The development of a HTA guideline forhospitals in cross-border regions –results from Work Package 5 of Euregio IISaskia K...
Border regions and cross-border care• Cross-border regions: two or more bordering  countries or regions (where healthcare ...
HTA in hospitals or local level• Growing use of HTA on national level• Several guidelines for HTA at hospitals, e.g.  Cana...
Requirements for HTA guideline forcross-border regions• For hospitals and other local healthcare institutions• Inclusion o...
Development of the guidelineSeveral steps:  1. Literature review  2. Interviewing local decision makers in cross-     bord...
Description of guidelineAim: to support healthcare professionals who areworking in healthcare institutions in cross-border...
Testing guideline using case studies• Two different case studies both in hospital setting• Analysing applicability in real...
Selection of case studies• Consent for carrying out case studies from board of  directors of both hospitals• Meeting with ...
Case study 1: Nuclear Medicine• Shared head of department for both hospitals• Number of investments in equipment and facil...
Case study 2: Neurosurgery• Deep Brain Stimulation (DBS)• Experienced neurosurgeons at MUMC+, but no  neurosurgeon availab...
Experiences with guideline• General questions (section 1)   – Questions good to answer   – Description of current situatio...
Adjustments to guideline• Questions deleted   – Questions combined into one question due to     large overlap• Rephrasing ...
Conclusion• Increasing cross-border cooperation in healthcare• Increased use of HTA to support decision making at  local l...
EUREGIO II partners•   Maastricht University, Dep. of International Health (The Netherlands) (project leader)•   Gesundhei...
On behalf of all authors and everyone involved:Saskia Knies1, 2, Gloria Lombardi3, Matt Commers1, Hans-Peter Dauben4,Silvi...
Thank you for your attention   This presentation arises from the project     “Solutions for improving health care cooperat...
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The development of a HTA guideline for hospitals in cross-border regions – results from Work Package 5 of Euregio II

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The development of a HTA guideline for
hospitals in cross-border regions –
results from Work Package 5 of Euregio II

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The development of a HTA guideline for hospitals in cross-border regions – results from Work Package 5 of Euregio II

