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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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4

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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