Monitoring GARD Initiative -Shanghai Pilot Study on HTA Professor Jie Chen Key Lab of Health Technology Assessment, MOH

Outline提纲 卫生技术评估在GARD行动计划中的作用 三、 Shanghai Pilot Study on QC&HTA 一、 Overview of Health Technology & Assessment( HTA) 卫生技术和卫生技术评估概述 二、 The Role of HTA for GARD* Action Plan 卫生技术评估在GARD行动计划中的作用 三、 Shanghai Pilot Study on QC&HTA QC&HTA的上海试点研究 四、 QCCRM work in Shanghai QCCRM在上海开展的工作 * GARD：Global Alliance Against Chronic Respiratory Diseases 慢性呼吸病防治全球联盟

一、 Overview of Health Technology & Assessment(HTA) 卫生技术和卫生技术评估概述

Health Technology （HT）Definition 卫生技术的定义 Health Technology is considered to include the drugs, devices, medical and surgical procedures used in healthcare delivery, the knowledge associated with this, as well as the organisational and support systems within which such care is provided 卫生技术是指用于医疗保健的药物，仪器设备，内、外科程序及相关的组织管理系统和支持系统的特定的知识体系

Components of HT 卫生技术的组成 Medical Device 医学装置 Drugs 药物 Procedure 程序 Knowledge 知识 Support system 支持系统 Equipment 设备

HTA Definition 定义(1) HTA is a systematical evaluation on property, effects and other impacts of HT 对卫生技术的性质，效果和其他影响进行系统评价 HTA is a comprehensive form of policy research that examines the short- and long-term social consequences of the application or use of technology 对技术应用形成的短期和长期社会影响进行政策研究的 一种综合形式 HTA aims to provide useful information to health policies- making 目的是为卫生技术领域的政策制订提供信息

HTA Definition 定义(2) HTA can foresee the directed, expected outcome of HT, deal with the indirected, unexpected outcome caused by HT 可以预测卫生技术直接带来的效果和间接的意外后果 HTA employs the specific framework and methods 采用独特的分析框架和方法 HTA is performed by multi-discipline collaboration 卫生技术评估由多学科合作来完成

Basic HTA Orientations 基本卫生技术评估导向 • Technology-oriented assessments are intended to determine the characteristics or impacts of particular technologies. 技术导向型的评估 旨在判定特定技术的特征（性质）或影响； • Problem-oriented assessments focus on solutions or strategies for managing a particular problem for which alternative or complementary technologies might be used. 问题导向型的评估 关注处理特定问题的办法或策略，对于该问题可能会使用不 同的备选技术或补充技术； • Project-oriented assessments focus on a local placement or use of a technology in a particular institution, program, or other designated project. 方案导向型的评估 关注特定技术在特定机构、计划或其他指定方 案中的具体应用。

Why HTA is necessary? 卫生技术评估的必要性 Technology as two sides of a coin 技术具有两重性 Advantages利 Technology innovation 技术创新 Improve medical quality 改善医疗质量 Enhance population’s health 提高人群健康 Disadvantages弊 Adverse effects caused by technologies 技术带来的负面后果 Ethic dispute 伦理争论 Excess increase of medical expense 医疗费用过度增长

Why HTA is necessary? 卫生技术评估的必要性 Visibility of new technologies 新技术的广泛使用 High expenditures for health care 医疗费用的不断上涨 Necessity to begin to rationalize health care technology 卫生技术资源优化的要求

Content 技术评估的内容 Technical properties 技术特性 Safety安全性 Efficacy and effectiveness功效和效果 Cost and other economic attributes经济性 Social, legal, ethical, or political impacts 社会、法律、伦理道德和政治影响

A Process for HTA 卫生技术评估的过程 Identification 识别 Testing 研究 Synthesis 综合 Dissemination 传播 Banta, D. Health care technology and its assessment

Two Main Groups of Studies (Methods) 两种主要研究方法 Primary data collection原始资料收集 Collect original new data, for example, using experiments 收集原始的新数据，例如，利用试验数据 Secondary data analyses第二手资料分析 Combine (Synthesize or integrate) data from existing sources 采用已有资料 (综合或者整合)

Secondary Data Analyses 第二手资料分析 Expert opinion专家意见 Group judgment (Consensus development) 团体判断（得出一致意见） Literature review文献评阅 Meta-analysis文献综合分析 Decision analysis, other modeling 决策分析及其他模型

二、The Role of HTA for GARD Action Plan 卫生技术评估在GARD 行动计划中的作用

Goals of GARD 目标 To reduce the global burden of CRDs 降低全球慢性呼吸性疾病负担 To better recognize, prevent and manage CRDs 更好认识，预防和管理慢性呼吸性疾病 To propose an action plan for CRDs, coordinated by the WHO 在WHO的合作下，提出CRDs行动计划 To foster country focused initiatives according to the special needs of each specific country 根据每一国家特殊需要鼓励开展CRDs行动

The Role of HTA for GARD 帮助卫生技术的准入 HTA 在GARD中的作用 To help the admission of Health technology 帮助卫生技术的准入 To the selection of benefit package for health insurance 卫生保险福利计划的选择 To decide the appropriate intervention of clinical practice 决定合适的临床干预方案 To support scientific evidence for policy maker 为卫生政策制定者提供科学证据

