This is a paper on health priority setting not research priority setting However, the multi criteria model has been also used to prioritise health technology assessment (which can include systematic reviews). Therefore, it seemed relevant to the Cochrane groups.
Tromp, N., Baltussen, R. (2012) Mapping of multiple criteria for priority setting of health interventions: an aid for decision makers. BMC Health Services Research Open Access. 12:454 http://www.biomedcentral.com/1472-6963/12/454
Paper summarised by Jill Pooler
This paper argues that whilst many criteria such as costs, effectiveness, equity and feasibility are considered when making rationing decisions in health; a single underlying conceptual framework that incorporates all criteria for example: disease, socio-economic status, gender, ease of implementation or political acceptability, does not yet exist. Moreover a recent report found that most prioritisation applications have a fixed set of criteria and lack explanation of the rationale behind the selected criteria and the categories used (5).
The aim of this paper is to develop a conceptual map of prioritisation criteria with rationale, based on theWorld Health Organization’s Health Systems Performance, (7) andHealth and Systems Building Blocks,(8,9) frameworks, to aid decision makers in identifying relevant criteria for priority setting.
Drawing upon health rationing criteria identified in a review of the literature (1,2,3,4,5,6), the authors first made an inventory of all possible criteria for priority setting. Each criterion was then categorised using the World Health Organization’sHealth Systems Performance (7)andHealth and Systems Building Blocks(8,9) frameworks. The former of which sets out the goals of a health system and includes i) improved health; ii) responsiveness; iii) social and financial risk protection and iv) improved efficiency. The latter, definesthe components (or inputs) for an effective health system. These building blocks include i)service delivery; ii) health workforce; iii) information; iv) medicinal products, vaccines and technologies; v) financing; vi) leadership and governance. The authors argue that criteria used by decision makers when setting health priorities are a direct manifestation of these frameworks. Taken together, the authors suggest that these two frameworks combined offer a comprehensive framework for classifying priority setting criteria.
Prioritisation criteria derived from the literature review were tabulated and considered for inclusion and exclusion, in the categorisation process, accompanied by the authors decision-making rationale (Additional File 1).
An integrated World Health Organization Health Systems Performance (7) and Health and Systems Building Blocks (8,9) framework was established against which thirty one prioritisation criteria with definitions, were plotted.
A conceptual map was then developed to display relationships between overall goal/outcomes, prioritisation criteria and systems building block categories. In the middle of the map beginning in orange with the labelhealth level are displayed the interventions overall goals/outcomes, and includes criteria‘effectiveness on individual level’, ‘effectiveness on population level’ ‘patient reported health status’ and ‘safety’. Similarlyhealth distribution (green);responsiveness (red),social and financial risk protection (purple) andimproved efficiency (yellow) each include related criteria.
On the left of the map (blue), feasibility is subdivided into six categories, beginning at the top with service delivery. These categories relate to requirements for the implementation of an intervention. The authors acknowledge that little work has been done on these criteria (except on the criteria ‘cost’) thus this work represents initial propositions.
The authors propose that their conceptual map can inform decision makers engaged in both ‘context-specific prioritisation’ and more ‘generalized priority setting’. However it is not considered to be a fixed set of criteria. Rather an aid to decision making in the selection of relevant prioritisation criteria. A position they consider particularly pertinent when considering disease specific priorities.
The authors propose further research aimed at defining indicators for operationalizing prioritisation criteria, which they suggest would complement their work so far, and facilitate the construction of a performance matrix, to demonstrate the performance of an intervention on all criteria.
The authors state that their mapping of priority setting criteria as a work in progress and welcome comments.
The aim of this paper was to develop a conceptual map of prioritisation criteria, based on the World Health Organization’s Health Systems Performance, (7) and Health and Systems Building Blocks, (8,9) frameworks, to aid decision makers in identifying relevant criteria for priority setting. Thirty one prioritisation criteria with definitions, were identified and mapped to overall goal/outcomes, feasibility and six systems building block categories. Further work is required aimed at defining indicators for operationalizing prioritisation criteria.
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