1、衛生技術和衛生技術評估概述Outline提綱一、 Overview of Health Technology & Assessment( HTA) 衛生技術和衛生技術評估概述二、 The Role of HTA for GARD* Action Plan 衛生技術評估在GARDGARD行動計劃中的作用三、 Shanghai Pilot Study on QC&HTA QC&HTA的上海試點研究四、 QCCRM work in Shanghai QCCRM在上海開展的工作 * GARD：Global Alliance Against Chronic Respiratory

2、 Diseases 慢性呼吸病防治全球聯盟一、 Overview of Health Technology & Assessment(HTA)衛生技術和衛生技術評估概述Health Technology （HT）Definition衛生技術的定義 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 t

3、he organisational and support systems within which such care is provided 衛生技術是指用于醫療保健的藥物，儀器設備，內、外科程序及相關的組織管理系統和支持系統的特定的知識體系Support system支持系統Components of HT衛生技術的組成Procedure程序Knowledge知識Medical Device醫學裝置Drugs藥物Equipment設備HTA Definition 定義(1) HTA is a systematical evaluation on property, effects and

4、 other impacts of HT對衛生技術的性質，效果和其他影響進行系統評價 HTA is a comprehensive form of policy research that examines the short- and long-term social consequences of the application or use of technology對技術應用形成的短期和長期社會影響進行政策研究的一種綜合形式 HTA aims to provide useful information to health policies- making目的是為衛生技術領域的政策制訂提

5、供信息 HTA can foresee the directed, expected outcome of HT, deal with the indirected, unexpected outcome caused by HT 可以預測衛生技術直接帶來的效果和間接的意外后果 HTA employs the specific framework and methods 采用獨特的分析框架和方法 HTA is performed by multi-discipline collaboration 衛生技術評估由多學科合作來完成HTA Definition 定義(2) Basic HTA Ori

6、entations 基本衛生技術評估導向 Technology-oriented assessments are intended to determine the characteristics or impacts of particular technologies. 技術導向型的評估技術導向型的評估 旨在判定特定技術的特征（性質）或影響；旨在判定特定技術的特征（性質）或影響； Problem-oriented assessments focus on solutions or strategies for managing a particular problem for which

7、alternative or complementary technologies might be used. 問題導向型的評估問題導向型的評估 關注處理特定問題的辦法或策略，對于該問題可能會使用不關注處理特定問題的辦法或策略，對于該問題可能會使用不 同的備選技術或補充技術同的備選技術或補充技術； Project-oriented assessments focus on a local placement or use of a technology in a particular institution, program, or other designated project. 方案導

8、向型的評估方案導向型的評估 關注特定技術在特定機構、計劃或其他指定方關注特定技術在特定機構、計劃或其他指定方 案中的具體應用。案中的具體應用。Why HTA is necessary?衛生技術評估的必要性 Technology as two sides of a coin 技術具有兩重性Advantages利Technology innovation 技術創新Improve medical quality 改善醫療質量Enhance populations health 提高人群健康Disadvantages弊Adverse effects caused by technologies 技術帶

9、來的負面后果Ethic dispute 倫理爭論Excess increase of medical expense 醫療費用過度增長Why HTA is necessary?衛生技術評估的必要性 Visibility of new technologies 新技術的廣泛使用 High expenditures for health care 醫療費用的不斷上漲 Necessity to begin to rationalize health care technology 衛生技術資源優化的要求Content技術評估的內容 Technical properties 技術特性 Safety安全

10、性 Efficacy and effectiveness功效和效果 Cost and other economic attributes經濟性 Social, legal, ethical, or political impacts 社會、法律、倫理道德和政治影響A Process for HTA衛生技術評估的過程Testing研究Identification識別Synthesis綜合Dissemination傳播Banta, D. Health care technology and its assessmentTwo Main Groups of Studies (Methods)兩種主要

11、研究方法 Primary data collection原始資料收集 Collect original new data, for example, using experiments 收集原始的新數據，例如，利用試驗數據 Secondary data analyses第二手資料分析 Combine (Synthesize or integrate) data from existing sources 采用已有資料 (綜合或者整合)Secondary Data Analyses第二手資料分析 Expert opinion專家意見 Group judgment (Consensus devel

