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Systems thinking in health technology assessment: a scoping review

Published online by Cambridge University Press:  24 June 2021

Marina Richardson Open the ORCID record for Marina Richardson [Opens in a new window] ,
Lauren C. Ramsay ,
Joanna M. Bielecki ,
Whitney Berta  and
Beate Sander
Marina Richardson*
Affiliation:
Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Suite 425, Toronto, Ontario, CanadaM5T 3M6 Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Eaton Building, 10th Floor, Room 247, 200 Elizabeth Street, Toronto, Ontario, CanadaM5G 2C4
Lauren C. Ramsay
Affiliation:
Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Suite 425, Toronto, Ontario, CanadaM5T 3M6 Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Eaton Building, 10th Floor, Room 247, 200 Elizabeth Street, Toronto, Ontario, CanadaM5G 2C4
Joanna M. Bielecki
Affiliation:
Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Eaton Building, 10th Floor, Room 247, 200 Elizabeth Street, Toronto, Ontario, CanadaM5G 2C4
Whitney Berta
Affiliation:
Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Suite 425, Toronto, Ontario, CanadaM5T 3M6
Beate Sander
Affiliation:
Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Suite 425, Toronto, Ontario, CanadaM5T 3M6 Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Eaton Building, 10th Floor, Room 247, 200 Elizabeth Street, Toronto, Ontario, CanadaM5G 2C4 ICES, 155 College Street, Suite 424, Toronto, Ontario, CanadaM5T 3M6 Public Health Ontario, 480 University Ave #300, Toronto, Ontario, CanadaM5G 1V2
*
Author for correspondence: Marina Richardson, E-mail: marina.richardson@mail.utoronto.ca
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Abstract

Objective

Our objective was to assess how, and to what extent, a systems-level perspective is considered in decision-making processes for health interventions by illustrating how studies define the boundaries of the system in their analyses and by defining the decision-making context in which a systems-level perspective is undertaken.

Method

We conducted a scoping review following the Joanna Briggs Institute methodology. MEDLINE, EMBASE, Cochrane Library, and EconLit were searched and key search concepts included decision making, system, and integration. Studies were classified according to an interpretation of the “system” of analysis used in each study based on a four-level model of the health system (patient, care team, organization, and/or policy environment) and using categories (based on intervention type and system impacts considered) to describe the decision-making context.

Results

A total of 2,664 articles were identified and 29 were included for analysis. Most studies (16/29; 55%) considered multiple levels of the health system (i.e., patient, care team, organization, environment) in their analysis and assessed multiple classes of interventions versus a single class of intervention (e.g., pharmaceuticals, screening programs). Approximately half (15/29; 52%) of the studies assessed the influence of policy options on the system as a whole, and the other half assessed the impact of interventions on other phases of the disease pathway or life trajectory (14/29; 48%).

Conclusions

We found that systems thinking is not common in areas where health technology assessments (HTAs) are typically conducted. Against this background, our study demonstrates the need for future conceptualizations and interpretations of systems thinking in HTA.

Keywords

Technology assessmentHealth systemsIntersectoral collaborationScoping review
Type
Assessment
Information
International Journal of Technology Assessment in Health Care , Volume 37 , Issue 1 , 2021 , e71
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

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