Outcomes of Guidelines from Health Technology Assessment Organizations: A Systematic Mixed Studies Review

Context: Health Technology Assessment (HTA) organizations determine the value of health technologies such as medical devices, lab tests, or medications. HTA organizations are generally funded by governments, they guide health care professionals and decision/policy-makers, and they publish knowledge translation products such as guidelines.

Objectives: To explore and measure the outcomes of HTA organizations’ guidelines in family medicine.

Study Design and Analysis: A systematic mixed studies review (including qualitative, quantitative, and mixed methods studies) was performed. Published literature in English and French was retrieved through searches of seven databases. A two-phase sequential data synthesis was performed. Phase-1: We conducted a hybrid deductive-inductive thematic analysis, identified the types of outcomes, and displayed the relationships between these types on a concept map. Phase-2: We extracted descriptive statistics and tabulated them by type of outcome.

Setting: Community-based primary health care.

Population Studied: Family physicians, general practitioners, and patients.

Main outcome measures: Situational relevance, cognitive/affective impact (e.g., learning), the use of guideline-based information in clinical practice, and subsequent patient health outcomes. Health organization outcomes.

Results: A total of 6719 records were retrieved. After de-duplication, the selection process started with 4922 articles. The full-text screening started with 345 studies and resulted in 120 included observational studies (21 qualitative, 94 quantitative, and 5 mixed methods). Twenty-nine types of outcomes are qualitatively documented. Descriptive statistics (e.g., means, rates, ratios, p-values) and the direction of the outcome (i.e., positive, neutral, and negative impact) are presented for 17 types of outcomes. Considering the heterogeneity of evidence, a meta-analysis was not feasible. We built a concept map explaining 29 outcomes of guidelines from HTA organizations and their relationships. In addition, the map aggregates measures of 17 (58.6%) of these outcomes.

Conclusion: Knowledge about the outcomes of guidelines produced by HTA organizations can help physicians and decision/policy-makers in future evaluations.