M A N A G E M E N T B R I E F

Created by the Management Decision & Research Center, HSR&D, Office of Research & Development. Number 3, April 1996

Health Care Technology Assessment: Value for Veterans

“VA is committed to treating veterans with the highest quality care using proven, appropriate, health care technologies. Health care technology

assessment in VA ensures quality health care, both in delivery of care and in the ultimate outcome of that care. The Veterans Integrated Service

Networks (VISNs) are responsible for achieving health care value for veterans. To fulfill this responsibility, VISN managers need technology

assessment support on an ongoing basis.”

Thomas L. Garthwaite, M.D., Deputy Under Secretary for Health

What is health care technology? Health care technology is far more than instruments and equipment. Health care

technology is the practical application of knowledge to the prevention, diagnosis and treatment of disease. Health care

technologies include drugs, devices, medical and surgical procedures, support systems, as well as organizational and managerial

systems.

What is health care technology assessment? Health care technology assessment systematically collects and evaluates

information on the properties, effects, and other impacts (economic, social, ethical and legal) of technology use. Health care

technology assessment evolved in response to concerns about the costs of health care, recognition of the limited number of

health care interventions whose effectiveness has been well documented, and wide variation in the ways that technologies are

applied.

Why is health care technology assessment important to managers? Formal technology assessment can support policy decision

making when:

• the decision is highly complex

• the decision will be precedent setting

• the proposed treatment, diagnostic test, or other technology is an innovation

• the decision may result in high individual, aggregate cost, or resource allocation

• the decision involves significant uncertainty

Where can VA managers get Technology Assessment support? The Technology Assessment Program within HSR&D’s

Management Decision and Research Center offers a range of support to VA senior managers for health caretechnology related

decision making in VA. Its focus is on enhancing quality of care within VA by promoting evidence-based clinical practice and

policy decisions. The Technology Assessment Program provides services such as:

• systematic reviews of the literature and syntheses of other information;

• assistance with framing assessment questions and consultation on TA methodology to others within VA;

• major assessments on topics with system-wide impact as prioritized by the Technology Assessment Advisory

Committee

RECENT TECHNOLOGY ASSESSMENT REPORTS AND ASSESSMENTS IN PROGRESS:

Positron Emission Tomography (PET) as a diagnostic test in oncology and Alzheimer’s disease. VHA, in

cooperation with some of its academic medical center affiliates, owns 11 PET imaging facilities. Significant resource

commitments are associated with the acquisition, maintenance, and operation of these facilities. MDRC has just completed a

major PET assessment. The draft report is under review by its advisory committee. The report will soon be available for all

VA managers. The assessment thoroughly reviews the VA PET sites, the general barriers and incentives to PET use and it

includes a systematic review of PET. A systematic review, critical to health technology
assessment, uses a rigorous scientific approach and critically appraises published literature to determine the current state of

knowledge on a defined topic. The PET review also discusses the FDA status of PET radio pharmaceuticals, suggestions for

further research and conclusions for consideration by VA. Contact: Karen Flynn or Liz Adams, MDRC, FTS 700-839-4469.

Picture Archiving and Communications Systems (PACS): their impact on diagnostic accuracy and work processes in

radiology services. Many VA Medical Centers are considering whether to install “filmless” radiology image acquisition and

storage systems. The MDRC TA Program is performing a systematic review of the published research literature documenting

the potential benefits of PACS. The assessment addresses time savings, decreased number of lost or misplaced imaging

studies, enhanced diagnostic accuracy (the ability to manipulate images on a computer), improved patient outcomes, and

more efficient use of resources. The MDRC is also developing a document describing an approach to cost and work process

analysis that will assist the decision process for VAMCs considering PACS. Contact: Diana Anderson, MDRC, FTS 700-839-

5758

The outcomes of Gamma Knife stereotactic radiosurgery in patients with brain tumors or arteriovenous

malformations. The Gamma Knife is a device that focuses a high dose of radiation on a surgically inaccessible brain tumor.

VHA managers, aware of this new technology, require information to assist their decision making regardingreferring veterans

for this treatment. The MDRC Technology Assessment Program is initially conducting a survey ofVAMCs on referral request

frequencies, and numbers of veterans treated with the Gamma Knife. Next, the TA Program is performing a systematic review

of the published research literature documenting the outcomes of Gamma Knife radiosurgery in patients with specific

conditions. Contact Diana Anderson, MDRC, FTS 700-839-5758.

Technology Assessment projects underway in the MDRC TA Program: Interim information, summaries of work in

progress, or annotated bibliographies are available on the following topics. Full reports are not yet available.

• effects of managed care practices

• approaches to assessing surgical procedures and diagnostic tests;

• diagnostic accuracy and clinical utility of digitizing imaging studies in dentistry;

• randomized clinical trials in interventional cardiology;

• lasers in surgery.

FOR MORE INFORMATION: 

Request a copy of the soon to be released primer: Technology Assessment in VA, by Cliff Goodman, Gordon Snider and

Karen Flynn. Boston, Mass: Management Decision & Research Center, 1996. 26 pgs.

CONTACT: Gerry McGlynn, M.Ed, Management Decision & Research Center, Manager, Information Dissemination Program,

Boston, MA. FTS 700-839-4433 or 617-278-4433. 

The MANAGEMENT BRIEF is a new publication for VA senior managers. We want to know how you like it. For quick

feedback just circle Gerry McGlynn in the box below and fax your response back to 617-278-4438:

What topics would you like to see in future Briefs? .

What additional information regarding the VA projects listed will be helpful?___Article citations,___investigator names

 & contact info, Other? .

Your comments on the Management Brief: 

Name:_______________________________ Title:________________________ Phone: 

Address:_______________________________________________________ FAX:_________________________

E-mail:____________________________________ Please send me the Mgmt Brief by E-mail ___ or FAX ___

The Management Brief is produced by the Management Decision & Research Center, a program within the VA’s Health Services

Research & Development Service, Office of Research & Development. The purpose of the Management Brief is to provide VA

senior managers with a concise and timely overview of a specific health care topic that includes topic definition, benefits, VA

activities and resources for further information. Please send comments to Gerry McGlynn, MDRC 152- M, 150 S.

Huntington Ave, Boston, MA, 02130. Or, by phone at FTS 700-839-4433 or 617-278-4433, FAX 617- 278-4438. 

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