三、 Shanghai Pilot Study on QC&HTA QC&HTA上海试点研究

A proposal of practicing GARD in Shanghai The Platform of Quality Control and Health Technology Assessment for Respiratory Medicine in Shanghai 建立上海市呼吸病质量控制和卫生技术评估平台

Objective 目标 To reduce chronic respiratory disease burden降低慢性呼吸疾病负担 - asthma哮喘 - chronic obstructive pulmonary disease 慢性阻塞性肺疾病 - occupational lung disease职业性肺病 - lung cancer肺癌

Background背景(1) The Quality Control Center for Respiratory Medicine (Zhongshan Hospital） 呼吸病质量控制中心（中山医院） - Collecting data for practicing the guidelines 为实践指南收集数据 - Supervising the quality of facilities and human resources of hospitals医院设施及人力资源质量的监管 - Inspecting the hospital performance and quality 医院绩效和质量的检查

Background背景(2) -Communication and collaboration交流与合作 The Key Lab of Health Technology Assessment, MOH in China（Fudan University） 卫生部卫生技术评估重点实验室（复旦大学） -Research 研究 -Training 培训 -Information 信息 -Communication and collaboration交流与合作

The HTA Research Center of Fudan University is an active national and international organization 复旦大学医学技术评估研究中心是一个在国际、国内十分活跃的HTA机构

Organization 组织机构 QCCRM&HTA Advisory Supervising 指导 慢性呼吸性疾病质量控制 与卫生技术评估 Advisory 顾问 Supervising 指导 Steering 执行 Departments or Divisions for Respiratory Medicine,医院临床科室 at 58 Hospitals in Shanghai

Main Action 主要任务 疾病管理（质量及成本控制） Information (data collection) 信息（数据收集） Training (capacity building) 培训（能力培养） Developing standard clinical pathway 标准临床路径的开发 Disease management(quality and cost control) 疾病管理（质量及成本控制） Medical technology assessment 医学技术评估 Inspection &supervising hospital performance 医院绩效的监管

四、QCCRM work in Shanghai

-Professor Chunxue Bai (Zhongshan Hospital) 白春学教授（中山医院） The work has been done by QCCRM in recent two years 最近两年QCCRM开展的工作 -Professor Chunxue Bai (Zhongshan Hospital) 白春学教授（中山医院）

Expectation 期待 -Support from GARD GARD支持 - Support from WHO WHO 支持

Thank you！

QCCRM Accomplishment in the past two years 最近两年QCCRM开展的工作 -Prof. Chunxue Bai (Zhongshan Hospital, Fudan University) 白春学教授（复旦大学中山医院）

Launch of QCCRM in Shanghai, March 23, 2004

Main Work In 2004 QCCRM has investigated all the necessary data (including facilities and human resources) at 58 departments of Respiratory Medicine in Shanghai. QCCRM has developed simple guidelines for COPD, ARDS according to the related guidelines .

Main Work In 2005 QCCRM had supervised the quality of facilities and human resources for all the Departments of Respiratory Medicine in Shanghai. QCCRM had developed simple guidelines for mechanical ventilation, nebulizing therapy and antibiotic therapy according to the related guidelines.

How to perform Quality Control for Respiratory Medicine?

Set up scoring criteria Regularly Convened Steering Committee is responsible for supervision scoring criteria and considering related guidelines. Get approval from the joint meeting by Regularly Convened Steering Committee & Advisory Committee.

Rehearsal of Supervising Committee 42 censors of Supervising Committee were trained before supervision according the scoring criteria . In order to standardize the scoring criteria and guarantee the justness, QCCRM supervised 2 hospitals in advance as rehearsal .

Example of the first supervision Rules and regulations the records of professional education, malpractice, death discussion, intractable case discussion shifting of duty Case history and discharge abstract the medical records in out-patient clinic the diagnosis background the discharge abstracts Three-grade clinical rounds The records of discussion and solution

Example of the first supervision Applying medical techniques the common techniques Emergency and monitoring: the emergency apparatus Respiratory Care Unit. Examination on site theory X-ray reading Human resources

Hospital classification Results (June, 2005) Hospital classification Excellent Score> 90 Fine Score> 80 Middling Score> 70 Passed Score> 60 under qualified Score<60 Class III 9 10 1 Class IIA 4 21 2 Total 13（22.4％） 31（53.4％） 11（19.0％） 1（1.7％） 2（3.4％）

Feedback of the results The censors pointed out the problems on site and fed back the results after supervision. QCCRM sent the supervision proposal in document to those hospitals with severe problems based on the inspection.

Recheck Recheck the scores for all hospitals after half year. The four worst scored hospitals made some progress.

Main Work In 2006 QCCRM will be supervising the practice of pulmonary function test, nebulizing therapy, mechanical ventilation and antibiotic therapy according to the guidelines .

Summary It has been quite cooperative between QCCRM and each hospital in Shanghai. QCCRM has been capable of managing the necessary data (including facilities and human resources) from all the Departments of Respiratory Medicine in Shanghai. QCCRM is such an unique platform with the function of supervision that it could play a very important role for GUARD.

Expectation 期待 -Support from GARD (GARD支持) - Support from WHO (WHO 支持)

Thank you！