MAST: a model for HTA-based assessment of telemedicine applications
1. MAST: a model for HTA-based
assessment of telemedicine
applications
ANNA KOTZEVA, on behalf of the MAST Working group
Catalan Agency for Health Information, Assessment and Quality, Spain
HTAi Annual meeting, June 2012, Bilbao
2. Contents
1. MAST as a multidisciplinary assessment model
Background
Development process
Aim and structure of the model
2. Empirical test of MAST in the RENEWING HEALTH project
Project overview
Experiences and results so far
3. Conclusions
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 of
telemedicine as a main barrier for its wider implementation
4. Background
Promotion 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
6. Aim
MAST can be used when the assessment aims to describe
effectiveness and contribution of telemedicine to quality
of care and to produce basis for decision making
Assessment defined as:
A multidisciplinary process that summarizes and evaluates
information about the clinical, economic, organizational and
socio-ethical issues related to the use of telemedicine, in a
systematic, unbiased and robust manner.
*based on EUnetHTA Core Model
8. Structure and elements of MAST
The framework suggests 3 stages of assessment:
I. Preceding considerations
II. Multidisciplinary Assessment
III. Transferability of results
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. II. Multidisciplinary assessment
WHAT should be assessed?
1. Health problem and characteristics of the application Descriptive
2. Clinical effectiveness
DOMAINS
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. II. Multidisciplinary assessment
HOW 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. 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. Empirical test of MAST in the
RENEWING HEALTH project
Project overview
Experiences and results so far
Tools to support study design, reporting & analysis
Training
Close collaboration and feedback from users
14. Empirical test of MAST in the
RENEWING HEALTH project
Project overview
Experiences and results so far
Tools to support study design, reporting & analysis
Training
Close collaboration and feedback from users
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. 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, BUT
a broader knowledge on benefits of telemedicine services through a
number of multidisciplinary outcomes
17. Empirical test of MAST in the
RENEWING HEALTH project
Project overview
Experiences and results so far
Tools to support study design, reporting & analysis
Training
Close collaboration and feedback from users
18. Application of MAST in practice stimulates its
further development and improvement
A number of tools were developed to support
study design, data management, analysis
and reporting of results
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
4
Ensures quality and comparability of data
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. 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. 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 l'Evaluation (Economique) de la Télémédecine
Recherche Clinique Santé Publique, Paris
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. 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