Managed Uptake of Medical Methods (MUMM)
description
Transcript of Managed Uptake of Medical Methods (MUMM)
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Impact of Managed Uptake of Medical Methods (MUMM) -program on uptake of new technologies in secondary health care in Finland
Sinikka Sihvo1, Tuija S Ikonen1, Sirpa-Liisa Hovi1, Marjukka Mäkelä1, Risto P. Roine2, Pirjo Räsänen2,
1) Finohta, THL (National Institute of Health and Welfare)2) Hospital District of Helsinki and Uusimaa
Managed Uptake of Medical Methods (MUMM)
A joint venture of the 20 hospital districts providing specialized care and Finnish Office for Health Technology Assessment (Finohta) started in 2006
The aim is to use critical appraisal and joint decisions in uptake of new methods Effectiveness / Efficacy
Safety
Costs
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Traffic light Effectiveness Safety Costs
Green Adequate Adequate Reasonable
Yellow Promising, but evidence scarce Obviously adequate Reasonable
Adequate Adequate High
Adequate Known insufficiently Reasonable
Information inadequate Adequate Reasonable
Red Poor or unknown Adequate Reasonable
Adequate Poor or unknown Reasonable
Adequate Adequate Overly expensive
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MUMM recommendations(Traffic light model)
Should be used- may have limitations
Should not be used
Use while gathering information
research, registry, literature
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MUMM recommendation:Induced hypothermia in the treatment of acute brain damages
Content:* Effectiveness* Safety* Costs* Restrictions* Distribution of work* Prodedure code (new)
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Topic Yr Recommendation
Endovenous laser ablation in the treatment of varicose veins
2007
MARS – extracorporeal albumin dialysis for patients with liver failure
2007
Negative pressure wound therapy (NPWT) 2007 Vagus nerve stimulation for treatment-resistant depression
2008
30 d antithrombotic treatment after elective 1) knee & 2) total hip replacement
2008
64-multislice-CT in the diagnosis of coronary disease 2008 Intravitreous inhibition of angiogenesis (Bevacizumab) in the treatment of age-related macular degeneration
2008
Hysteroscopic sterilisation using a metal micro-insert 2008 Radiofrequency thermal ablation in the treatment of nasal obstruction
2008
Transcatheter aortic valve replacement for severe aortic valve stenosis
2008
Efficacy and safety of cooling in newborns with hypoxic-ischaemic encephalopathy
2008
treatment of snoring by soft palate radiofrequency ablation
2009
Spinal cord stimulation for chronic neuropathic pain and complex regional pain sydrome
2009
Treatment of severe hearing impairment with bilateral cochlear implants
2009
Does foetal electrocardiography enhance the safety of monitoring during labour
2009
Green laser for treatment of benign prostatic hyperplasia 2009 Continuous glucose monitoring in DM 2009 A surgical checklist increases patient safety 2009 Cooling for acute brain injury after 1) cardiac arrest 2) brain infarct 3) trauma
2010
PCA3 gene test in the diagnostics and surveillance of prostate cancer
2010
Since 2008: 38 recommendations for 32 technologies: 3 redred19 yellowyellow14 greengreen
Objective
• Since the program started in 2006, there is a need to evaluate its impact
• The objective was to evaluate the impact of MUMM program on the uptake of assessed methods
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Methods
1) Methods in MUMM reviews/recommendations from years 2008-2010 were searched from the National Hospital Discharge Register using procedure codes.► Correspondence of trend of a procedure and the colour of traffic light were compared
2) A query to hospital districts on one method (STAN) which had a red light recommendation
3) A survey for chief physicians responsible for decisions about uptake of new methods in hospital districts in May-June 2012
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Results• Based on the Hospital Discharge Register:
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Prodedures / Use of the method Recommendation No
code Decreased Increased Remained
stable Green 5 0 2 2 Yellow 9 2 4 0 Red 3 - - - TOTAL 16 2 6 2
Green light
Source: National Hospital Discharge Register
Yellow light
Spinal nerve stimulation in severe neuropathic pain (2009)
Green laser treatment of benign prostatic hyperplasia (2009)
Red light
• Fetal intrapartum surveillance with STAN– recommendation in May 2009 – a survey for hospital districts in September 2009
(17/20 responded)
Has been used in your hospital district
Is currently used in your hospital district
Yes No Yes No 15 2 14 2
Results from survey to chief physicians• ” The contents of MUMM
recommendations are unambigious and easy to understand”
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% (n=244)
Agree 57 Disagree 11 Cannot say 32
”There is enough informing about MUMM recommendations”
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% (n=244)
Agree 28 Disagree 46 Cannot say 26
”MUMM recommendations are followed/obeyed well in my specialty”
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% (n=242)
Agree 29 Disagree 25 Cannot say 46
Conclusions (1)• This was a first attempt to evalute impact of
recommendations in MUMM programme:
• Hospital discharge registers are currently inadequate source for evaluation since prodedure codes are often missing
• Impact of other factors than recommendations on seen changes cannot be ruled out
• MUMM recommendations are not yet well known
-> need for more informing
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Conclusions (2)
• Large number of yellow lights makes evaluation difficult
• Inclusion of the code on MUMM recommendations hopefully will increase use of codes in the future
• Methods to follow impact of recommendations need to be developed• Especially for those methods that are not registered
anywhere
• Systematic follow-up for RED lights
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