INAHTA - Framework for reporting on impact of HTA reports Before completing this form, please review the accompanying instructions (Appendix A). To complete this form, tick boxes or add text where indicated. Send completed form to the INAHTA Secretariat at INAHTA@ihe.ca Agency Name of Technology B.1. Add any needed qualification e.g., – particular application Date of this Date of HTA report: The date of the record should be not less than 6 record: months the publication date of the HTA report Origin of HTA [Give the name or type of organization that made the request. This be government related (e.g. – health ministry) or non government (e.g. professional body). If the report was not solicited from request – outside the agency, please indicate this] Purpose of F.1. F.2. [Tick one or more] HTA [Single sentence of explanation/qualification, if Coverage decisions 1 needed] Capital funding decisions 2 Formulary decisions 3 Referral for treatment 4 Program operation 5 Guideline formulation 6 Influence on routine practice 7 Indications for further research 8 Other: 9 HTA [1 or 2 sentences] conclusions Indications of H.1. H.2 [Tick one or more] impact [1 or 2 sentences to give further information] HTA considered by 1 maker HTA 2 recommendations/conclusions accepted HTA demonstrated that technology 3 met specific program requirements HTA material incorporated into 4 policy or administrative documents HTA information used as 5 reference material HTA linked to changes in practice 6
INAHTA - Framework for reporting on impact of HTA reports Before completing this form, please review the accompanying instructions (Appendix A). To complete this form, tick boxes or add text where indicated. Send completed form to the INAHTA Secretariat at INAHTA@ihe.ca Agency Name of Technology B.1. Add any needed qualification – e.g., particular application Date of this record: Date of HTA report: The date of the record should be not less than 6 months the publication date of the HTA report Origin of HTA request [Give the name or type of organization that made the request. This be government – related (e.g. health ministry) or non – government (e.g. professional body). If the report was not solicited from outside the agency, please indicate this] Purpose of HTA F.1. [Tick one or more] 1 Coverage decisions 2 Capital funding decisions 3 Formulary decisions 4 Referral for treatment 5 Program operation 6 Guideline formulation 7 Influence on routine practice 8 Indications for further research 9 Other: F.2. [Single sentence of explanation/qualification, if needed] HTA conclusions [1 or 2 sentences] Indications of impact H.1. [Tick one or more] 1 HTA considered by 2 HTA recommendations/conclusions accepted 3 HTA demonstrated that technology met specific program requirements 4 HTA material incorporated into policy or administrative documents 5 HTA information used as reference material 6 HTA linked to changes in practice H.2 [1 or 2 sentences to give further information] maker
INAHTA-HTA-Impact-Reporting-Framework-and-Instructions.docx