  1. 1. The development of a HTA guideline forhospitals in cross-border regions –results from Work Package 5 of Euregio IISaskia Knies PhDDepartment of International Health &Department of Health Services ResearchMaastricht University
  2. 2. Border regions and cross-border care• Cross-border regions: two or more bordering countries or regions (where healthcare is arranged at regional level)• Patients seeking healthcare abroad – E.g. waiting lists, perceived quality of care, costs of care, treatment available, strategic purchasing by healthcare insurers/providers• Hospital across border sometimes closer by than in home country• Strong cooperation in some euregios (regions with bordering European countries)Department
  3. 3. HTA in hospitals or local level• Growing use of HTA on national level• Several guidelines for HTA at hospitals, e.g. Canada, Denmark and Sweden• No HTA guideline for multiple countries or border regions• Why needed: support decision making process while taking border region into account• Main advantage: takes less time to complete than national HTA studyDepartment
  4. 4. Requirements for HTA guideline forcross-border regions• For hospitals and other local healthcare institutions• Inclusion of all elements of a HTA• Target audience: healthcare professionals• Simple to use with clear questions• Should not take too much time to complete• Taking cross-border situation into accountDepartment
  5. 5. Development of the guidelineSeveral steps: 1. Literature review 2. Interviewing local decision makers in cross- border settings 3. Expert workshop in May 2010 4. Adjustments to mini-HTA guideline of DACEHTA a. Divided into three sections b. Questions deleted or rephrased c. More sub-headings d. Added questionsDepartment
  6. 6. Description of guidelineAim: to support healthcare professionals who areworking in healthcare institutions in cross-bordersettingsThree sections: 1. General questions for all institutions 2. For healthcare institutions without any interaction with another healthcare institution across the border 3. For healthcare institutions situated on two sides of a border that are willing to cooperateDepartment
  7. 7. Testing guideline using case studies• Two different case studies both in hospital setting• Analysing applicability in real framework• Identifying missing topics in guideline• Case studies at university hospitals of Maastricht (MUMC+) and Aachen (UKA)• Hospitals work closely together: – Mostly top-clinical fields – Share various activities and personnelDepartment
  8. 8. Selection of case studies• Consent for carrying out case studies from board of directors of both hospitals• Meeting with policy advisors on cross-border cooperation of both hospitals• Several cross-border projects going on• Different types of decision problems selected – Case study 1: mutual investments in departments – Case study 2: reimbursement and legal issuesDepartment
  9. 9. Case study 1: Nuclear Medicine• Shared head of department for both hospitals• Number of investments in equipment and facilities requested to support further cooperation• Investments will increase clinical and research options for departments• Substantial investments needed• Considerations not only related to costs• Outcome: shared investments of two hospitals will benefit both hospitalsDepartment
  10. 10. Case study 2: Neurosurgery• Deep Brain Stimulation (DBS)• Experienced neurosurgeons at MUMC+, but no neurosurgeon available at UKA• Two questions: – Possibility of operating Dutch patient in Germany, because treatment is not reimbursement in Netherlands – Operating Dutch and German patients in either MUMC+ or UKA depending on complexity of surgery• Number of legal and reimbursement issuesDepartment
  11. 11. Experiences with guideline• General questions (section 1) – Questions good to answer – Description of current situation and nature of request• Cooperating hospitals (section 3) – Questions more complicated – Financial modelling for case study 1 needed additional questions as not extensively included in guideline• Sometimes limited information available• When is a question relevant or sufficiently answered Department
  12. 12. Adjustments to guideline• Questions deleted – Questions combined into one question due to large overlap• Rephrasing questions – Questions not clear and therefore difficult to interpret• Topics or questions added – Questions from legal domain EUnetHTA Core model – Economics questionsDepartment
  13. 13. Conclusion• Increasing cross-border cooperation in healthcare• Increased use of HTA to support decision making at local level• First HTA guideline focusing on cross-border regions• Taking differences into account between countries – Reimbursement – Legal issues – Expectations and preferences of patientsDepartment
  14. 14. EUREGIO II partners• Maastricht University, Dep. of International Health (The Netherlands) (project leader)• Gesundheitsamt Kreis Heinsberg (Heinsberg, Germany)• Euregio Rhein-Waal (ERW) (Kleve, Germany)• Gesundheitsmanagement Burger-Wieland (Vienna, Austria)• European Hospital and Healthcare Federation (HOPE) (Brussels, Belgium)• Association of European Border Regions (AEBR) (Gronau, Germany)• Landesinstitut für Gesundheit und Arbeit NRW (Düsseldorf/Bielefeld/Münster, Germany)• Deutsches Institut für Medizin Dokumentation und Information (DIMDI) (Köln, Germany)• ECORYS Research Rotterdam (Rotterdam, The Netherlands)• WHO Regional Office for Europe (Copenhagen, Denmark)• Regione del Veneto, International Health Social Affaire Office Venice (Venice, Italy)• Cooperation and Working Together (CAWT) (Londonderry, Ireland)• Medical University Sofia, Faculty of Public Health (Sofia, Bulgaria)• Center for Health Policies and Services (Bucharest, Romania)Department
  15. 15. On behalf of all authors and everyone involved:Saskia Knies1, 2, Gloria Lombardi3, Matt Commers1, Hans-Peter Dauben4,Silvia Evers2, Kai Michelsen1, Wija Oortwijn5, Chibuzo Opara1, HelmutBrand1Affiliations1.Department of International Health, Maastricht University, Maastricht,the Netherlands2.Department of Health Services Research, Maastricht University,Maastricht, the Netherlands3.HOPE – European Hospital and Healthcare Federation, Brussels,Belgium4.DIMDI - Deutsches Institut für Medizinische Dokumentation undInformation, Cologne, Germany5.ECORYS Nederland B.V., Rotterdam, the NetherlandsDepartment
  16. 16. Thank you for your attention This presentation arises from the project “Solutions for improving health care cooperation in border regions” (EUREGIO II)which has received funding from the European Union, in the framework of the Public HealthProgramme (Grant Agreement No. 2007118).Department

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