12、opment) 團體判斷（得出一致意見） Literature review文獻評閱 Meta-analysis文獻綜合分析 Decision analysis, other modeling 決策分析及其他模型二、The Role of HTA for GARD Action Plan 衛生技術評估在GARD 行動計劃中的作用 To reduce the global burden of CRDs 降低全球慢性呼吸性疾病負擔 To better recognize, prevent and manage CRDs 更好認識，預防和管理慢性呼吸性疾病 To propose an action

13、plan for CRDs, coordinated by the WHO 在WHO的合作下，提出CRDs行動計劃 To foster country focused initiatives according to the special needs of each specific country 根據每一國家特殊需要鼓勵開展CRDs行動Goals of GARD目標 To help the admission of Health technology 幫助衛生技術的準入 To the selection of benefit package for health insurance 衛生

14、保險福利計劃的選擇 To decide the appropriate intervention of clinical practice 決定合適的臨床干預方案 To support scientific evidence for policy maker 為衛生政策制定者提供科學證據The Role of HTA for GARD HTA 在GARD中的作用三、 Shanghai Pilot Study on QC&HTAQC&HTA上海試點研究A proposal of practicing GARD in Shanghai GARD上海試點研究方案The Platfor

15、m of Quality Control and Health Technology Assessment for Respiratory Medicine in Shanghai 建立上海市呼吸病質量控制和衛生技術評估平臺 To reduce chronic respiratory disease burden降低慢性呼吸疾病負擔 - asthma哮喘 - chronic obstructive pulmonary disease 慢性阻塞性肺疾病 - occupational lung disease職業性肺病 - lung cancer肺癌Objective目標 The Quality

16、Control Center for Respiratory Medicine (Zhongshan Hospital） 呼吸病質量控制中心（中山醫院） - Collecting data for practicing the guidelines 為實踐指南收集數據 - Supervising the quality of facilities and human resources of hospitals醫院設施及人力資源質量的監管 - Inspecting the hospital performance and quality 醫院績效和質量的檢查 Background背景(1) T

17、he Key Lab of Health Technology Assessment, MOH in China（Fudan University） 衛生部衛生技術評估重點實驗室（復旦大學） -Research 研究 -Training 培訓 -Information 信息 -Communication and collaboration交流與合作 Background背景(2)Organization 組織機構QCCRM&HTAAdvisory 顧問 Steering 執行Departments or Divisions for Respiratory Medicine,醫院臨床科室

18、at 58 Hospitals in ShanghaiSupervising 指導慢性呼吸性疾病質量控制與衛生技術評估 Information (data collection) 信息（數據收集） Training (capacity building) 培訓（能力培養） Developing standard clinical pathway 標準臨床路徑的開發 Disease management(quality and cost control) 疾病管理（質量及成本控制） Medical technology assessment 醫學技術評估 Inspection &supe

19、rvising hospital performance 醫院績效的監管Main Action 主要任務四、QCCRM work in Shanghai QCCRM在上海開展的工作-Professor Chunxue Bai (Zhongshan Hospital) 白春學教授（中山醫院）The work has been done by QCCRM in recent two years 最近兩年QCCRM開展的工作-Support from GARD GARD支持- Support from WHO WHO 支持Expectation 期待Thank you！-Prof. Chunxue

20、Bai (Zhongshan Hospital, Fudan University) 白春學教授（復旦大學中山醫院）QCCRM Accomplishment in the past two years 最近兩年QCCRM開展的工作QCCRM in Shanghai Launch of QCCRM in Shanghai, March 23, 2004 Main Work In 2004QCCRM has investigated all the necessary data (including facilities and human resources) at 58 departments

21、 of Respiratory Medicine in Shanghai. QCCRM has developed simple guidelines for COPD, ARDS according to the related guidelines . Main Work In 2005QCCRM had supervised the quality of facilities and human resources for all the Departments of Respiratory Medicine in Shanghai. QCCRM had developed simple

22、 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

23、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 criter

24、ia 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 medic

25、al 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 U

26、nit. Examination on site theory X-ray reading Human resourcesHospital classification ExcellentScore 90FineScore 80MiddlingScore 70PassedScore 60under qualifiedScore60Class III910100Class IIA4211012Total13（22.4）31（53.4）11（19.0）1（1.7）2（3.4）Results (June, 2005)Feedback of the resultsThe censors pointed out the problems on site and fed back