Eleanor Woodford Guegan

Identifying trial recruitment uncertainties using a James Lind Alliance Priority Setting Partnership - The PRioRiTy (Prioritising Recruitment in Randomised Trials) Study

BackgroundDespite the problem of inadequate recruitment to randomised trials, there is little evidence to guide researchers on decisions about how people are effectively recruited to take part in trials. The PRioRiTy study aimed to identify and prioritise important unanswered trial recruitment questions for research. The PRioRiTy study - Priority Setting Partnership (PSP) included members of the public approached to take part in a randomised trial or who have represented participants on randomised trial steering committees, health professionals and research staff with experience of recruiting to randomised trials, people who have designed, conducted, analysed or reported on randomised trials and people with experience of randomised trials methodology.MethodsThis partnership was aided by the James Lind Alliance and involved eight stages: (i) identifying a unique, relevant prioritisation area within trial methodology; (ii) establishing a steering group (iii) identifying and engaging with partners and stakeholders; (iv) formulating an initial list of uncertainties; (v) collating the uncertainties into research questions; (vi) confirming that the questions for research are a current recruitment challenge; (vii) shortlisting questions and (viii) final prioritisation through a face-to-face workshop.ResultsA total of 790 survey respondents yielded 1693 open-text answers to 6 questions, from which 1880 potential questions for research were identified. After merging duplicates, the number of questions was reduced to 496. Questions were combined further, and those that were submitted by fewer than 15 people and/or fewer than 6 of the 7 stakeholder groups were excluded from the next round of prioritisation resulting in 31 unique questions for research. All 31 questions were confirmed as being unanswered after checking relevant, up-to-date research evidence. The 10 highest priority questions were ranked at a face-to-face workshop. The number 1 ranked question was “How can randomised trials become part of routine care and best utilise current clinical care pathways?” The top 10 research questions can be viewed at www.priorityresearch.ie.ConclusionThe prioritised questions call for a collective focus on normalising trials as part of clinical care, enhancing communication, addressing barriers, enablers and motivators around participation and exploring greater public involvement in the research process.

Mapping public health research across the National Institute for Health Research 2006–2013

BackgroundPublic health research is an important component of United Kingdom (UK) health research and strategic analysis of its breadth and balance is key to ensure value. The National Institute for Health Research (NIHR) is one of the main funders of health research in the UK and includes many research programmes and schools. This study reports on public health research funded by the NIHR between April 2006 and March 2013.MethodsThe NIHR research programmes and schools were asked for information about all research funded during the study period. Firstly, projects were classified as a public health research project according to inclusion and exclusion criteria. The public health research projects were further categorised according to the Public Health Outcomes Framework and the National Institute for Health and Care Excellence taxonomy.ResultsApproximately 3000 research projects were funded by the NIHR, of which about 900 were relevant to public health. This represents approximately one-third of the research portfolio. All NIHR research funding programmes and schools funded research related to public health. The most prevalent domain of the Public Health Outcomes Framework was ‘healthcare public health and preventing premature mortality’ and there were a large number of health planning and self-management projects. One-quarter of projects were concerned with mental health and behavioural conditions.ConclusionsThe NIHR is a significant funder of research relevant to public health. This analysis offers a snapshot of the breadth and balance of NIHR research, which forms a basis for discussion. This is important for the NIHR and other research funders as it shows areas that are better represented and opportunities to fill important gaps. Appropriate research priority setting is an integral part of a needs-led research agenda and adds value to research.

EUNETHTA: FURTHER STEPS TOWARDS EUROPEAN COOPERATION ON HEALTH TECHNOLOGY ASSESSMENT

The European network for Health Technology Assessment (EUnetHTA) was established to increase cooperation in European health technology assessment (HTA) by developing a common set of tools, methods, documents, and HTA information. The collaboration is well recognized within the European HTA community and at an international level. Timely and efficient usage of European HTA resources is possible as demonstrated by EUnetHTA partners and associates successfully working together. Factors that support collaboration include knowledge of each other’s work plans, use of common templates and methodology, and using a common scientific and working “language.” HTA is a resource intensive activity with a heavy burden of evidence gathering. The sharing of data and findings in a standardized manner has the potential to reduce those resource requirements. Although tools were developed within the EUnetHTA Joint Action, their use is not restricted to the European setting. This Special Issue describes the EUnetHTA Joint Action (JA) project (2010–2012) as a further step towards sustainable European cooperation on HTA which can add value at the European, national and regional levels. Several networks have aimed to increase international collaboration in HTA, including the International Network of Agencies for Health Technology Assessment (INAHTA), Health Technology Assessment international (HTAi) and HTAsiaLink. Since the mid-1990s, the European Union (EU) Commission has supported several initiatives to increase cooperation and share information between HTA agencies within the European community. The European network of HTA (EUnetHTA) stemmed from previous work in this area: EUR-ASSESS (1994–97), HTA Europe (1997–98), and ECHTA/ECAHI (2000–02). The first 3-year EUnetHTA project (2006–08) sought to “provide reliable, timely, transparent, and transferable information on the shortand long-term effects of health technologies as input to decision making in Member States of the EU” through the development of a set of practical tools for HTA (1). The outputs included the HTA Core Model (a framework for structuring an HTA report into standardized assessment elements), information for decision makers about emerging technologies, and collaboration on access with evidence generation. Recommendations were made at the end of the project, including the need to continue developing and evaluating these HTA tools in real-life settings (1). Three additional years of EU funding was granted for a EUnetHTA joint action (2010–12). This JA1 project recruited thirty-eight government-appointed organizations from twentysix EU member states, Norway, and Croatia. The work was structured into eight work streams. The Executive Committee provided strategic leadership of the project, all member agencies met yearly in the Plenary Assembly, and a Stakeholder Forum facilitated information exchange. The project’s overarching aim was to “establish an effective and sustainable HTA collaboration in Europe that brought added value at the regional, national and European level”, with three specific objectives:

Success factors for international HTA projects: evaluating EUnetHTA Joint Action as an exemplar

OBJECTIVES Evaluation is essential for the management of international projects or networks in health technology assessment (HTA). It extends beyond the normal process of project management by incorporating qualitative dimensions and provides information about a projects effectiveness and achievements. This article aimed to identify the factors that are important for the success of international HTA projects. The European network for Health Technology Assessment Joint Action (EUnetHTA JA) is presented as an exemplar. METHODS METHODS for the evaluation of international HTA projects include interviews, focus groups, questionnaires, observations and documentary review, and the key points of these approaches have been summarized. The impact and effectiveness of the EUnetHTA JA was evaluated by questionnaires of project participants and external stakeholders, and by documentary review. RESULTS The response rate for the three annual questionnaires sent to project participants ranged from 86 percent to 88 percent and for external stakeholders ranged from 65 percent to 88 percent. Key factors for project success included production of deliverables according to the workplan, achievement of objectives, added value generated, effective communication, involvement of external stakeholders, workstream management and progress from the preceding EUnetHTA 2006-2008 project. CONCLUSIONS The experience of this project can inform the evaluation of future international HTA collaborations, such as the EUnetHTA 2nd Joint Action and HTAsiaLink. A high response rate was achieved to the self-completion questionnaires and the strategy followed is recommended for evaluation of international HTA projects. Future assessments of international HTA projects should strive to measure outcomes and impact, not just outputs and process.