowledge transfer  Scientific societies - as authoritative sources  Connection between managers and research teams – direct/indirect participation and collaboration The channels used to transfer new knowledge into clinical practice are complex … dissemination…. “... the participation of hospital and primary care specialists in charge was beneficial [to change]”
  15. 15. Impact on informing decision-making  Structural barriers  Lack of channels for the translation of research  Organizational dynamics  Individual barriers  Personal factors: reluctance to change  Nature of research: gap between researchers and practitioners ...and translation barriers:“Overall, I would say that researchers areforced to take on many roles. I am ready “Because hospital directors changeto be a researcher, but not to make an frequently, or because this issue iselectoral pamphlet. In this regard, I think not deemed to be as important asthe relationship with healthcare policies it should be...”and health plans is not as it should be.”
  16. 16. Impact on informing decision-makingIMPACT Capacity Relevant contribution (few Dissemination in Impact found mainly in intermediate levels prior studies) Scientific Societies Building Contribution to the design Informed care to chronic patients and Forecast of health care hospital management* decision- services to reduce making Identification of modificable admissions risk factors New lines of research Gaps or distances Difficulty to cultural change due to the between potential and patients (learning with the disease)l real impacts Health Prevention in benefits excerbations Overall economic Cost reduction benefit Input Primary Secondary Adoption Final Other impacts PHASE outcome outcome outcome emerged implicitly and not intentionally Project: Risk factors for relapse in COPD
  17. 17. ISOR project: Challenges ‘Ongoing project’ SIRECS Comparability (across countries, research programmes, disciplines, …) Attribution Time-lag Interviewees (researchers, health policy or healthcare decision-makers) interpret narrowly the terms (‘impact’) General context: incipient culture of assessment
  18. 18. Thanks to Paula Adam, Marta Aymerich, Silvina Berra, Imma Guillamón, Gaietà Permanyer-Miralda, Joan MV Pons and Emilia Sánchez for their contribution to CAHIAQ strategy and theISOR project

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