What's new in this update
No new research relevant to the chapter was identified during the October 2022 update.
Health Technology Assessments (HTAs) not only evaluate a health technology and its effectiveness (and often cost-effectiveness) but also consider organizational aspects surrounding its implentation, or sometimes removal, within a specific context or setting. This domain of an HTA examines how various types of resources (administrative, human, technological, etc.) need to be structured when implementing a technology. Any impacts that may result within the health care organization or the health system as a whole are considered. (1,2).
In general, the organizational domain explored the following issues, but may also consider others (1,2):
Health care delivery processes and how the technology may affect current work flows
The structure of health care services and equitable access to the new technology
Process related costs for purchasing and setting up the new technology along with budget impacts
Cultural issues including acceptance of the new technology by those within health care organizations
General Search Guidance
There is little information regarding the optimal methods for conducting analyses in this domain and consequently little guidance on best practices for searching the evidence base. EUnetHTA’s HTA Core Model (1) and the Danish Centre for Health Technology Assessment’s Health Technology Assessment Handbook (2) offer the most detailed guidance in this area.
In general, both sources agree that this is a challenging area for information retrieval as evidence on the organization and delivery of health services encompases a wide range of disciplines, study types, and is spread across a wide range of published and grey literature. The information required for this section of an HTA is often context (and often country) specific which can result in little to no published literature being available. (1,2)
It is recommended that, as a first attempt, an extensive literature search focusing on identifying systematic reviews of organizational aspects should be conducted. If no systematic reviews are available, then the search should be revised to focus on guidelines and relevant primary studies. If no relevant data are identified, the third step is to identify primary data which might involve conducting surveys or interviews of healthcare professionals and content experts. Data might also be obtained from administrative databases of the relevant organizations involved in the analysis (1). New primary qualitative research might be the only way to assess real world practice use and misuse. (2)
Sources to search
A wide range of sources of published and unpublished (grey) information should be searched. Other search techniques should also be considered including contacting experts and scanning reference lists of relevant papers and hand searching of journals. Information should be gathered not just from traditional health sciences literature sources but also from sources of social sciences, business, and even education literature. The choice and number of resources to search will depend on the topic of the assessment and the time/resources available for searching. At a minimum, the most commonly used databases below should be consulted (1,2).
Resources recommended to search for the organizational domain (1,2) include:
CRD (Centre for Reviews and Dissemination) Databases
DARE (Database of Abstracts of Reviews of Effects)
HTA (Health Technology Assessment)
NHS EED (National Institute for Health Research / Economic Evaluation Database)
CINAHL (Cumulative Index to Nursing and Allied Health Literature)
GIN (Guideline International Network)
In addition the following sources could also be searched:
Health sciences databases (Embase, PsycINFO, any regional/country specific databases of clinical studies such as HMIC from the U.K.)
Social sciences databases (Sociological Abstracts, Social Services Abstracts, Social Care Online, SocINDEX, ASSIA)
Education databases (ERIC)
Ongoing research databases (EUnetHTA POP database, ClinicalTrials.gov, Prospero)
Horizon scanning databases (EuroScan, ukBIOSIS)
Other databases (Joanna Briggs Institute Library, EUnetHTA pool of structured HTA information)
Grey literature (dissertations, guidelines, conference proceedings, OAIster, registries and statistics, administrative data, pharmaceutical registries, working papers, industry reports, handbooks, organizational reports).
Types of Research Studies to Include in the Search
Because of the complexity of the organizational domain in terms of the variety of literature that is needed, no single type of research study is appropriate. The evidence base may encompass many varying types of studies, both quantitative and qualitative. The HTA Core Model (1) recommends searching for the following study types:
Health delivery process questions: Guidelines, observational, mostly qualitative, partly quantitative, RCT or systematic reviews of RCTs
Structure of health care questions: Guidelines, observational, mostly qualitative.
Process related costs questions: Guidelines, producer technical handbooks, Costing and budget impact analyses
Management questions: Guidelines, observational studies mostly qualitative, consensus, protocols
Culture questions: Observational, mostly qualitative.
With this is mind, we also recommend that individuals consult the chapter on searching for qualitative research to aid in the development of search strategies for the organizational domain.
Designing Search Strategies
In terms of designing the search strategy for this topic area, there is little guidance available and we suggest that information specialists explore published reviews and HTAs to see how others have searched for topics such as health delivery processes and health structures.
A number of search filters can be employed in the design of search strategies, each with a specific focus. Wilczynski et al. (3) have developed a health services research filter and Simon et al. (4) have created a filter aimed at uncovering nurse staffing research. Van Walraven et al. (5) have developed a filter to identify studies that use administrative data, and Hempel et al. on quality improvement interventions (6). Each of these authors acknowledge that research in these topic areas is difficult to search for because of the wide variety of applicable subject headings/terms and the variable keywords and language used to describe the field (3-6). While all of these filters have quite good sensitivity, they all have much poorer precision which is likely to result in quite large search yields and many irrelevant records that need to be manually screened.
Additional search filters can be identified from the InterTASC Information Specialists' Sub-Group (ISSG) Search Filter Resource.