Objective Early-stage decision aid (EsDA), a generic form that guides clinical leaders who consider implementing a new intervention in their department, is currently under development at Haukeland University Hospital. In Norway, there is a lack of knowledge about how clinical leaders set priorities, a need to train leaders in systematic quality improvement and principles for priority setting, and for tools that enhance open and fair priority setting for new health interventions across medical specialties.
What EsDa does: EsDA is a digital form and involves two main tasks. 1) To synthesize evidence about the intervention by describing the perspective (patient, medical treatment, health service) and most relevant dimensions of heath care quality (safety, effectiveness, patient-centered and timely intervention, efficiency, equity), as well as expected benefit and resource use (including disinvestment) associated with the intervention compared to existing strategies, disease severity, ethical challenges and existing guidelines. 2) To summarize relevant reasons for and against adoption of the intervention, and conclude.
Results Having completed the form, the clinical leader should be able to decide to implement the intervention, or initiate another decision-making process, such as a national health technology assessment, experimental treatment in- or outside of studies, further risk or economic evaluation, clinical ethics consultation, an expert panel evaluation, or other (depending on local circumstances).
Discussion EsDA provides a systematic process for increasing awareness about principles for quality management and priority setting among clinical leaders, in order to develop safe, effective, efficient and patient-centered services. A database of completed EsDa forms facilitates comparison and harmonization of decisions and research, and documents how the hospital sets priorities to improve the quality and outcome of care. Further work includes a pilot project among clinical leaders, establishment of criteria for when they should use EsDA, evaluation of the digital platform and database, and implementation research.
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