Dossier n. 185/2009 [Abstract] The Research & Innovation Emilia-Romagna Program. 2005-2008 Report

This Dossier summarizes the scientific and policy background as well as the main features and results of the projects carried out over the period 2005-8 in the framework of the “Research & Innovation Emilia-Romagna Program (PRI E-R)”.
PRI E-R was an initiative launched with the main objective of raising awareness around health services research in the region by making explicit its importance when an health care system becomes aware of the immaturity of most health technologies at the time they enter clinical practice and decides that promotion and direct support to research belongs to its core mission.

PRI E-R was conceptualised and launched at a time when the prevalent view of how research produces knowledge, and how this knowledge enter clinical practice, was still based on the traditional “linear path”. According to this view scientific advancements start with a “good idea” and then move through the different phases of evaluation. At the end of this process a new intervention/technology enters in, or disappears from, the market depending on the “verdict” of these evaluations (effective/cost effective; ineffective/harmful).

Main reasons for moving away from this simplistic view:

• many health technology enter clinical practice without a sufficient assessment;
• many effective interventions have too long a lag time before being successfully incorporated into clinical practice;
• new technologies, even when labelled as “highly innovative” end up becoming complementary rather than substitute of previous technologies;
• rarely the assessment path of a technology includes the organisational and financial impact that its uptake is likely to bring about.

PRI E-R is now an essential component of Emilia-Romagna Region research portfolio, which also includes:

• one program conducted in collaboration with the 4 regional Universities (“Programma di ricerca Regione-Università”);
• one program where the assessment of “small ticket” technologies or new configuration of health services are evaluated (“Fondo modernizzazione”);
• a permanent regional horizon scanning network aimed at making possible an early identification systems of potential innovation (ORI).

PRI E-R had a few distinctive features that contribute to its originality in the Italian context:

• it is not an “investigator initiated” activity but rather a framework where projects common denominator is the identification of “grey areas” (as far as efficacy, safety, feasibility, etc.) is concerned;
• projects are not designed by professional researchers alone but rather by multidisciplinary groups where different competences, skills and perspectives work closely together;
• to support PRI E-R, the Emilia-Romagna Region sought the financial support of those biomedical industries that shared the overall objectives of the Program creating a special Innovation fund fed by both public and private money (through the form of unrestricted grants).

In the second section of this Dossier, for each of the main project started over the period 2005-2008 a brief description of the background, methodology, main results and further areas of development is reported. Oncology (radiotherapy, anticancer drugs and follow up delivery modes), cerebrovascular (implementation of stroke care), cardiology (benefits risk profile of drug eluting stents), sepsis management as well as the assessment of big tickets diagnostic technologies (multislice cardiac tomography and positron emission tomography) are the theme areas of the projects whose achievements are briefly described. In addition, two “infrastructure development” actions are also described referring to the launch of:

• a regional registry of research projects;
• a “standing forum” of the 9 local Ethics Committees operating in the region.

In this report other more recently launched projects (in the fields of mental health and humanisation of health care are not reported as they are still in their initial phases.

In keeping with PRI E-R’s philosophy, these projects have been developed through the organisation of events (workshops) aimed at the identification of scientific and health care open issues, educational events together with empirical studies aimed at the identification of quality improvement interventions. Results of these projects will be presented in future editions of PRI E-R’s reports.

We hope that the information reported in this Dossier will raise awareness about PRI E-R’s experience (with its positive and critical aspects) so that it can be seen as an initial model to test the ability of health services research to feed the information and operational needs of the health service.