Ranking Policy Options for Health Technology Innovation and Adoption in Canada: Results of a Multi-stakeholder Concept Mapping Process

Ranking policy options for health technology innovation and adoption in Canada: Results
of a multi-stakeholder concept mapping process

SUBJECT:

• Innovators, industry representatives, researchers and policymakers participated in a mixed online/in-person concept mapping exercise to brainstorm, sort and rate evidence-based policy options to health technology innovation and adoption for older adults.

ISSUE:

• Innovators find it challenging to navigate complex policies and regulations to bring technology to market in Canada. Policy options to support better uptake of technologies have been outlined by interest groups ^{i ii iii}, however it is unclear how the policy options were developed and their feasibility to implement has not been explored.

BACKGROUND:

• Earlier stages of this research identified facilitators and barriers to health technology innovation and adoption in Canada.
• Policy options that are supported by large constituencies of people may be of specific interest to policymakers^iv.
• Concept mapping is a six-stage research method (see Appendix A), which describes a topic using qualitative individual group processes combined with multivariate statistics^v.
• Concept mapping can offer insight to complex problems by involving diverse stakeholders in brainstorming, idea sorting and interpretation of results^vi.
• The aim of this study was to use group concept mapping to compile opinions of policymakers, researchers, industry stakeholders and innovators to understand what experts perceive to be the most relevant and feasible policy options to facilitate health technology innovation and adoption for older adults.

METHODOLOGY:

• Between April-July 2019, eight policymakers, nine industry representatives, four innovators, and two researchers (n=22) completed the concept mapping exercise.
• Our previous work on facilitators and barriers to technology innovation and adoption was coded to generate answers to the following prompt: What can be done to create a policy and regulatory environment that will support safe adoption of effective technologies (especially those for older adults)? Ninety-five specific answers to the prompt were generated, and each answer represents a single policy action.
• Using an online software, participants were asked to complete an “unstructured similarity sorting” process – placing ideas in piles and naming them^vii. Next, participants rated each answer on its relevance to the prompt and its feasibility to implement using a five-point scale.
• Statistical analysis within the concept mapping software was completed and a concept map representation of the participant’s thinking was created, featuring seven clusters (See Appendix B). Each dot represents one policy option; dots that appear closer together were sorted in a similar way by the participants.
• The patient and user involvement cluster was rated as the most relevant (4.17/5) and the most feasible (4.46/5). The legislative, legal and regulatory cluster was rated as the second most relevant (4.15/5) but the least feasible to implement (3.62/5).
• A ‘go zone’ is a type of concept map that uses a bivariate graph where:
  • Top right quadrant = Statements with above average rating scores on both relevance and feasibility
  • Bottom right quadrant = Statements with scores above average in terms of relevance and below average in feasibility
  • Top left quadrant = Statements with below average scores in relevance but above average scores in feasibility
  • Bottom left quadrant = Statements with scores below average in both relevance and feasibility
• Twenty-seven of 95 statements were rated higher than average in terms of relevance and feasibility. Six of 27 go zone statements came from the evaluation cluster, five statements came from the funding and incentives cluster. Patient and end-user engagement and system capacity each had four states in the go-zone, while three statements came from the processes and pathways cluster. For example, resources to support patient recruitment for co-creation was rated as both highly relevant and highly feasible.
• Twenty-one statements were rated below average in both relevance and feasibility, which could narrow the number of potential policy options to consider.

CONCLUSIONS:

• Twenty-two stakeholders rated the patient and user involvement cluster as important and easy to implement. This could be a starting point for policy change to encourage health technology innovation and adoption for older adults. The legislative & regulatory cluster was seen as important, but an area which will require more attention, resources and time to achieve a meaningful change.
• Given that health technologies to support older adults may be used, administered, prescribed, regulated, evaluated, purchased, invested in, and developed, all by different interests^viii, it follows that these research findings support policy action at a variety of different institutional levels.
• At an individual level, these findings suggest that older adults and caregivers should define problems for technology developers to address. Resources are required to help recruit patients to co-design innovations, and sustain their involvement across the innovation pathway.
• At a regional level, this research supports empowering the home care sector to fund, test and implement new technologies. This may require dedicated resources so that home care agencies do not have to allocate funds designed for care delivery to technology activities. This may also necessitate new expertise or human resources designed to support these activities, as there may be a shortage of economic evaluation expertise for evaluating integrated care interventions which span home and community care and acute care^ix.
• At a provincial level, these findings support changed funding models to ensure health care budgets are integrated across years, departments and health care settings, such as those models which fund a continuum of care as opposed to an episode of care. These funding changes, (which are underway in some jurisdictions^x) would have impacts on how the health care system procures new technologies and would be responsive to technologies which offer benefits in terms of prevention, or decreased health care costs.
• At a provincial level, resources are required to build the evidence base for new technologies such as: real world trials, trials which have health care provider participation, assessments of decision-makers’ willingness to pay for a new technology, and studies which capture user experience/user acceptance.
• The federal government is in a unique position to require that health technology innovations respond to demonstrated health system needs, through federal innovation granting programs. This includes building awareness among innovators of: health system priorities; how their technology fits with existing systems, workflows and scopes of practice; and what types of studies they needs to conduct to ensure their technology can produce clinical and cost-effectiveness data for HTA.
• Concept mapping has been suggested as a helpful methodology to organize responses to complex policy issues, and to align a group’s vision with action^xi. This research supports the application of group concept mapping for policy research.
• This work generated an understanding of diverse stakeholders’ perceptions about the relevance and feasibility of potential policy options. Our results form an evidence-based policy agenda with specific actions at different institutional levels, to facilitate innovation and safe adoption of health technologies for older adults.

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^vii Kane, M., & Trochim, W. (2007). Concept mapping for planning and evaluation. California, Sage Publications Inc.
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^ix Knai, C., Nolte, E., Brunn, M., Elissen, A., Conklin, A., Pedersen, J., … & Fullerton, B. (2013). Reported barriers to evaluation in chronic care: Experiences in six European countries. Health Policy, 110(2-30, 220-228. Retrieved from https://pubmed.ncbi.nlm.nih.gov/23453595/
^x Ontario Ministry of Health and Long-Term Care. (2018). Bundled care (integrated funding model). Retrieved from https://www.health.gov.on.ca/en/pro/programs/ecfa/funding/ifm/
^xi Trochim, W. & Cabrera, D. (2005). The complexity of concept mapping for policy analysis. Emergence: Complexity & Organization, 7(11), 11-22. Retrieved from https://journal.emergentpublications.com/article/the-complexity-of-concept-mapping-for-policy-analysis/